Formulario 2018 - es.bcbsri.com · columna de la lista. ¿Qué son los medicamentos genéricos?...

H4152_2018formulary_sp NM

Formulario 2018 (Lista de medicamentos cubiertos)

IMPORTANTE: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS MEDICAMENTOS QUE CUBRIMOS EN ESTE PLAN.

00018137, Versión

Este formulario fue actualizado el . Para obtener información actualizada o si tiene otras preguntas, comuníquese con el Equipo de asistencia de Medicare al (401) 277-2958 o al 1-800-267-0439 (los usuarios de TTY deben llamar al 711), los siete días de la semana desde el 1 de octubre hasta el 14 de febrero, de 8:00 a. m. a 8:00 p. m. Desde el 15 de febrero hasta el 30 de setiembre, puede llamar de lunes a viernes, de 8:00 a. m a 8:00 p. m. Los sábados y domingos, llame de 8:00 a. m. hasta el mediodía. Fuera de estos horarios, puede usar nuestro sistema automatizado de respuesta, o visitar www.bcbsri.com/Medicare.

This information is available for free in other languages. Please call the Medicare Concierge Team at (401) 277-2958 or 1-800-267-0439 (TTY users should call 711), seven days a week from October 1 to February 14, 8:00 a.m. to 8:00 p.m. From February 15 to September 30, you can call Monday through Friday, from 8:00 a.m. to 8:00 p.m. On Saturday and Sunday, call from 8:00 a.m. to noon. You can use our automated answering system outside of these hours, or visit bcbsri.com/Medicare.

This information is also available in large print English and large print Spanish.

Esta información está disponible gratis en otros idiomas. Si desea obtener información adicional, llame al Equipo de asistencia de Medicare al (401) 277-2958 o al 1-800-267-0439 (los usuarios de TTY deben llamar al 711), los siete días de la semana del 1 de octubre al 14 de febrero, de 8:00 a. m. a 8:00 p. m. Del 15 de febrero hasta el 30 de setiembre, puede llamar de lunes a viernes de 8:00 a. m. a 8:00 p. m., y los sábados y domingos, de 8:00 a. m. hasta el mediodía. Fuera de estos horarios, puede utilizar el sistema automatizado de respuesta, o visitar bcbsri.com/Medicare. El Servicio al Cliente también tiene servicios gratis de intérprete de idiomas disponibles para las personas que no hablan inglés.

BlueCHiP for Medicare Value (HMO-POS)

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Nota a los miembros actuales: Este formulario ha cambiado desde el año pasado. Revise este documento para asegurarse de que contiene los medicamentos que usted consume.

Cuando en esta lista de medicamentos (formulario) dice “nosotros” o “nuestro”, significa Blue Cross & Blue Shield of Rhode Island. Cuando dice “plan” o “nuestro plan”, se refiere a BlueCHiP for Medicare.

Este documento incluye una lista de los medicamentos (formulario) para nuestro plan, que está vigente hasta . Comuníquese con nosotros para obtener un formulario actualizado. Nuestra información de contacto, junto con la última fecha en la que actualizamos el formulario, aparece en la portada y en la contraportada.

En general, usted debe utilizar las farmacias de la red para usar su beneficio de medicamentos recetados. Los beneficios, el formulario (la lista de medicamentos cubiertos por el plan), la red de farmacias, la prima o los copagos o coseguros pueden cambiar el 1.º de enero de 2018, y ocasionalmente durante el año.

agosto 1, 2018

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¿Qué es el formulario de BlueCHiP for Medicare?Un formulario es una lista de medicamentos cubiertos seleccionados por BlueCHiP for Medicare en colaboración con un equipo de proveedores de atención médica, que representa las terapias de medicamentos recetados que se consideran una parte necesaria de un programa de tratamiento de calidad. Por lo general, BlueCHiP for Medicare cubrirá los medicamentos incluidos en nuestro formulario siempre que el medicamento sea médicamente necesario, que el medicamento recetado sea surtido en una farmacia de la red de BlueCHiP for Medicare, y que se acaten otras normas del plan. Para obtener información adicional sobre cómo surtir sus medicamentos recetados, revise su Evidencia de cobertura.

¿El formulario (lista de medicamentos) puede cambiar?Por lo general, si usted está consumiendo un medicamento de nuestro formulario de 2018 que estaba cubierto al inicio del año, no discontinuaremos ni reduciremos la cobertura del medicamento durante el año de cobertura de 2018, excepto cuando salga a la venta un medicamento genérico nuevo y menos costoso, o cuando se divulgue nueva información adversa sobre la seguridad o eficacia del medicamento. Otros tipos de cambios en el formulario, tales como el retiro de un medicamento de nuestro formulario, no afectarán a los miembros que actualmente estén consumiendo el medicamento. Permanecerá disponible al mismo nivel de costo compartido para aquellos miembros que lo consuman por el resto del año de cobertura. Consideramos que es importante que tenga acceso continuo durante el resto del año de cobertura a los medicamentos del formulario que estuvieron disponibles cuando usted eligió nuestro plan, excepto para los casos en los que usted pueda ahorrar un dinero adicional o podamos garantizar su seguridad.

Si retiramos medicamentos de nuestro formulario, agregamos una autorización previa, restricciones sobre límites de cantidad o de terapia escalonada para un medicamento, o cambiamos un medicamento a un nivel de costo compartido más alto, debemos informar a los miembros afectados sobre dicho cambio al menos 60 días antes de que el cambio entre en vigencia, o en el momento en el que el miembro solicite una reposición del medicamento; en ese momento el miembro recibirá un suministro para 60 días del medicamento. Si la Administración

de Medicamentos y Alimentos considera que un medicamento que figura en nuestro formulario no es seguro, o si el fabricante del medicamento retira el medicamento del mercado, procederemos inmediatamente a retirar el medicamento de nuestro formulario y a informar a los miembros que consumen el medicamento. El formulario adjunto tiene vigencia hasta

Para obtener información actualizada sobre los medicamentos cubiertos por BlueCHiP for Medicare, comuníquese con nosotros. Nuestra información de contacto aparece en la portada y en la contraportada.

¿Cómo utilizo el formulario?Existen dos maneras de encontrar su medicamento en el formulario:

Afección médicaEl formulario empieza en la página 1. Los medicamentos en este formulario están agrupados en categorías dependiendo del tipo de afección médica que tratan. Por ejemplo, los medicamentos utilizados para tratar una enfermedad cardíaca están listados bajo la categoría “Agentes cardiovasculares”. Si usted sabe para qué se utiliza su medicamento, busque el nombre de la categoría en la lista que comienza en la página 1. Luego busque bajo el nombre de la categoría para encontrar su medicamento.

Listado alfabéticoSi no está seguro de la categoría, debe buscar su medicamento en el índice que comienza en la página . El índice presenta un listado alfabético de todos los medicamentos incluidos en este documento. En el índice se incluyen tanto los medicamentos de marca como los genéricos. Consulte el índice y busque su medicamento. Al lado de su medicamento encontrará el número de página donde puede consultar la información sobre la cobertura. Vaya a la página indicada en el índice y busque el nombre de su medicamento en la primera columna de la lista.

¿Qué son los medicamentos genéricos? BlueCHiP for Medicare cubre tanto medicamentos de marca como medicamentos genéricos. Un medicamento genérico es un medicamento aprobado por la FDA, que tiene los mismos ingredientes activos que el medicamento de marca. En general, los medicamentos genéricos cuestan menos que los medicamentos de marca.

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¿Existe alguna restricción en mi cobertura?Algunos medicamentos cubiertos pueden tener requisitos o límites adicionales para la cobertura. Entre estos requisitos y límites se pueden incluir los siguientes:

• Autorización previa: BlueCHiP for Medicare requiere que usted o su médico obtengan autorización previa para determinados medicamentos. Esto significa que deberán obtener aprobación de BlueCHiP for Medicare antes de surtir sus recetas. Si no obtienen la aprobación, es posible que BlueCHiP for Medicare no cubra el medicamento.

• Límites de cantidad: BlueCHiP for Medicare limita la cantidad de determinados medicamentos que cubrimos. Por ejemplo, BlueCHiP for Medicare provee 30 comprimidos por receta de alfuzosin hcl. Esto puede agregarse a un suministro estándar para un mes o tres meses.

• Terapia escalonada: En algunos casos, BlueCHiP for Medicare requiere que usted pruebe primero determinados medicamentos para tratar su afección médica antes de cubrir otro medicamento para dicha afección. Por ejemplo: si tanto el medicamento A como el medicamento B sirven para tratar su problema médico, es posible que BlueCHiP for Medicare no cubra el medicamento B, salvo que usted pruebe primero el medicamento A. Si el medicamento A no surte efecto en su caso, entonces BlueCHiP for Medicare cubrirá el medicamento B.

Usted puede averiguar si su medicamento tiene requisitos o limitaciones adicionales consultando en el formulario que comienza en la página 1. También puede visitar nuestro sitio Web para obtener más información sobre las restricciones aplicadas a medicamentos específicos que cubrimos. Hemos publicado nuestras restricciones de autorización previa y terapia escalonada en línea. También puede pedirnos que le enviemos una copia. Nuestra información de contacto, junto con la última fecha en la que actualizamos el formulario, aparece en la portada y en la contraportada.

Puede solicitar a BlueCHiP for Medicare que se realice una excepción a estas restricciones o estos límites, o solicitar una lista de otros medicamentos similares con los que se puede tratar su afección. Consulte la sección, “¿Cómo solicito una excepción al formulario de BlueCHiP for Medicare?” en esta página para obtener información sobre cómo solicitar una excepción.

¿Qué pasa si mi medicamento no está en el formulario?Si su medicamento no está incluido en este formulario (lista de medicamentos cubiertos), debe comunicarse primero con el Equipo de asistencia de Medicare y preguntar si su medicamento está cubierto.

Si le confirman que BlueCHiP for Medicare no cubre su medicamento, tiene dos opciones:

• Puede pedirle al Equipo de asistencia de Medicare una lista de medicamentos similares que estén cubiertos por BlueCHiP for Medicare. Cuando reciba la lista, muéstrela a su médico y pídale que le recete un medicamento similar que esté cubierto por BlueCHiP for Medicare.

• Puede pedirle a BlueCHiP for Medicare que haga una excepción y que cubra su medicamento. Consulte la información a continuación para saber cómo solicitar una excepción.

¿Cómo solicitar una excepción al formulario de BlueCHiP for Medicare?Puede pedirle a BlueCHiP for Medicare que haga una excepción a las normas de cobertura. Existen varios tipos de excepciones que nos puede solicitar que hagamos.

• Nos puede solicitar que cubramos un medicamento incluso si este no se incluye en nuestro formulario. Si se aprueba, este medicamento estará cubierto a un nivel de costo compartido predeterminado, y no podría pedirnos que le proporcionemos este medicamento a un nivel de costo compartido más bajo.

• Nos puede solicitar que cubramos un medicamento del formulario a un nivel de costo compartido más bajo, si este medicamento no se encuentra en el nivel de especialidad. Si se aprueba, esto reduciría el monto que debe pagar por su medicamento.

• Nos puede solicitar una exención a las restricciones o limitaciones de cobertura en su medicamento. Por ejemplo, BlueCHiP for Medicare limita la cantidad de determinados medicamentos que cubrimos. Si su medicamento tiene un límite de cantidad, nos puede solicitar que le exceptuemos el límite y cubramos una cantidad mayor.

Generalmente, BlueCHiP for Medicare solo aprobará su solicitud para una excepción si los medicamentos alternativos incluidos en el formulario del plan, el medicamento del nivel de costo compartido más bajo o las restricciones de uso adicionales, no tienen la misma eficacia para tratar su afección o si le provocan consecuencias médicas adversas.

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Debe contactarnos para pedirnos una decisión inicial de cobertura con respecto a la excepción al formulario o a la restricción de uso. Cuando solicite una excepción al formulario o a la restricción de uso, deberá presentar una declaración de su médico o profesional que elaboró la receta que fundamente su pedido. Por lo general, debemos tomar una decisión dentro de las 72 horas de haber recibido la declaración de respaldo del profesional que otorgó la receta. Puede solicitar una excepción agilizada (rápida) si usted o su médico consideran que su salud puede verse seriamente afectada al esperar 72 horas por una decisión. Si se aprueba el pedido de agilización, debemos tomar una decisión a más tardar 24 horas después de haber recibido la declaración de respaldo del profesional o del médico que otorgó la receta.

¿Qué puedo hacer antes de hablar con mi médico sobre el cambio de mis medicamentos o la solicitud de una excepción? Como miembro nuevo o permanente de nuestro plan, usted puede estar consumiendo medicamentos que no figuran en nuestro formulario. O bien puede estar consumiendo un medicamento que figura en nuestro formulario, pero la posibilidad para obtenerlo es limitada. Por ejemplo, es posible que necesite una autorización previa de nuestra parte antes de que pueda surtir su receta médica. Debe hablar con su médico para decidir si debería cambiar a un medicamento apropiado que cubramos osolicitar una excepción del formulario para quecubramos el medicamento que consume. Mientras habla con su médico para decidir el curso de acción correcto para usted, es posible que cubramos el medicamento en determinados casos durante los primeros 90 días desde su ingreso como miembro de nuestro plan.

Para cada uno de sus medicamentos que no figuran en nuestro formulario, o si tiene limitaciones para obtener los medicamentos, cubriremos un suministro temporal de 30 días (salvo que tenga una receta médica emitida por un plazo menor) cuando acuda a una farmacia de la red. Luego de su primer suministro de 30 días, no pagaremos por estos medicamentos, incluso si usted ha sido un miembro del plan por un período menor de 90 días.

Si usted es residente de un establecimiento de atención a largo plazo, le permitiremos surtir nuevamente su receta hasta que le proporcionemos un suministro de transición hasta un máximo de 98 días, de acuerdo con el incremento de despacho

(salvo que tenga una receta emitida por un plazo menor). Cubriremos más de un reabastecimiento de estos medicamentos por los primeros 90 días desde su ingreso como miembro de nuestro plan. Si necesita un medicamento que no está en nuestro formulario, o si la posibilidad de obtener sus medicamentos es limitada, pero ya transcurrieron los primeros 90 días como miembro de nuestro plan, cubriremos un suministro de emergencia de dicho medicamento por 31 días (salvo que tenga una receta médica por un período menor) mientras usted solicita una excepción al formulario.

Pueden ocurrir cambios que modifiquen el entorno de tratamiento. Durante este nivel de cambio en la atención, se pueden recetar medicamentos que no estén cubiertos por nuestro plan. En este caso, usted y su médico deberán recurrir a los procesos de apelaciones y excepciones al plan. Sin embargo, cuando usted ingrese a un LTC (establecimiento de atención a largo plazo) o le den el alta, es posible que no pueda obtener los medicamentos que le habían recetado previamente. Puede surtir nuevamente la receta durante la admisión o el alta para evitar una interrupción de la atención.

Para obtener más informaciónPara acceder a información detallada sobre la cobertura de medicamentos recetados de BlueCHiP for Medicare, revise la Evidencia de cobertura y los demás materiales del plan.

Si tiene preguntas acerca de BlueCHiP for Medicare, comuníquese con nosotros. Nuestra información de contacto, junto con la última fecha en la que actualizamos el formulario, aparece en la portada y en la contraportada.

Si tiene preguntas en general con respecto a la cobertura de medicamentos recetados de Medicare, llame a Medicare al 1-800-MEDICARE (1-800-633-4227), las 24 horas del día, los siete días de la semana. Los usuarios de TTY deben llamar al 1-877-486-2048. También puede visitar medicare.gov.

Formulario de BlueCHiP for MedicareEl formulario que comienza en la página 1 brinda información sobre la cobertura de los medicamentos cubiertos por BlueCHiP for Medicare. Si tiene problemas para encontrar su medicamento en la lista, consulte el índice que empieza en la página .

La primera columna del cuadro indica el nombre del medicamento. Los medicamentos de marca figuran en mayúsculas (por ejemplo, NYMALIZE) y los medicamentos genéricos figuran en minúsculas en cursiva (por ej., lidocaína).

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La información de la columna Requisitos/Límites indica si BlueCHiP for Medicare tiene requisitos especiales para la cobertura del medicamento.

Todos los medicamentos incluidos en este formulario están disponibles a través del beneficio de pedido por correo. Comuníquese con su plan para obtener más detalles.

Formulario de Nivel 5 de BlueCHiP for Medicare1: Medicamentos genéricos preferidos

2: Medicamentos genéricos

3: Medicamentos de marca preferidos

4: Medicamentos de marca no preferidos

5: Medicamentos especiales

BD: Medicamentos que pueden ser cubiertos por la Parte B o la Parte D de Medicare, dependiendo de las circunstancias. Estos medicamentos necesitan autorización previa para determinar la cobertura bajo la Parte B o la Parte D. Puede ser necesario brindar información que describa el uso o el lugar donde se recibe el medicamento para decidir la cobertura.

AP: Autorización previa; consulte la página II para obtener más información.

LC: Límites de cantidad; consulte la página II para obtener más información.

TE: Terapia escalonada; consulte la página II para obtener más información.

*: Medicamento de distribución limitada. Este medicamento recetado puede estar disponible únicamente en ciertas farmacias. Para obtener más información, consulte su Directorio de farmacias o comuníquese con el Equipo de asistencia de Medicare (la información de contacto aparece en la portada y en la contraportada).

#: Medicamento de alto riesgo (High risk medication, HRM). Medicamento que puede ser peligroso para pacientes mayores de 65 años. Nuestro formulario incluye cobertura para algunos de estos medicamentos, pero se pueden encontrar alternativas en niveles de copago más bajos. Consulte con su médico si existen alternativas para estos medicamentos que puedan ser adecuados para usted.

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Clave de abreviaturas de la formulación para 2018

acc acción mcg microgramo

ad adsorción meq miliequivalente

aer, aero aerosol mg miligramo

ar, act resp, activ respir activado por la respiración ml mililitro

uab unidades alérgicas bioequivalentes um unidades de millón

cap cápsulas nebu solución de nebulización

comp mast comprimidos masticables NF no incluido en formulario

conc concentrado cdo comprimidos de desintegración oral

conj conjugado un, ung ungüento

lc liberación controlada of, oftlm oftálmico

cris cristales env envase

lr liberación retardada pol, plv polvo

dis disuasivo sc sin conservantes

re con recubrimiento entérico ufp unidades formadoras de placas

el, elisaensayo por inmunoabsorción ligado a enzimas

psurt presurtida

lp, liberación prolongada, prolongada, lib prol, xl liberación prolongada recmb recombinante

conc concentrado sl sublingual

g, gm gramo sol, soln solución

gu genitourinario supos supositorios

hr hora sus, susp suspensión

ig inmunoglobulinalib cont liberación continua

ir índice de reactividad

inh, inhal inhalación jer jeringa

iny inyección com, comp comprimidos

im intramuscular td transdérmico

iv intravenoso tl translingual

l litro un unidad

uf unidades de floculación va vaginal

liq líquidovac vacuna

ap de acción prolongada

2018

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

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Nombre del medicamentoNivel delmedicamento Requisitos/Límites

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

2018

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


etodolac tab er 24hr 600 mg 2 QL (30 tablets/30 days)etodolac tab 400 mg 2 QL (60 tablets/30 days)etodolac tab 500 mg 2 QL (60 tablets/30 days)fentanyl citrate lozenge on a handle 200 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 400 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 600 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 800 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1200 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1600 mcg 5 PA, QL (120 lozenges/30 days)fentanyl td patch 72hr 12 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 25 mcg/hr 3 PA, QL (15 patches/30 days)fentanyl td patch 72hr 37.5 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 50 mcg/hr 3 PA, QL (15 patches/30 days)fentanyl td patch 72hr 62.5 mcg/hr 5 PA, QL (15 patches/30 days)fentanyl td patch 72hr 75 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 87.5 mcg/hr 5 PA, QL (15 patches/30 days)fentanyl td patch 72hr 100 mcg/hr 4 PA, QL (15 patches/30 days)flurbiprofen tab 50 mg 2 QL (180 tablets/30 days)flurbiprofen tab 100 mg 2 QL (90 tablets/30 days)hydrocodone-acetaminophen soln 7.5-325 mg/15ml 3 QL (3600 mls/30 days)hydrocodone-acetaminophen tab 10-325 mg 3 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-300 mg 2 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-300 mg 2 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-325 mg 3 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-325 mg 3 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 10-300 mg 2 QL (180 tablets/30 days)hydrocodone-ibuprofen tab 5-200 mg 2 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 7.5-200 mg 2 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 10-200 mg 2 QL (150 tablets/30 days)hydromorphone hcl liqd 1 mg/ml 3 QL (1440 mls/30 days)hydromorphone hcl preservative free inj 10 mg/ml 3 BDhydromorphone hcl tab 2 mg 3 QL (180 tablets/30 days)hydromorphone hcl tab 4 mg 3 QL (180 tablets/30 days)hydromorphone hcl tab 8 mg 3 QL (180 tablets/30 days)ibuprofen susp 100 mg/5ml 1 QL (4800 mls/30 days)ibuprofen tab 400 mg 1 QL (240 tablets/30 days)ibuprofen tab 600 mg 1 QL (150 tablets/30 days)ibuprofen tab 800 mg 1 QL (120 tablets/30 days)

2018


3


KADIAN - morphine sulfate cap er 24hr 10 mg 4 PA, QL (60 capsules/30 days)KADIAN - morphine sulfate cap er 24hr 20 mg 4 PA, QL (60 capsules/30 days)KADIAN - morphine sulfate cap er 24hr 30 mg 4 PA, QL (60 capsules/30 days)KADIAN - morphine sulfate cap er 24hr 40 mg 4 PA, QL (60 capsules/30 days)KADIAN - morphine sulfate cap er 24hr 50 mg 4 PA, QL (60 capsules/30 days)KADIAN - morphine sulfate cap er 24hr 60 mg 4 PA, QL (60 capsules/30 days)KADIAN - morphine sulfate cap er 24hr 80 mg 4 PA, QL (60 capsules/30 days)KADIAN - morphine sulfate cap er 24hr 100 mg 4 PA, QL (60 capsules/30 days)KADIAN - morphine sulfate cap er 24hr 200 mg 4 PA, QL (60 capsules/30 days)ketoprofen cap 50 mg 2 QL (180 capsules/30 days)ketoprofen cap 75 mg 2 QL (120 capsules/30 days)LAZANDA - fentanyl citrate nasal spray 100 mcg/act 5 PA, QL (30 bottles/30 days)LAZANDA - fentanyl citrate nasal spray 300 mcg/act 5 PA, QL (30 bottles/30 days)LAZANDA - fentanyl citrate nasal spray 400 mcg/act 5 PA, QL (30 bottles/30 days)LEVORPHANOL TARTRATE - levorphanol tartrate tab 2 mg 4 QL (120 tablets/30 days)meloxicam tab 7.5 mg 1 QL (60 tablets/30 days)meloxicam tab 15 mg 1 QL (30 tablets/30 days)methadone hcl tab 5 mg 3 QL (180 tablets/30 days)methadone hcl tab 10 mg 3 QL (360 tablets/30 days)MORPHINE SULFATE - morphine sulfate tab 15 mg 4 QL (240 tablets/30 days)MORPHINE SULFATE - morphine sulfate tab 30 mg 4 QL (180 tablets/30 days)morphine sulfate cap er 24hr 10 mg 2 PA, QL (60 capsules/30 days)morphine sulfate cap er 24hr 20 mg 2 PA, QL (60 capsules/30 days)morphine sulfate cap er 24hr 30 mg 2 PA, QL (60 capsules/30 days)morphine sulfate cap er 24hr 50 mg 2 PA, QL (60 capsules/30 days)morphine sulfate cap er 24hr 60 mg 2 PA, QL (60 capsules/30 days)morphine sulfate cap er 24hr 80 mg 2 PA, QL (60 capsules/30 days)morphine sulfate cap er 24hr 100 mg 2 PA, QL (60 capsules/30 days)morphine sulfate inj pf 0.5 mg/ml 3 BDmorphine sulfate inj pf 1 mg/ml 3 BDmorphine sulfate oral soln 10 mg/5ml 2 QL (2700 mls/30 days)morphine sulfate oral soln 20 mg/5ml 2 QL (1350 mls/30 days)morphine sulfate oral soln 100 mg/5ml (20 mg/ml) 2 QL (270 mls/30 days)morphine sulfate tab er 15 mg 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 30 mg 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 60 mg 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 100 mg 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 200 mg 2 PA, QL (90 tablets/30 days)

2018



nabumetone tab 500 mg 2 QL (120 tablets/30 days)nabumetone tab 750 mg 2 QL (60 tablets/30 days)naproxen sodium tab 275 mg 1 QL (150 tablets/30 days)naproxen sodium tab 550 mg 1 QL (90 tablets/30 days)naproxen susp 125 mg/5ml 2 QL (1800 mls/30 days)naproxen tab ec 375 mg 2 QL (120 tablets/30 days)naproxen tab ec 500 mg 2 QL (90 tablets/30 days)naproxen tab 250 mg 1 QL (180 tablets/30 days)naproxen tab 375 mg 1 QL (120 tablets/30 days)naproxen tab 500 mg 1 QL (90 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 50 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 100 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 150 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 200 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 250 mg 3 PA, QL (60 tablets/30 days)oxaprozin tab 600 mg 2 QL (90 tablets/30 days)oxycodone hcl tab 5 mg 3 QL (360 tablets/30 days)oxycodone hcl tab 10 mg 3 QL (180 tablets/30 days)oxycodone hcl tab 15 mg 3 QL (180 tablets/30 days)oxycodone hcl tab 20 mg 3 QL (180 tablets/30 days)oxycodone hcl tab 30 mg 3 QL (180 tablets/30 days)oxycodone w/ acetaminophen tab 2.5-325 mg 2 QL (360 tablets/30 days)oxycodone w/ acetaminophen tab 5-325 mg 3 QL (360 tablets/30 days)oxycodone w/ acetaminophen tab 7.5-325 mg 3 QL (240 tablets/30 days)oxycodone w/ acetaminophen tab 10-325 mg 3 QL (180 tablets/30 days)oxycodone-aspirin tab 4.8355-325 mg 2 QL (360 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 10 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 15 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 20 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 30 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 40 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 60 mg 3 PA, QL (120 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 80 mg 3 PA, QL (120 tablets/30 days)piroxicam cap 10 mg 2 QL (60 capsules/30 days)piroxicam cap 20 mg 2 QL (30 capsules/30 days)sulindac tab 150 mg 2 QL (60 tablets/30 days)sulindac tab 200 mg 2 QL (60 tablets/30 days)TENCON - butalbital-acetaminophen tab 50-325 mg# 4 PA, QL (180 tablets/30 days)

2018


5


TOLMETIN SODIUM - tolmetin sodium cap 400 mg 3 QL (120 capsules/30 days)tramadol hcl tab er 24hr 100 mg 2 PA, QL (30 tablets/30 days)tramadol hcl tab er 24hr 200 mg 2 PA, QL (30 tablets/30 days)tramadol hcl tab er 24hr 300 mg 2 PA, QL (30 tablets/30 days)tramadol hcl tab 50 mg 3 QL (240 tablets/30 days)tramadol-acetaminophen tab 37.5-325 mg 2 QL (240 tablets/30 days)VIMOVO - naproxen-esomeprazole magnesium tab dr 375-20 mg 5 QL (60 tablets/30 days)VIMOVO - naproxen-esomeprazole magnesium tab dr 500-20 mg 5 QL (60 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)









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

1 mg3

2018



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

3

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

delivered)4

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

100 mg/0.5ml5

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

5

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

2018


7


AMOXICILLIN/CLAVULANATE POTASSIUM - amoxicillin & kclavulanate chew tab 200-28.5 mg

4

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

4

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

soln 3 (2-1) gm2

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

3

AZACTAM - aztreonam for inj 1 gm 4AZACTAM - aztreonam for inj 2 gm 4AZACTAM IN ISO-OSMOTIC DEXTROSE - aztreonam in

dextrose inj 1 gm/50ml4

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

4

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

unit/ml4

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

4

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

4

cefaclor cap 250 mg 2cefaclor cap 500 mg 2

2018



cefadroxil cap 500 mg 1cefadroxil for susp 250 mg/5ml 2cefadroxil for susp 500 mg/5ml 2cefadroxil tab 1 gm 2CEFAZOLIN SODIUM - cefazolin sodium for inj 20 gm 3cefazolin sodium for inj 500 mg 2cefazolin sodium for inj 1 gm 2cefazolin sodium for inj 10 gm 2cefdinir cap 300 mg 2cefdinir for susp 125 mg/5ml 2cefdinir for susp 250 mg/5ml 2cefepime hcl for inj 1 gm 2cefepime hcl for inj 2 gm 2CEFOTAXIME SODIUM - cefotaxime sodium for inj 500 mg 3CEFOTAXIME SODIUM - cefotaxime sodium for inj 2 gm 3CEFOTAXIME SODIUM - cefotaxime sodium for inj 10 gm 3cefotaxime sodium for inj 1 gm 2cefoxitin sodium for inj 10 gm 2cefoxitin sodium for iv soln 1 gm 3cefoxitin sodium for iv soln 2 gm 4cefpodoxime proxetil for susp 50 mg/5ml 2cefpodoxime proxetil for susp 100 mg/5ml 2cefpodoxime proxetil tab 100 mg 2cefpodoxime proxetil tab 200 mg 2cefprozil for susp 125 mg/5ml 2cefprozil for susp 250 mg/5ml 2cefprozil tab 250 mg 2cefprozil tab 500 mg 2ceftazidime for inj 1 gm 2ceftazidime for inj 2 gm 2ceftazidime for inj 6 gm 2ceftazidime for iv soln 2 gm 2ceftazidime for iv soln 1 gm 2CEFTRIAXONE IN ISO-OSMOTIC DEXTROSE - ceftriaxone

sodium in dextrose inj 20 mg/ml4

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

4

ceftriaxone sodium for inj 250 mg 2

2018


9


ceftriaxone sodium for inj 500 mg 2ceftriaxone sodium for inj 1 gm 2ceftriaxone sodium for inj 2 gm 2ceftriaxone sodium for inj 10 gm 4ceftriaxone sodium for iv soln 1 gm 2ceftriaxone sodium for iv soln 2 gm 2CEFTRIAXONE/DEXTROSE - ceftriaxone sodium for iv soln 1 gm

and dextrose 3.74%4

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

4

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

sodium succinate for iv inj 1 gm4

ciprofloxacin for oral susp 250 mg/5ml (5%) (5 gm/100ml) 2ciprofloxacin for oral susp 500 mg/5ml (10%) (10 gm/100ml) 2CIPROFLOXACIN HCL - ciprofloxacin hcl tab 100 mg 4ciprofloxacin hcl tab er 24hr 500 mg 2ciprofloxacin hcl tab er 24hr 1000 mg 2ciprofloxacin hcl tab 250 mg 1ciprofloxacin hcl tab 500 mg 1ciprofloxacin hcl tab 750 mg 1ciprofloxacin 200 mg/100ml in d5w 2ciprofloxacin 400 mg/200ml in d5w 2clarithromycin for susp 125 mg/5ml 2clarithromycin for susp 250 mg/5ml 2clarithromycin tab er 24hr 500 mg 2clarithromycin tab 250 mg 2clarithromycin tab 500 mg 2clindamycin hcl cap 75 mg 1clindamycin hcl cap 150 mg 1

2018



clindamycin hcl cap 300 mg 1clindamycin phosphate gel 1% 2clindamycin phosphate in d5w iv soln 300 mg/50ml 2clindamycin phosphate in d5w iv soln 600 mg/50ml 2clindamycin phosphate in d5w iv soln 900 mg/50ml 2clindamycin phosphate inj 300 mg/2ml 1clindamycin phosphate inj 600 mg/4ml 1clindamycin phosphate inj 900 mg/6ml 1clindamycin phosphate inj 9 gm/60ml 1clindamycin phosphate iv soln 300 mg/2ml 1clindamycin phosphate iv soln 600 mg/4ml 1clindamycin phosphate iv soln 900 mg/6ml 1clindamycin phosphate lotion 1% 2clindamycin phosphate soln 1% 2clindamycin phosphate swab 1% 2clindamycin phosphate vaginal cream 2% 2colistimethate sod for inj 150 mg 5DALVANCE - dalbavancin hcl for iv soln 500 mg 5daptomycin for iv soln 500 mg 5demeclocycline hcl tab 150 mg 2demeclocycline hcl tab 300 mg 2dicloxacillin sodium cap 250 mg 2dicloxacillin sodium cap 500 mg 2DIFICID - fidaxomicin tab 200 mg 5doxycycline hyclate cap 50 mg 2doxycycline hyclate cap 100 mg 2doxycycline hyclate for inj 100 mg 3doxycycline hyclate tab 20 mg 2doxycycline hyclate tab 100 mg 2doxycycline monohydrate cap 50 mg 2doxycycline monohydrate cap 75 mg 2doxycycline monohydrate cap 100 mg 2doxycycline monohydrate cap 150 mg 2doxycycline monohydrate tab 50 mg 2doxycycline monohydrate tab 75 mg 2doxycycline monohydrate tab 100 mg 2doxycycline monohydrate tab 150 mg 2ERY-TAB - erythromycin tab delayed release 250 mg 4

2018


11


ERY-TAB - erythromycin tab delayed release 333 mg 4ERY-TAB - erythromycin tab delayed release 500 mg 4ERYPED 400 - erythromycin ethylsuccinate for susp 400 mg/5ml 4ERYTHROCIN LACTOBIONATE - erythromycin lactobionate for

inj 500 mg4

ERYTHROCIN STEARATE - erythromycin stearate tab 250 mg 4erythromycin ethylsuccinate for susp 200 mg/5ml 2erythromycin pads 2% 2erythromycin soln 2% 2erythromycin tab 250 mg 4erythromycin tab 500 mg 4gentamicin in saline inj 0.8 mg/ml 2gentamicin in saline inj 1 mg/ml 2gentamicin in saline inj 1.2 mg/ml 2gentamicin in saline inj 1.6 mg/ml 2gentamicin sulfate inj 10 mg/ml 2gentamicin sulfate inj 40 mg/ml 2imipenem-cilastatin intravenous for soln 250 mg 3imipenem-cilastatin intravenous for soln 500 mg 4IMPAVIDO - miltefosine cap 50 mg 5INVANZ - ertapenem sodium for inj 1 gm 4INVANZ - ertapenem sodium for iv inj 1 gm 4LEVOFLOXACIN - levofloxacin oral soln 25 mg/ml 3levofloxacin in d5w iv soln 250 mg/50ml 2levofloxacin in d5w iv soln 500 mg/100ml 2levofloxacin in d5w iv soln 750 mg/150ml 2levofloxacin iv soln 25 mg/ml 4levofloxacin tab 250 mg 1levofloxacin tab 500 mg 1levofloxacin tab 750 mg 1LINEZOLID - linezolid in sodium chloride iv soln

600 mg/300ml-0.9%5

linezolid for susp 100 mg/5ml 5 PAlinezolid iv soln 600 mg/300ml (2 mg/ml) 4linezolid tab 600 mg 3 PAmeropenem iv for soln 500 mg 2meropenem iv for soln 1 gm 2methenamine hippurate tab 1 gm 2

2018



METRO IV - metronidazole in nacl 0.74% iv soln 500 mg/100ml 4metronidazole cap 375 mg 2metronidazole in nacl 0.79% iv soln 500 mg/100ml 2metronidazole iv soln 5 mg/ml 2metronidazole tab 250 mg 2metronidazole tab 500 mg 2metronidazole vaginal gel 0.75% 2minocycline hcl cap 50 mg 2minocycline hcl cap 75 mg 2minocycline hcl cap 100 mg 2minocycline hcl tab 50 mg 2minocycline hcl tab 75 mg 2minocycline hcl tab 100 mg 2MOXIFLOXACIN HCL - moxifloxacin hcl iv solution 400 mg/250ml 2moxifloxacin hcl tab 400 mg 2moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8% inj 2NAFCILLIN SODIUM - nafcillin sodium for iv soln 1 gm 4NAFCILLIN SODIUM - nafcillin sodium for iv soln 2 gm 4nafcillin sodium for inj 1 gm 3nafcillin sodium for inj 2 gm 2nafcillin sodium for iv soln 10 gm 5neomycin sulfate tab 500 mg 2neomycin-polymyxin b gu irrigation soln 2nitrofurantoin macrocrystalline cap 50 mg# 4 PAnitrofurantoin macrocrystalline cap 100 mg# 4 PAnitrofurantoin monohydrate macrocrystalline cap 100 mg# 4 PAnitrofurantoin susp 25 mg/5ml# 4 PAofloxacin tab 400 mg 2paromomycin sulfate cap 250 mg 4penicillin g potassium for inj 5000000 unit 2penicillin g potassium for inj 20000000 unit 2PENICILLIN G POTASSIUM IN DEXTROSE - penicillin g

potassium inj 20000 unit/ml in dextrose4

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

4

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

4

PENICILLIN G SODIUM - penicillin g sodium for inj 5000000 unit 4penicillin v potassium for soln 125 mg/5ml 2

2018


13


penicillin 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) 4piperacillin 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) 4SIVEXTRO - tedizolid phosphate for iv soln 200 mg 5SIVEXTRO - tedizolid phosphate tab 200 mg 5 PASTREPTOMYCIN SULFATE - streptomycin sulfate for inj 1 gm 4sulfacetamide sodium lotion 10% 2SULFADIAZINE - sulfadiazine tab 500 mg 4sulfamethoxazole-trimethoprim iv soln 400-80 mg/5ml 2sulfamethoxazole-trimethoprim susp 200-40 mg/5ml 2sulfamethoxazole-trimethoprim tab 400-80 mg 1sulfamethoxazole-trimethoprim tab 800-160 mg 1SUPRAX - cefixime cap 400 mg 4SUPRAX - cefixime chew tab 100 mg 4SUPRAX - cefixime chew tab 200 mg 4SYNERCID - quinupristin-dalfopristin for inj 500 mg (150-350 mg) 5TEFLARO - ceftaroline fosamil for iv soln 400 mg 5TEFLARO - ceftaroline fosamil for iv soln 600 mg 5tetracycline hcl cap 250 mg 3tetracycline hcl cap 500 mg 3tigecycline for iv soln 50 mg 5TOBRAMYCIN SULFATE - tobramycin sulfate inj 2 gm/50ml

(40 mg/ml)4

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

2018



vancomycin hcl for inj 5000 mg 2vancomycin hcl for inj 10 gm 2VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl in dextrose

5% inj 500 mg/100ml4

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

4

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

4

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

2-0.25gm/50ml4

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

4

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

4

Medicamentos anticonvulsantesAPTIOM - eslicarbazepine acetate tab 200 mg 5APTIOM - eslicarbazepine acetate tab 400 mg 5APTIOM - eslicarbazepine acetate tab 600 mg 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 2carbamazepine tab 200 mg 2CELONTIN - methsuximide cap 300 mg 4

2018


15


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 RECTAL GEL - diazepam rectal gel delivery system2.5 mg

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

DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system10 mg


DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system20 mg


DILANTIN - phenytoin sodium extended cap 30 mg 4divalproex sodium cap delayed release sprinkle 125 mg 2divalproex sodium tab delayed release 125 mg 2divalproex sodium tab delayed release 250 mg 2divalproex sodium tab delayed release 500 mg 2divalproex sodium tab er 24 hr 250 mg 2divalproex sodium tab er 24 hr 500 mg 2ethosuximide cap 250 mg 2ethosuximide soln 250 mg/5ml 2felbamate susp 600 mg/5ml 5felbamate tab 400 mg 4felbamate tab 600 mg 4fosphenytoin sodium inj 100 mg/2ml 3fosphenytoin sodium inj 500 mg/10ml 3FYCOMPA - perampanel susp 0.5 mg/ml 5FYCOMPA - perampanel tab 2 mg 4FYCOMPA - perampanel tab 4 mg 5FYCOMPA - perampanel tab 6 mg 5FYCOMPA - perampanel tab 8 mg 5FYCOMPA - perampanel tab 10 mg 5FYCOMPA - perampanel tab 12 mg 5gabapentin cap 100 mg 1 QL (1080 capsules/30 days)gabapentin cap 300 mg 1 QL (360 capsules/30 days)gabapentin cap 400 mg 1 QL (270 capsules/30 days)gabapentin oral soln 250 mg/5ml 2 QL (2160 mls/30 days)gabapentin tab 600 mg 2 QL (180 tablets/30 days)gabapentin tab 800 mg 2 QL (135 tablets/30 days)GABITRIL - tiagabine hcl tab 12 mg 4GABITRIL - tiagabine hcl tab 16 mg 4

2018



lamotrigine tab chewable dispersible 5 mg 2lamotrigine tab chewable dispersible 25 mg 2lamotrigine tab 25 mg 1lamotrigine tab 100 mg 1lamotrigine tab 150 mg 1lamotrigine tab 200 mg 1levetiracetam in sodium chloride iv soln 500 mg/100ml 3levetiracetam in sodium chloride iv soln 1000 mg/100ml 3levetiracetam in sodium chloride iv soln 1500 mg/100ml 3levetiracetam inj 500 mg/5ml (100 mg/ml) 3levetiracetam oral soln 100 mg/ml 2levetiracetam tab 250 mg 2levetiracetam tab 500 mg 2levetiracetam tab 750 mg 2levetiracetam tab 1000 mg 2LYRICA - pregabalin cap 25 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 50 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 75 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 100 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 150 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 200 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 225 mg 3 QL (60 capsules/30 days)LYRICA - pregabalin cap 300 mg 3 QL (60 capsules/30 days)LYRICA - pregabalin soln 20 mg/ml 3 QL (900 mls/30 days)ONFI - clobazam suspension 2.5 mg/ml 5 PA, QL (480 mls/30 days)ONFI - clobazam tab 10 mg 5 PA, QL (60 tablets/30 days)ONFI - clobazam tab 20 mg 5 PA, QL (60 tablets/30 days)oxcarbazepine susp 300 mg/5ml (60 mg/ml) 4oxcarbazepine tab 150 mg 2oxcarbazepine tab 300 mg 2oxcarbazepine tab 600 mg 2PEGANONE - ethotoin tab 250 mg 4PHENOBARBITAL - phenobarbital tab 15 mg# 4 PAPHENOBARBITAL - phenobarbital tab 30 mg# 4 PAPHENOBARBITAL - phenobarbital tab 60 mg# 4 PAPHENOBARBITAL - phenobarbital tab 100 mg# 4 PAphenobarbital elixir 20 mg/5ml# 4 PAPHENOBARBITAL SODIUM - phenobarbital sodium inj 65 mg/ml# 4 PA

2018


17


PHENOBARBITAL SODIUM - phenobarbital sodium inj 130 mg/ml#

4 PA

phenobarbital tab 16.2 mg# 4 PAphenobarbital tab 32.4 mg# 4 PAphenobarbital tab 64.8 mg# 4 PAphenobarbital tab 97.2 mg# 4 PAphenytoin chew tab 50 mg 2phenytoin sodium extended cap 100 mg 2phenytoin sodium extended cap 200 mg 2phenytoin sodium extended cap 300 mg 2phenytoin susp 125 mg/5ml 2primidone tab 50 mg 2primidone tab 250 mg 2SABRIL - vigabatrin powd pack 500 mg* 4SABRIL - vigabatrin tab 500 mg* 5SPRITAM - levetiracetam tab disintegrating soluble 250 mg 4SPRITAM - levetiracetam tab disintegrating soluble 500 mg 4SPRITAM - levetiracetam tab disintegrating soluble 750 mg 5SPRITAM - levetiracetam tab disintegrating soluble 1000 mg 4tiagabine hcl tab 2 mg 3tiagabine hcl tab 4 mg 4tiagabine hcl tab 12 mg 4tiagabine hcl tab 16 mg 4topiramate sprinkle cap 15 mg 2topiramate sprinkle cap 25 mg 2topiramate tab 25 mg 1topiramate tab 50 mg 1topiramate tab 100 mg 1topiramate tab 200 mg 1valproate sodium inj 100 mg/ml 2valproate sodium oral soln 250 mg/5ml 2valproic acid cap 250 mg 2vigabatrin powd pack 500 mg* 4VIMPAT - lacosamide iv inj 200 mg/20ml (10 mg/ml) 3VIMPAT - lacosamide oral solution 10 mg/ml 3VIMPAT - lacosamide tab 50 mg 3VIMPAT - lacosamide tab 100 mg 3VIMPAT - lacosamide tab 150 mg 3

2018



VIMPAT - lacosamide tab 200 mg 3zonisamide cap 25 mg 2zonisamide cap 50 mg 2zonisamide cap 100 mg 2Agentes contra la demenciadonepezil hydrochloride orally disintegrating tab 5 mg 2donepezil hydrochloride orally disintegrating tab 10 mg 2donepezil hydrochloride tab 5 mg 1donepezil hydrochloride tab 10 mg 1donepezil hydrochloride tab 23 mg 3ERGOLOID MESYLATES - ergoloid mesylates tab 1 mg# 3 PAEXELON - rivastigmine td patch 24hr 4.6 mg/24hr 4EXELON - rivastigmine td patch 24hr 9.5 mg/24hr 4EXELON - rivastigmine td patch 24hr 13.3 mg/24hr 4GALANTAMINE HYDROBROMIDE - galantamine hydrobromide

oral soln 4 mg/ml4

galantamine hydrobromide cap er 24hr 8 mg 2galantamine hydrobromide cap er 24hr 16 mg 2galantamine hydrobromide cap er 24hr 24 mg 2galantamine hydrobromide tab 4 mg 2galantamine hydrobromide tab 8 mg 2galantamine hydrobromide tab 12 mg 2memantine hcl oral solution 2 mg/ml 2 PAmemantine hcl tab 5 mg 2 PAmemantine hcl tab 10 mg 2 PAmemantine hcl tab 5 mg (28) & 10 mg (21) titration pak 2 PANAMENDA - memantine hcl tab 5 mg 4 PANAMENDA - memantine hcl tab 10 mg 4 PANAMENDA TITRATION PAK - memantine hcl tab 5 mg (28) &

10 mg (21) titration pak4 PA

rivastigmine tartrate cap 1.5 mg 2rivastigmine tartrate cap 3 mg 2rivastigmine tartrate cap 4.5 mg 2rivastigmine tartrate cap 6 mg 2rivastigmine td patch 24hr 4.6 mg/24hr 2rivastigmine td patch 24hr 9.5 mg/24hr 2rivastigmine td patch 24hr 13.3 mg/24hr 2Medicamentos antidepresivosamitriptyline hcl tab 10 mg# 4 PA

2018


19


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

2018



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

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

FLUOXETINE DR - fluoxetine hcl cap delayed release 90 mg 2 QL (4 capsules/28 days)fluoxetine hcl cap 10 mg 1 QL (90 capsules/30 days)fluoxetine hcl cap 20 mg 1 QL (120 capsules/30 days)fluoxetine hcl cap 40 mg 1 QL (60 capsules/30 days)fluoxetine hcl solution 20 mg/5ml 2 QL (600 mls/30 days)fluoxetine hcl tab 10 mg 2 QL (90 tablets/30 days)fluoxetine hcl tab 20 mg 2 QL (120 tablets/30 days)fluvoxamine maleate tab 25 mg 2 QL (30 tablets/30 days)fluvoxamine maleate tab 50 mg 2 QL (30 tablets/30 days)fluvoxamine maleate tab 100 mg 2 QL (90 tablets/30 days)imipramine hcl tab 10 mg# 4 PAimipramine hcl tab 25 mg# 4 PAimipramine hcl tab 50 mg# 4 PAMAPROTILINE HCL - maprotiline hcl tab 25 mg 4 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 50 mg 4 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 75 mg 4 QL (90 tablets/30 days)MARPLAN - isocarboxazid tab 10 mg 4mirtazapine orally disintegrating tab 15 mg 2 QL (30 tablets/30 days)mirtazapine orally disintegrating tab 30 mg 2 QL (30 tablets/30 days)mirtazapine orally disintegrating tab 45 mg 2 QL (30 tablets/30 days)mirtazapine tab 7.5 mg 2 QL (30 tablets/30 days)

2018


21


mirtazapine tab 15 mg 2 QL (45 tablets/30 days)mirtazapine tab 30 mg 2 QL (30 tablets/30 days)mirtazapine tab 45 mg 2 QL (30 tablets/30 days)NEFAZODONE HCL - nefazodone hcl tab 100 mg 4NEFAZODONE HCL - nefazodone hcl tab 150 mg 4NEFAZODONE HCL - nefazodone hcl tab 200 mg 4nefazodone hcl tab 50 mg 2nefazodone hcl tab 250 mg 2nortriptyline hcl cap 10 mg# 4 PAnortriptyline hcl cap 25 mg# 4 PAnortriptyline hcl cap 50 mg# 4 PAnortriptyline hcl cap 75 mg# 4 PAnortriptyline hcl soln 10 mg/5ml# 4 PAparoxetine hcl tab 10 mg# 4 PA, QL (45 tablets/30 days)paroxetine hcl tab 20 mg# 4 PA, QL (30 tablets/30 days)paroxetine hcl tab 30 mg# 4 PA, QL (60 tablets/30 days)paroxetine hcl tab 40 mg# 4 PA, QL (45 tablets/30 days)PAXIL - paroxetine hcl oral susp 10 mg/5ml# 4 PA, QL (900 mls/30 days)phenelzine sulfate tab 15 mg 2PRISTIQ - desvenlafaxine succinate tab er 24hr 25 mg 4 QL (30 tablets/30 days)PRISTIQ - desvenlafaxine succinate tab er 24hr 50 mg 4 QL (30 tablets/30 days)PRISTIQ - desvenlafaxine succinate tab er 24hr 100 mg 4 QL (30 tablets/30 days)protriptyline hcl tab 5 mg# 4 PAprotriptyline hcl tab 10 mg# 4 PAsertraline hcl oral concentrate for solution 20 mg/ml 2 QL (300 mls/30 days)sertraline hcl tab 25 mg 1 QL (45 tablets/30 days)sertraline hcl tab 50 mg 1 QL (45 tablets/30 days)sertraline hcl tab 100 mg 1 QL (60 tablets/30 days)tranylcypromine sulfate tab 10 mg 3trazodone hcl tab 50 mg 1trazodone hcl tab 100 mg 1trazodone hcl tab 150 mg 1trazodone hcl tab 300 mg 1trimipramine maleate cap 25 mg# 4 PAtrimipramine maleate cap 50 mg# 4 PAtrimipramine maleate cap 100 mg# 4 PATRINTELLIX - vortioxetine hbr tab 5 mg 4 QL (30 tablets/30 days)TRINTELLIX - vortioxetine hbr tab 10 mg 4 QL (30 tablets/30 days)

2018



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

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

Medicamentos antieméticosALOXI - palonosetron hcl iv soln 0.25 mg/5ml 4aprepitant capsule therapy pack 80 & 125 mg 2 BDaprepitant capsule 40 mg 2 BDaprepitant capsule 80 mg 2 BDaprepitant capsule 125 mg 2 BDCHLORPROMAZINE HCL - chlorpromazine hcl inj 25 mg/ml 4 PACHLORPROMAZINE HCL - chlorpromazine hcl inj 50 mg/2ml 4 PAchlorpromazine hcl tab 10 mg 2 PAchlorpromazine hcl tab 25 mg 3 PAchlorpromazine hcl tab 50 mg 3 PAchlorpromazine hcl tab 100 mg 4 PAchlorpromazine hcl tab 200 mg 4 PAdronabinol cap 2.5 mg 3 BDdronabinol cap 5 mg 4 BDdronabinol cap 10 mg 4 BDEMEND - fosaprepitant dimeglumine for iv infusion 150 mg 4granisetron hcl inj 1 mg/ml 2granisetron hcl inj 4 mg/4ml (1 mg/ml) 2granisetron hcl tab 1 mg 2 BDmeclizine hcl tab 12.5 mg# 4

2018


23


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

0.25 mg/2ml4

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

2018



clotrimazole cream 1% 1clotrimazole troche 10 mg 2CRESEMBA - isavuconazonium sulfate cap 186 mg 5 PACRESEMBA - isavuconazonium sulfate for iv soln 372 mg 5 PAeconazole nitrate cream 1% 2fluconazole for susp 10 mg/ml 2fluconazole for susp 40 mg/ml 2fluconazole in dextrose inj 200 mg/100ml 2fluconazole in dextrose inj 400 mg/200ml 2fluconazole in nacl 0.9% inj 200 mg/100ml 2fluconazole in nacl 0.9% inj 400 mg/200ml 2fluconazole tab 50 mg 2fluconazole tab 100 mg 2fluconazole tab 150 mg 2fluconazole tab 200 mg 2flucytosine cap 250 mg 5flucytosine cap 500 mg 5griseofulvin microsize susp 125 mg/5ml 2griseofulvin ultramicrosize tab 125 mg 2griseofulvin ultramicrosize tab 250 mg 2itraconazole cap 100 mg 4ketoconazole cream 2% 2ketoconazole shampoo 2% 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 2nystatin topical powder 100000 unit/gm 2terbinafine hcl tab 250 mg 1terconazole vaginal cream 0.4% 2terconazole vaginal cream 0.8% 2terconazole vaginal suppos 80 mg 2

2018


25


voriconazole for inj 200 mg 4 PAvoriconazole for susp 40 mg/ml 5 PAvoriconazole tab 50 mg 5 PAvoriconazole tab 200 mg 5 PAAgentes contra la gotaallopurinol sodium for inj 500 mg 2allopurinol tab 100 mg 1allopurinol tab 300 mg 1colchicine w/ probenecid tab 0.5-500 mg 2COLCRYS - colchicine tab 0.6 mg 3probenecid tab 500 mg 2ULORIC - febuxostat tab 40 mg 3 STULORIC - febuxostat tab 80 mg 3 STAgentes contra las migrañasMIGERGOT - ergotamine w/ caffeine suppos 2-100 mg 5MIGRANAL - dihydroergotamine mesylate nasal spray 4 mg/ml 3 QL (8 mls/28 days)naratriptan hcl tab 1 mg 2 QL (18 tablets/30 days)naratriptan hcl tab 2.5 mg 2 QL (18 tablets/30 days)rizatriptan benzoate oral disintegrating tab 5 mg 2 QL (18 tablets/30 days)rizatriptan benzoate oral disintegrating tab 10 mg 2 QL (18 tablets/30 days)rizatriptan benzoate tab 5 mg 2 QL (18 tablets/30 days)rizatriptan benzoate tab 10 mg 2 QL (18 tablets/30 days)sumatriptan nasal spray 5 mg/act 2 QL (12 units (2

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

packages)/30 days)sumatriptan succinate inj 6 mg/0.5ml 4sumatriptan succinate solution auto-injector 4 mg/0.5ml 2sumatriptan succinate solution auto-injector 6 mg/0.5ml 4sumatriptan succinate solution cartridge 4 mg/0.5ml 4sumatriptan succinate solution cartridge 6 mg/0.5ml 4sumatriptan succinate tab 25 mg 2 QL (18 tablets/30 days)sumatriptan succinate tab 50 mg 2 QL (18 tablets/30 days)sumatriptan succinate tab 100 mg 2 QL (18 tablets/30 days)Agentes antimiasténicosGUANIDINE HCL - guanidine hcl tab 125 mg 4MESTINON - pyridostigmine bromide syrup 60 mg/5ml 5pyridostigmine bromide tab er 180 mg 2pyridostigmine bromide tab 60 mg 2

2018



Medicamentos antimicobacterialesCAPASTAT SULFATE - capreomycin sulfate for inj 1 gm 4CYCLOSERINE - cycloserine cap 250 mg 5dapsone tab 25 mg 2dapsone tab 100 mg 2ethambutol hcl tab 100 mg 2ethambutol hcl tab 400 mg 2ISONIAZID - isoniazid inj 100 mg/ml 3isoniazid tab 100 mg 1isoniazid tab 300 mg 1PASER - aminosalicylic acid er granules packet 4 gm 4PRIFTIN - rifapentine tab 150 mg 4pyrazinamide tab 500 mg 2rifabutin cap 150 mg 4rifampin cap 150 mg 2rifampin cap 300 mg 2rifampin for inj 600 mg 5SIRTURO - bedaquiline fumarate tab 100 mg 5TRECATOR - ethionamide tab 250 mg 4Medicamentos antineoplásicosABRAXANE - paclitaxel protein-bound particles for iv susp 100 mg 5AFINITOR - everolimus tab 2.5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 7.5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 10 mg 5 PA, QL (30 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 2 mg 5 PA, QL (60 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 3 mg 5 PA, QL (90 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 5 mg 5 PA, QL (60 tablets/30 days)ALECENSA - alectinib hcl cap 150 mg* 5 PA, QL (240 capsules/30 days)ALIMTA - pemetrexed disodium for iv soln 100 mg 5ALIMTA - pemetrexed disodium for iv soln 500 mg 5ALIQOPA - copanlisib hcl for iv soln 60 mg 5ALUNBRIG - brigatinib tab initiation therapy pack 90 mg & 180 mg 5 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 30 mg 5 PA, QL (180 tablets/30 days)ALUNBRIG - brigatinib tab 90 mg 5 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 180 mg 5 PA, QL (30 tablets/30 days)anastrozole tab 1 mg 1ARRANON - nelarabine iv soln 5 mg/ml 5

2018


27


ARZERRA - ofatumumab conc for iv infusion 100 mg/5ml* 5ARZERRA - ofatumumab conc for iv infusion 1000 mg/50ml* 5AVASTIN - bevacizumab iv soln 100 mg/4ml (for infusion)* 5AVASTIN - bevacizumab iv soln 400 mg/16ml (for infusion)* 5BAVENCIO - avelumab soln for iv infusion 200 mg/10ml (20 mg/

ml)5

BELEODAQ - belinostat for iv inj 500 mg* 5BENDEKA - bendamustine hcl iv soln 100 mg/4ml (25 mg/ml) 5BESPONSA - inotuzumab ozogamicin for iv soln 0.9 mg 5bexarotene cap 75 mg 5 PAbicalutamide tab 50 mg 2BICNU - carmustine for inj 100 mg 4bleomycin sulfate for inj 15 unit 2 BDbleomycin sulfate for inj 30 unit 3 BDBLINCYTO - blinatumomab for iv infusion 35 mcg* 5 BDBOSULIF - bosutinib tab 100 mg 5 PA, QL (180 tablets/30 days)BOSULIF - bosutinib tab 400 mg 5 PA, QL (30 tablets/30 days)BOSULIF - bosutinib tab 500 mg 5 PA, QL (30 tablets/30 days)busulfan inj 6 mg/ml 5CABOMETYX - cabozantinib s-malate tab 20 mg* 5 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 40 mg* 5 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 60 mg* 5 PA, QL (30 tablets/30 days)CALQUENCE - acalabrutinib cap 100 mg 5 PA, QL (60 capsules/30 days)CAPRELSA - vandetanib tab 100 mg* 5 PA, QL (60 tablets/30 days)CAPRELSA - vandetanib tab 300 mg* 5 PA, QL (30 tablets/30 days)carboplatin iv soln 50 mg/5ml 2carboplatin iv soln 150 mg/15ml 2carboplatin iv soln 450 mg/45ml 2carboplatin iv soln 600 mg/60ml 2CISPLATIN - cisplatin inj 200 mg/200ml (1 mg/ml) 2cisplatin inj 50 mg/50ml (1 mg/ml) 2cisplatin inj 100 mg/100ml (1 mg/ml) 2cladribine iv soln 10 mg/10ml (1 mg/ml) 5 BDclofarabine iv soln 1 mg/ml 5COMETRIQ - cabozantinib s-mal cap 1 x 80 mg & 1 x 20 mg (100

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

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


2018



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


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

20 mg/4ml2

DAUNORUBICIN HYDROCHLORIDE - daunorubicin hcl iv soln50 mg/10ml

2

decitabine for inj 50 mg 5dexrazoxane for inj 250 mg 5dexrazoxane for inj 500 mg 5DOCETAXEL - docetaxel for inj conc 20 mg/ml 5DOCETAXEL - docetaxel for inj conc 80 mg/4ml (20 mg/ml) 5DOCETAXEL - docetaxel for inj conc 160 mg/8ml (20 mg/ml) 5DOCETAXEL - docetaxel for inj conc 200 mg/10ml (20 mg/ml) 5DOCETAXEL - docetaxel soln for iv infusion 20 mg/2ml 5DOCETAXEL - docetaxel soln for iv infusion 80 mg/8ml 5DOCETAXEL - docetaxel soln for iv infusion 160 mg/16ml 5DOCETAXEL - docetaxel soln for iv infusion 200 mg/20ml 5docetaxel for inj conc 20 mg/ml 5docetaxel for inj conc 80 mg/4ml (20 mg/ml) 5docetaxel soln for iv infusion 20 mg/2ml 5docetaxel soln for iv infusion 80 mg/8ml 5

2018


29


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

unit5

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

2018



FOLOTYN - pralatrexate iv inj 40 mg/2ml 5GAZYVA - obinutuzumab soln for iv infusion 1000 mg/40ml

(25 mg/ml)5

gemcitabine hcl for inj 200 mg 3gemcitabine hcl for inj 1 gm 3gemcitabine hcl for inj 2 gm 3gemcitabine hcl inj 200 mg/5.26ml (38 mg/ml) 2gemcitabine hcl inj 1 gm/26.3ml (38 mg/ml) 2gemcitabine hcl inj 2 gm/52.6ml (38 mg/ml) 2GILOTRIF - afatinib dimaleate tab 20 mg 5 PA, QL (30 tablets/30 days)GILOTRIF - afatinib dimaleate tab 30 mg 5 PA, QL (30 tablets/30 days)GILOTRIF - afatinib dimaleate tab 40 mg 5 PA, QL (30 tablets/30 days)GLEEVEC - imatinib mesylate tab 100 mg 5 PA, QL (90 tablets/30 days)GLEEVEC - imatinib mesylate tab 400 mg 5 PA, QL (60 tablets/30 days)GLEOSTINE - lomustine cap 5 mg 4GLEOSTINE - lomustine cap 10 mg 4GLEOSTINE - lomustine cap 40 mg 4GLEOSTINE - lomustine cap 100 mg 4HALAVEN - eribulin mesylate inj 1 mg/2ml (0.5 mg/ml) 5HERCEPTIN - trastuzumab for iv soln 150 mg* 5HERCEPTIN - trastuzumab for iv soln 440 mg* 5HEXALEN - altretamine cap 50 mg 5 PAhydroxyurea cap 500 mg 2IBRANCE - palbociclib cap 75 mg* 5 PA, QL (21 capsules/28 days)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) 2

2018


31


imatinib mesylate tab 100 mg 5 PA, QL (90 tablets/30 days)imatinib mesylate tab 400 mg 5 PA, QL (60 tablets/30 days)IMBRUVICA - ibrutinib cap 70 mg 5 PA, QL (30 capsules/30 days)IMBRUVICA - ibrutinib cap 140 mg 5 PA, QL (120 capsules/30 days)IMBRUVICA - ibrutinib tab 140 mg 5 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 280 mg 5 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 420 mg 5 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 560 mg 5 PA, QL (30 tablets/30 days)IMFINZI - durvalumab soln for iv infusion 120 mg/2.4ml (50 mg/ml) 5IMFINZI - durvalumab soln for iv infusion 500 mg/10ml (50 mg/ml) 5IMLYGIC - talimogene laherparepvec intralesional inj 1000000

unit/ml*4

IMLYGIC - talimogene laherparepvec intralesional inj 100000000unit/ml*

5

INLYTA - axitinib tab 1 mg* 5 PA, QL (180 tablets/30 days)INLYTA - axitinib tab 5 mg* 5 PA, QL (120 tablets/30 days)IRESSA - gefitinib tab 250 mg* 5 PA, QL (30 tablets/30 days)IRINOTECAN - irinotecan hcl inj 500 mg/25ml (20 mg/ml) 3irinotecan hcl inj 40 mg/2ml (20 mg/ml) 3irinotecan hcl inj 100 mg/5ml (20 mg/ml) 3ISTODAX - romidepsin for iv inj 10 mg 5ISTODAX (OVERFILL) - romidepsin for iv inj 10 mg 5IXEMPRA KIT - ixabepilone for iv infusion 15 mg 5IXEMPRA KIT - ixabepilone for iv infusion 45 mg 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) 5KADCYLA - ado-trastuzumab emtansine for iv soln 100 mg 5KADCYLA - ado-trastuzumab emtansine for iv soln 160 mg 5KEYTRUDA - pembrolizumab iv soln 100 mg/4ml (25 mg/ml)* 5KISQALI - ribociclib succinate tab 200 mg 5 PA, QL (63 tablets/28 days)KISQALI FEMARA 200 DOSE - ribociclib tab 200 mg & letrozole

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

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

5 PA, QL (91 tablets/28 days)

2018



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


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

ml)5

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

5

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


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


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


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


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


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


letrozole tab 2.5 mg 1LEUCOVORIN CALCIUM - leucovorin calcium for inj 500 mg 4LEUCOVORIN CALCIUM - leucovorin calcium tab 10 mg 3LEUCOVORIN CALCIUM - leucovorin calcium tab 15 mg 4leucovorin calcium for inj 50 mg 4leucovorin calcium for inj 100 mg 4leucovorin calcium for inj 200 mg 4leucovorin calcium for inj 350 mg 3leucovorin calcium tab 5 mg 2leucovorin calcium tab 25 mg 4LEUKERAN - chlorambucil tab 2 mg 3LONSURF - trifluridine-tipiracil tab 15-6.14 mg 5 PA, QL (100 tablets/28 days)LONSURF - trifluridine-tipiracil tab 20-8.19 mg 5 PA, QL (80 tablets/28 days)LYNPARZA - olaparib cap 50 mg* 5 PA, QL (480 capsules/30 days)LYNPARZA - olaparib tab 100 mg* 5 PA, QL (120 tablets/30 days)LYNPARZA - olaparib tab 150 mg* 5 PA, QL (120 tablets/30 days)MARQIBO - vincristine sulfate liposome iv susp 5 mg/31ml

(0.16 mg/ml)5

MATULANE - procarbazine hcl cap 50 mg* 5 PAMEKINIST - trametinib dimethyl sulfoxide tab 0.5 mg* 5 PA, QL (90 tablets/30 days)MEKINIST - trametinib dimethyl sulfoxide tab 2 mg* 5 PA, QL (30 tablets/30 days)

2018


33


melphalan hcl for inj 50 mg 5mercaptopurine tab 50 mg 2mesna inj 100 mg/ml 2MESNEX - mesna tab 400 mg 4mitomycin for iv soln 5 mg 4mitomycin for iv soln 20 mg 2mitomycin for iv soln 40 mg 5mitoxantrone hcl inj conc 20 mg/10ml (2 mg/ml) 2mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/ml) 2mitoxantrone hcl inj conc 30 mg/15ml (2 mg/ml) 2MUSTARGEN - mechlorethamine hcl for inj 10 mg 4MYLOTARG - gemtuzumab ozogamicin for iv soln 4.5 mg 5NERLYNX - neratinib maleate tab 40 mg 5 PA, QL (180 tablets/30 days)NEXAVAR - sorafenib tosylate tab 200 mg* 5 PA, QL (120 tablets/30 days)nilutamide tab 150 mg 5NINLARO - ixazomib citrate cap 2.3 mg 5 PA, QL (3 capsules/28 days)NINLARO - ixazomib citrate cap 3 mg 5 PA, QL (3 capsules/28 days)NINLARO - ixazomib citrate cap 4 mg 5 PA, QL (3 capsules/28 days)NIPENT - pentostatin for inj 10 mg 5ODOMZO - sonidegib phosphate cap 200 mg* 5 PA, QL (30 capsules/30 days)ONCASPAR - pegaspargase inj 750 unit/ml 5ONIVYDE - irinotecan hcl liposome iv inj 43 mg/10ml (4.3 mg/ml) 5OPDIVO - nivolumab iv soln 40 mg/4ml* 5OPDIVO - nivolumab iv soln 100 mg/10ml* 5OPDIVO - nivolumab iv soln 240 mg/24ml* 5oxaliplatin for iv inj 50 mg 5oxaliplatin for iv inj 100 mg 5oxaliplatin iv soln 50 mg/10ml 4oxaliplatin iv soln 100 mg/20ml 4paclitaxel iv conc 30 mg/5ml (6 mg/ml) 3paclitaxel iv conc 100 mg/16.7ml (6 mg/ml) 3paclitaxel iv conc 300 mg/50ml (6 mg/ml) 3PANRETIN - alitretinoin gel 0.1% 5PERJETA - pertuzumab soln for iv infusion 420 mg/14ml (30 mg/

ml)*5

POMALYST - pomalidomide cap 1 mg* 5 PA, QL (21 capsules/28 days)POMALYST - pomalidomide cap 2 mg* 5 PA, QL (21 capsules/28 days)POMALYST - pomalidomide cap 3 mg* 5 PA, QL (21 capsules/28 days)

2018



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

1400-23400 mg-unit/11.7ml5 PA

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

5 PA

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

2018


35


tamoxifen citrate tab 10 mg 2tamoxifen citrate tab 20 mg 2TARCEVA - erlotinib hcl tab 25 mg 5 PA, QL (60 tablets/30 days)TARCEVA - erlotinib hcl tab 100 mg 5 PA, QL (30 tablets/30 days)TARCEVA - erlotinib hcl tab 150 mg 5 PA, QL (30 tablets/30 days)TARGRETIN - bexarotene gel 1% 5TASIGNA - nilotinib hcl cap 50 mg 5 PA, QL (120 capsules/30 days)TASIGNA - nilotinib hcl cap 150 mg 5 PA, QL (120 capsules/30 days)TASIGNA - nilotinib hcl cap 200 mg 5 PA, QL (120 capsules/30 days)TECENTRIQ - atezolizumab iv soln 1200 mg/20ml* 5TEMODAR - temozolomide for iv soln 100 mg 5THALOMID - thalidomide cap 50 mg 5 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 100 mg 5 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 150 mg 5 PA, QL (60 capsules/30 days)THALOMID - thalidomide cap 200 mg 5 PA, QL (60 capsules/30 days)thiotepa for inj 15 mg 5topotecan hcl for inj 4 mg 5topotecan hcl inj 4 mg/4ml (for infusion) 5TORISEL - temsirolimus soln for iv infusion 25 mg/ml 5TREANDA - bendamustine hcl for iv soln 25 mg 5TREANDA - bendamustine hcl for iv soln 100 mg 5tretinoin cap 10 mg 5 PATRISENOX - arsenic trioxide iv soln 12 mg/6ml (2 mg/ml) 5TYKERB - lapatinib ditosylate tab 250 mg* 5 PA, QL (180 tablets/30 days)UNITUXIN - dinutuximab iv soln 17.5 mg/5ml (3.5 mg/ml)* 5VALCHLOR - mechlorethamine hcl gel 0.016%* 5VECTIBIX - panitumumab iv soln 100 mg/5ml 5VECTIBIX - panitumumab iv soln 400 mg/20ml 5VELCADE - bortezomib for inj 3.5 mg 5VENCLEXTA - venetoclax tab 10 mg* 3 PA, QL (60 tablets/30 days)VENCLEXTA - venetoclax tab 50 mg* 4 PA, QL (30 tablets/30 days)VENCLEXTA - venetoclax tab 100 mg* 5 PA, QL (120 tablets/30 days)VENCLEXTA STARTING PACK - venetoclax tab therapy starter

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

tablets)/28 days)VERZENIO - abemaciclib tab 50 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 100 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 150 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 200 mg 5 PA, QL (60 tablets/30 days)

2018



VINBLASTINE SULFATE - vinblastine sulfate inj 1 mg/ml 4 BDvincristine sulfate iv soln 1 mg/ml 2 BDvinorelbine tartrate inj 10 mg/ml 3vinorelbine tartrate inj 50 mg/5ml (10 mg/ml) 3VOTRIENT - pazopanib hcl tab 200 mg* 5 PA, QL (120 tablets/30 days)VYXEOS - daunorubicin-cytarabine liposome for iv inj 44-100 mg 5XALKORI - crizotinib cap 200 mg* 5 PA, QL (60 capsules/30 days)XALKORI - crizotinib cap 250 mg* 5 PA, QL (60 capsules/30 days)XTANDI - enzalutamide cap 40 mg* 5 PA, QL (120 capsules/30 days)YERVOY - ipilimumab soln for iv infusion 50 mg/10ml (5 mg/ml)* 5YERVOY - ipilimumab soln for iv infusion 200 mg/40ml (5 mg/ml)* 5YONDELIS - trabectedin for inj 1 mg 5ZALTRAP - ziv-aflibercept iv soln 100 mg/4ml (for infusion) 5ZALTRAP - ziv-aflibercept iv soln 200 mg/8ml (for infusion) 5ZANOSAR - streptozocin for inj 1 gm 4ZEJULA - niraparib tosylate cap 100 mg 5 PA, QL (90 capsules/30 days)ZELBORAF - vemurafenib tab 240 mg* 5 PA, QL (240 tablets/30 days)ZOLINZA - vorinostat cap 100 mg 5 PA, QL (120 capsules/30 days)ZYDELIG - idelalisib tab 100 mg* 5 PA, QL (60 tablets/30 days)ZYDELIG - idelalisib tab 150 mg* 5 PA, QL (60 tablets/30 days)ZYKADIA - ceritinib cap 150 mg* 5 PA, QL (150 capsules/30 days)ZYTIGA - abiraterone acetate tab 250 mg* 5 PA, QL (120 tablets/30 days)ZYTIGA - abiraterone acetate tab 500 mg* 5 PA, QL (60 tablets/30 days)Medicamentos antiparasitariosALBENZA - albendazole tab 200 mg 5ALINIA - nitazoxanide for susp 100 mg/5ml 5ALINIA - nitazoxanide tab 500 mg 5atovaquone susp 750 mg/5ml 5atovaquone-proguanil hcl tab 62.5-25 mg 2atovaquone-proguanil hcl tab 250-100 mg 2BENZNIDAZOLE - benznidazole tab 12.5 mg 4BENZNIDAZOLE - benznidazole tab 100 mg 4BILTRICIDE - praziquantel tab 600 mg 4CHLOROQUINE PHOSPHATE - chloroquine phosphate tab

250 mg3

chloroquine phosphate tab 500 mg 2COARTEM - artemether-lumefantrine tab 20-120 mg 4DARAPRIM - pyrimethamine tab 25 mg 5

2018


37


hydroxychloroquine sulfate tab 200 mg 2ivermectin tab 3 mg 2LINDANE - lindane shampoo 1% 3malathion lotion 0.5% 3mefloquine hcl tab 250 mg 2NEBUPENT - pentamidine isethionate for nebulization soln

300 mg4 BD

PENTAM 300 - pentamidine isethionate for soln 300 mg 4 BDpermethrin cream 5% 2praziquantel tab 600 mg 4PRIMAQUINE PHOSPHATE - primaquine phosphate tab 26.3 mg 4Agentes contra la enfermedad de Parkinsonamantadine hcl cap 100 mg 2amantadine hcl syrup 50 mg/5ml 2amantadine hcl tab 100 mg 2APOKYN - apomorphine hcl soln cartridge 30 mg/3ml* 5 PA, QL (60 mls/30 days)benztropine mesylate tab 0.5 mg# 3 PAbenztropine mesylate tab 1 mg# 3 PAbenztropine mesylate tab 2 mg# 3 PAbromocriptine mesylate cap 5 mg 2bromocriptine mesylate tab 2.5 mg 3carbidopa & levodopa orally disintegrating tab 10-100 mg 2carbidopa & levodopa orally disintegrating tab 25-100 mg 2carbidopa & levodopa orally disintegrating tab 25-250 mg 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 mg3

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

3

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

3


3


3

2018



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

3

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

2018


39


ARISTADA - aripiprazole lauroxil im er susp prefilled syr441 mg/1.6ml

5 PA, QL (1 syringe/28 days)







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

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

tablets)/28 days)fluphenazine decanoate inj 25 mg/ml 2 PAFLUPHENAZINE HCL - fluphenazine hcl elixir 2.5 mg/5ml 4 PAFLUPHENAZINE HCL - fluphenazine hcl inj 2.5 mg/ml 4 PAFLUPHENAZINE HCL - fluphenazine hcl oral conc 5 mg/ml 4 PAfluphenazine hcl tab 1 mg 2 PAfluphenazine hcl tab 2.5 mg 2 PAfluphenazine hcl tab 5 mg 2 PAfluphenazine hcl tab 10 mg 2 PAGEODON - ziprasidone mesylate for inj 20 mg 4 PA, QL (60 vials/30 days)haloperidol decanoate im soln 50 mg/ml 2 PAhaloperidol decanoate im soln 100 mg/ml 2 PAhaloperidol lactate inj 5 mg/ml 2 PAhaloperidol lactate oral conc 2 mg/ml 2 PAhaloperidol tab 0.5 mg 2 PAhaloperidol tab 1 mg 2 PA

2018



haloperidol tab 2 mg 2 PAhaloperidol tab 5 mg 2 PAhaloperidol tab 10 mg 2 PAhaloperidol tab 20 mg 2 PAINVEGA - paliperidone tab er 24hr 1.5 mg 4 PA, QL (30 tablets/30 days)INVEGA - paliperidone tab er 24hr 3 mg 4 PA, QL (30 tablets/30 days)INVEGA - paliperidone tab er 24hr 6 mg 4 PA, QL (60 tablets/30 days)INVEGA - paliperidone tab er 24hr 9 mg 4 PA, QL (30 tablets/30 days)INVEGA SUSTENNA - paliperidone palmitate im extend-release

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

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

4 PA, QL (1 kit/28 days)



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




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








LATUDA - lurasidone hcl tab 20 mg 5 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 40 mg 5 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 60 mg 5 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 80 mg 5 PA, QL (60 tablets/30 days)LATUDA - lurasidone hcl tab 120 mg 5 PA, QL (30 tablets/30 days)loxapine succinate cap 5 mg 2 PAloxapine succinate cap 10 mg 2 PAloxapine succinate cap 25 mg 2 PAloxapine succinate cap 50 mg 2 PANUPLAZID - pimavanserin tartrate tab 17 mg* 5 PA, QL (60 tablets/30 days)olanzapine for im inj 10 mg 2 PA, QL (90 vials/30 days)olanzapine orally disintegrating tab 5 mg 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 10 mg 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 15 mg 2 PA, QL (30 tablets/30 days)

2018


41


olanzapine orally disintegrating tab 20 mg 2 PA, QL (30 tablets/30 days)olanzapine tab 2.5 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 5 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 7.5 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 10 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 15 mg 2 PA, QL (30 tablets/30 days)olanzapine tab 20 mg 2 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 1.5 mg 4 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 3 mg 4 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 6 mg 4 PA, QL (60 tablets/30 days)paliperidone tab er 24hr 9 mg 5 PA, QL (30 tablets/30 days)pimozide tab 1 mg 2pimozide tab 2 mg 2quetiapine fumarate tab er 24hr 50 mg 4 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 150 mg 4 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 200 mg 4 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 300 mg 4 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 400 mg 4 PA, QL (60 tablets/30 days)quetiapine fumarate tab 25 mg 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 50 mg 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 100 mg 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 200 mg 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 300 mg 2 PA, QL (60 tablets/30 days)quetiapine fumarate tab 400 mg 2 PA, QL (60 tablets/30 days)REXULTI - brexpiprazole tab 0.25 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 0.5 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 1 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 2 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 3 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 4 mg 5 PA, QL (30 tablets/30 days)RISPERDAL CONSTA - risperidone microspheres for inj 12.5 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 25 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 37.5 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 50 mg 5 PA, QL (2 vials/28 days)risperidone orally disintegrating tab 0.25 mg 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 0.5 mg 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 1 mg 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 2 mg 2 PA, QL (60 tablets/30 days)

2018



risperidone orally disintegrating tab 3 mg 3 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 4 mg 3 PA, QL (120 tablets/30 days)risperidone soln 1 mg/ml 2 PA, QL (480 mls/30 days)risperidone tab 0.25 mg 1 PA, QL (60 tablets/30 days)risperidone tab 0.5 mg 1 PA, QL (60 tablets/30 days)risperidone tab 1 mg 1 PA, QL (60 tablets/30 days)risperidone tab 2 mg 1 PA, QL (60 tablets/30 days)risperidone tab 3 mg 1 PA, QL (60 tablets/30 days)risperidone tab 4 mg 1 PA, QL (120 tablets/30 days)SAPHRIS - asenapine maleate sl tab 2.5 mg 4 PA, QL (60 tablets/30 days)SAPHRIS - asenapine maleate sl tab 5 mg 4 PA, QL (60 tablets/30 days)SAPHRIS - asenapine maleate sl tab 10 mg 4 PA, QL (60 tablets/30 days)thioridazine hcl tab 10 mg 4 PAthioridazine hcl tab 25 mg 4 PAthioridazine hcl tab 50 mg 4 PAthioridazine hcl tab 100 mg 4 PAthiothixene cap 1 mg 2 PAthiothixene cap 2 mg 2 PAthiothixene cap 5 mg 2 PAthiothixene cap 10 mg 2 PAtrifluoperazine hcl tab 1 mg 2 PAtrifluoperazine hcl tab 2 mg 2 PAtrifluoperazine hcl tab 5 mg 2 PAtrifluoperazine hcl tab 10 mg 2 PAVERSACLOZ - clozapine susp 50 mg/ml 5 PA, QL (540 mls/30 days)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)

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43


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

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

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


cidofovir iv inj 75 mg/ml 5COMPLERA - emtricitabine-rilpivirine-tenofovir df tab


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 PA

2018



DAKLINZA - daclatasvir dihydrochloride tab 60 mg 5 PADAKLINZA - daclatasvir dihydrochloride tab 90 mg 5 PADENAVIR - penciclovir cream 1% 5DESCOVY - emtricitabine-tenofovir alafenamide fumarate tab

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

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

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

HARVONI - ledipasvir-sofosbuvir tab 90-400 mg 5 PAINTELENCE - etravirine tab 25 mg 4 QL (120 tablets/30 days)INTELENCE - etravirine tab 100 mg 4 QL (60 tablets/30 days)INTELENCE - etravirine tab 200 mg 5 QL (60 tablets/30 days)INTRON A - interferon alfa-2b inj 6000000 unit/ml 5INTRON A - interferon alfa-2b inj 10000000 unit/ml 5INTRON A - interferon alfa-2b for inj 10000000 unit 5INTRON A - interferon alfa-2b for inj 18000000 unit 5INTRON A - interferon alfa-2b for inj 50000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 10000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 18000000 unit 5

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INTRON A W/DILUENT - interferon alfa-2b for inj 50000000 unit 5INVIRASE - saquinavir mesylate cap 200 mg 5 QL (300 capsules/30 days)INVIRASE - saquinavir mesylate tab 500 mg 5 QL (120 tablets/30 days)ISENTRESS - raltegravir potassium chew tab 25 mg 3 QL (180 tablets/30 days)ISENTRESS - raltegravir potassium chew tab 100 mg 3 QL (180 tablets/30 days)ISENTRESS - raltegravir potassium packet for susp 100 mg 4 QL (60 packets/30 days)ISENTRESS - raltegravir potassium tab 400 mg 5 QL (60 tablets/30 days)ISENTRESS HD - raltegravir potassium tab 600 mg 5 QL (60 tablets/30 days)JULUCA - dolutegravir sodium-rilpivirine hcl tab 50-25 mg 5 QL (30 tablets/30 days)KALETRA - lopinavir-ritonavir tab 100-25 mg 5 QL (300 tablets/30 days)KALETRA - lopinavir-ritonavir tab 200-50 mg 5 QL (120 tablets/30 days)lamivudine oral soln 10 mg/ml 2 QL (960 mls/30 days)lamivudine tab 100 mg (hbv) 4lamivudine tab 150 mg 2 QL (60 tablets/30 days)lamivudine tab 300 mg 2 QL (30 tablets/30 days)lamivudine-zidovudine tab 150-300 mg 4 QL (60 tablets/30 days)LEXIVA - fosamprenavir calcium susp 50 mg/ml 4 QL (1800 mls/30 days)LEXIVA - fosamprenavir calcium tab 700 mg 5 QL (120 tablets/30 days)lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) 5 QL (480 mls/30 days)MAVYRET - glecaprevir-pibrentasvir tab 100-40 mg 5 PAnevirapine tab er 24hr 100 mg 3 QL (90 tablets/30 days)nevirapine tab er 24hr 400 mg 4 QL (30 tablets/30 days)nevirapine tab 200 mg 2 QL (60 tablets/30 days)NORVIR - ritonavir cap 100 mg 4 QL (360 capsules/30 days)NORVIR - ritonavir oral soln 80 mg/ml 4 QL (480 mls/30 days)NORVIR - ritonavir powder packet 100 mg 4 QL (360 packets/30 days)NORVIR - ritonavir tab 100 mg 4 QL (360 tablets/30 days)ODEFSEY - emtricitabine-rilpivirine-tenofovir af tab 200-25-25 mg 5 QL (30 tablets/30 days)oseltamivir phosphate cap 30 mg 2oseltamivir phosphate cap 45 mg 2oseltamivir phosphate cap 75 mg 2oseltamivir phosphate for susp 6 mg/ml 2PEGASYS - peginterferon alfa-2a inj 180 mcg/ml 5 PAPEGASYS - peginterferon alfa-2a inj 180 mcg/0.5ml 5 PAPEGASYS PROCLICK - peginterferon alfa-2a inj 135 mcg/0.5ml 5 PAPEGASYS PROCLICK - peginterferon alfa-2a inj 180 mcg/0.5ml 5 PAPREZCOBIX - darunavir-cobicistat tab 800-150 mg 5 QL (30 tablets/30 days)PREZISTA - darunavir ethanolate susp 100 mg/ml 5 QL (400 mls/30 days)

2018



PREZISTA - darunavir ethanolate tab 75 mg 4 QL (300 tablets/30 days)PREZISTA - darunavir ethanolate tab 150 mg 4 QL (180 tablets/30 days)PREZISTA - darunavir ethanolate tab 600 mg 5 QL (60 tablets/30 days)PREZISTA - darunavir ethanolate tab 800 mg 5 QL (30 tablets/30 days)REBETOL - ribavirin soln 40 mg/ml 4RELENZA DISKHALER - zanamivir aero powder breath activated

5 mg/blister4

RESCRIPTOR - delavirdine mesylate tab 100 mg 4 QL (360 tablets/30 days)RESCRIPTOR - delavirdine mesylate tab 200 mg 4 QL (180 tablets/30 days)RETROVIR IV INFUSION - zidovudine iv soln 10 mg/ml 4REYATAZ - atazanavir sulfate cap 150 mg 5 QL (30 capsules/30 days)REYATAZ - atazanavir sulfate cap 200 mg 5 QL (60 capsules/30 days)REYATAZ - atazanavir sulfate cap 300 mg 5 QL (30 capsules/30 days)REYATAZ - atazanavir sulfate oral powder packet 50 mg 5 QL (240 packets/30 days)RIBASPHERE - ribavirin tab 400 mg 5RIBASPHERE - ribavirin tab 600 mg 5RIBASPHERE RIBAPAK - ribavirin tab 400 mg 5RIBASPHERE RIBAPAK - ribavirin tab 600 mg 5ribavirin cap 200 mg 2ribavirin tab 200 mg 2rimantadine hydrochloride tab 100 mg 2ritonavir tab 100 mg 3 QL (360 tablets/30 days)SELZENTRY - maraviroc oral soln 20 mg/ml 5 QL (1840 mls/30 days)SELZENTRY - maraviroc tab 25 mg 4 QL (240 tablets/30 days)SELZENTRY - maraviroc tab 75 mg 5 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 150 mg 5 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 300 mg 5 QL (120 tablets/30 days)SOVALDI - sofosbuvir tab 400 mg 5 PAstavudine cap 15 mg 2 QL (60 capsules/30 days)stavudine cap 20 mg 2 QL (60 capsules/30 days)stavudine cap 30 mg 2 QL (60 capsules/30 days)stavudine cap 40 mg 2 QL (60 capsules/30 days)STRIBILD - elvitegrav-cobic-emtricitab-tenofovdf tab

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

SUSTIVA - efavirenz cap 50 mg 4 QL (90 capsules/30 days)SUSTIVA - efavirenz cap 200 mg 5 QL (60 capsules/30 days)SUSTIVA - efavirenz tab 600 mg 5 QL (30 tablets/30 days)SYLATRON - peginterferon alfa-2b for inj kit 200 mcg 5 PA

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47


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


TRUVADA - emtricitabine-tenofovir disoproxil fumarate tab133-200 mg

5 QL (30 tablets/30 days)





TYBOST - cobicistat tab 150 mg 3 QL (30 tablets/30 days)valacyclovir hcl tab 500 mg 2valacyclovir hcl tab 1 gm 2valganciclovir hcl for soln 50 mg/ml 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)VIEKIRA PAK - ombitas-paritapre-riton & dasab tab pak

12.5-75-50 & 250 mg5 PA

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

5 PA

VIRACEPT - nelfinavir mesylate tab 250 mg 5 QL (270 tablets/30 days)VIRACEPT - nelfinavir mesylate tab 625 mg 5 QL (120 tablets/30 days)VIRAMUNE - nevirapine susp 50 mg/5ml 4 QL (1200 mls/30 days)VIREAD - tenofovir disoproxil fumarate oral powder 40 mg/gm 5 QL (240 grams/30 days)VIREAD - tenofovir disoproxil fumarate tab 150 mg 5 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 200 mg 5 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 250 mg 5 QL (30 tablets/30 days)

2018



VIREAD - tenofovir disoproxil fumarate tab 300 mg 5 QL (30 tablets/30 days)VOSEVI - sofosbuvir-velpatasvir-voxilaprevir tab 400-100-100 mg 5 PAZEPATIER - elbasvir-grazoprevir tab 50-100 mg 5 PAZERIT - stavudine for oral soln 1 mg/ml 4 QL (2400 mls/30 days)ZIAGEN - abacavir sulfate soln 20 mg/ml 4 QL (960 mls/30 days)zidovudine cap 100 mg 2 QL (180 capsules/30 days)zidovudine syrup 10 mg/ml 2 QL (1920 mls/30 days)zidovudine tab 300 mg 2 QL (60 tablets/30 days)Medicamentos ansiolíticosalprazolam tab 0.25 mg 3 QL (120 tablets/30 days)alprazolam tab 0.5 mg 3 QL (120 tablets/30 days)alprazolam tab 1 mg 3 QL (120 tablets/30 days)alprazolam tab 2 mg 3 QL (150 tablets/30 days)buspirone hcl tab 5 mg 2buspirone hcl tab 7.5 mg 2buspirone hcl tab 10 mg 2buspirone hcl tab 15 mg 2buspirone hcl tab 30 mg 2clonazepam orally disintegrating tab 0.125 mg 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 0.25 mg 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 0.5 mg 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 1 mg 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 2 mg 2 PA, QL (300 tablets/30 days)clonazepam tab 0.5 mg 1 PA, QL (120 tablets/30 days)clonazepam tab 1 mg 1 PA, QL (120 tablets/30 days)clonazepam tab 2 mg 1 PA, QL (300 tablets/30 days)clorazepate dipotassium tab 3.75 mg 2 PA, QL (120 tablets/30 days)clorazepate dipotassium tab 7.5 mg 2 PA, QL (90 tablets/30 days)clorazepate dipotassium tab 15 mg 2 PA, QL (180 tablets/30 days)DIAZEPAM - diazepam oral soln 1 mg/ml 4 PA, QL (1200 mls/30 days)diazepam conc 5 mg/ml 2 PA, QL (240 mls/30 days)diazepam tab 2 mg 1 PA, QL (120 tablets/30 days)diazepam tab 5 mg 1 PA, QL (120 tablets/30 days)diazepam tab 10 mg 1 PA, QL (120 tablets/30 days)hydroxyzine hcl syrup 10 mg/5ml# 4 PAhydroxyzine hcl tab 10 mg# 4 PAhydroxyzine hcl tab 25 mg# 4 PAhydroxyzine hcl tab 50 mg# 4 PA

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49


lorazepam tab 0.5 mg 1 PA, QL (120 tablets/30 days)lorazepam tab 1 mg 1 PA, QL (120 tablets/30 days)lorazepam tab 2 mg 1 PA, QL (150 tablets/30 days)Agentes bipolaresLITHIUM - lithium oral solution 8 meq/5ml 4lithium carbonate cap 150 mg 3lithium carbonate cap 300 mg 1lithium carbonate cap 600 mg 3lithium carbonate tab er 300 mg 2lithium carbonate tab er 450 mg 2lithium carbonate tab 300 mg 2Reguladores de la glucosa en sangreacarbose tab 25 mg 2 QL (360 tablets/30 days)acarbose tab 50 mg 2 QL (180 tablets/30 days)acarbose tab 100 mg 2 QL (90 tablets/30 days)ALCOHOL SWABS 3BYDUREON - exenatide for inj extended release susp 2 mg 3 QL (4 vials/28 days)BYDUREON BCISE - exenatide extended release susp auto-

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

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

3 QL (4 pens/28 days)

BYETTA - exenatide soln pen-injector 5 mcg/0.02ml 4 QL (2 pens/30 days)BYETTA - exenatide soln pen-injector 10 mcg/0.04ml 4 QL (1 pen/30 days)CYCLOSET - bromocriptine mesylate tab 0.8 mg 4 QL (180 tablets/30 days)GAUZE PADS 2" X 2" 3glimepiride tab 1 mg 1 QL (240 tablets/30 days)glimepiride tab 2 mg 1 QL (120 tablets/30 days)glimepiride tab 4 mg 1 QL (60 tablets/30 days)glipizide tab er 24hr 2.5 mg 2 QL (240 tablets/30 days)glipizide tab er 24hr 5 mg 2 QL (120 tablets/30 days)glipizide tab er 24hr 10 mg 2 QL (60 tablets/30 days)glipizide tab 5 mg 1 QL (240 tablets/30 days)glipizide tab 10 mg 1 QL (120 tablets/30 days)glipizide-metformin hcl tab 2.5-250 mg 2 QL (240 tablets/30 days)glipizide-metformin hcl tab 2.5-500 mg 2 QL (120 tablets/30 days)glipizide-metformin hcl tab 5-500 mg 2 QL (120 tablets/30 days)GLUCAGEN HYPOKIT - glucagon hcl (rdna) for inj 1 mg 3GLUCAGON EMERGENCY KIT - glucagon (rdna) for inj kit 1 mg 3HUMALOG - insulin lispro inj 100 unit/ml 3 QL (60 mls/30 days)

2018



HUMALOG - insulin lispro soln cartridge 100 unit/ml 3 QL (20 cartridges/30 days)HUMALOG JUNIOR KWIKPEN - insulin lispro soln pen-injector

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

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

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

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


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

3 QL (6 vials/30 days)

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


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

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

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

500 unit/ml3 BD

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


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

3 QL (60 mls/30 days)

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


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

2018


51


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

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

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


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


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


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


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

ml3 QL (20 pens/30 days)

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

unit/ml3 QL (20 pens/30 days)

metformin hcl tab er 24hr 500 mg 2 QL (120 tablets/30 days)metformin hcl tab er 24hr 750 mg 2 QL (60 tablets/30 days)metformin hcl tab 500 mg 1 QL (150 tablets/30 days)metformin hcl tab 850 mg 1 QL (90 tablets/30 days)metformin hcl tab 1000 mg 1 QL (75 tablets/30 days)nateglinide tab 60 mg 2 QL (180 tablets/30 days)nateglinide tab 120 mg 2 QL (90 tablets/30 days)ONGLYZA - saxagliptin hcl tab 2.5 mg 3 QL (60 tablets/30 days)ONGLYZA - saxagliptin hcl tab 5 mg 3 QL (30 tablets/30 days)OZEMPIC - semaglutide soln pen-inj 0.25 or 0.5 mg/dose

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

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

2018



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

(1000 mcg/ml)3

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

3

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


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


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


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


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


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


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

unit/ml3 QL (20 pens/30 days)

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


TRULICITY - dulaglutide soln pen-injector 0.75 mg/0.5ml 4 QL (4 pens/28 days)TRULICITY - dulaglutide soln pen-injector 1.5 mg/0.5ml 4 QL (4 pens/28 days)VICTOZA - liraglutide soln pen-injector 18 mg/3ml (6 mg/ml) 3 QL (1 package/30 days)Hemoderivados/Modificadores de la sangre/ Expansores del volumen sanguíneoanagrelide hcl cap 0.5 mg 2

2018


53


anagrelide hcl cap 1 mg 2ARANESP ALBUMIN FREE - darbepoetin alfa soln inj 25 mcg/ml 4 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 40 mcg/ml 4 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 60 mcg/ml 4 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 100 mcg/ml 5 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 200 mcg/ml 5 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 300 mcg/ml 5 PAARANESP ALBUMIN FREE - darbepoetin alfa soln prefilled

syringe 10 mcg/0.4ml4 PA

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

4 PA


4 PA


4 PA


5 PA


5 PA


5 PA


5 PA

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

5 PA

aspirin-dipyridamole cap er 12hr 25-200 mg 2azacitidine 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 4

2018



COUMADIN - warfarin sodium tab 6 mg 4COUMADIN - warfarin sodium tab 7.5 mg 4COUMADIN - warfarin sodium tab 10 mg 4dipyridamole tab 25 mg# 4dipyridamole tab 50 mg# 4dipyridamole tab 75 mg# 4EFFIENT - prasugrel hcl tab 5 mg 3EFFIENT - prasugrel hcl tab 10 mg 3ELIQUIS - apixaban tab 2.5 mg 3 QL (60 tablets/30 days)ELIQUIS - apixaban tab 5 mg 3 QL (120 tablets/30 days)ELIQUIS STARTER PACK - apixaban tab 5 mg 3 QL (120 tablets/30 days)enoxaparin sodium inj 30 mg/0.3ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 40 mg/0.4ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 60 mg/0.6ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 80 mg/0.8ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 100 mg/ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 120 mg/0.8ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 150 mg/ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 300 mg/3ml 4 QL (10 vials/90 days)EPOGEN - epoetin alfa inj 2000 unit/ml 4 PAEPOGEN - epoetin alfa inj 3000 unit/ml 4 PAEPOGEN - epoetin alfa inj 4000 unit/ml 4 PAEPOGEN - epoetin alfa inj 10000 unit/ml 4 PAEPOGEN - epoetin alfa inj 20000 unit/ml 4 PAfondaparinux sodium subcutaneous inj 2.5 mg/0.5ml 4 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 5 mg/0.4ml 5 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml 5 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 10 mg/0.8ml 5 QL (30 syringes/90 days)GRANIX - tbo-filgrastim soln prefilled syringe 300 mcg/0.5ml 5GRANIX - tbo-filgrastim soln prefilled syringe 480 mcg/0.8ml 5heparin sodium (porcine) inj 1000 unit/ml 2heparin sodium (porcine) inj 5000 unit/ml 2heparin sodium (porcine) inj 10000 unit/ml 2heparin sodium (porcine) inj 20000 unit/ml 2heparin sodium (porcine) pf inj 5000 unit/0.5ml 2heparin sodium (porcine) 40 unit/ml in d5w 2LEUKINE - sargramostim lyophilized for inj 250 mcg 5MOZOBIL - plerixafor subcutaneous inj 24 mg/1.2ml (20 mg/ml) 5

2018


55


NEULASTA - pegfilgrastim soln prefilled syringe 6 mg/0.6ml 5NEULASTA ONPRO KIT - pegfilgrastim soln prefilled syringe kit

6 mg/0.6ml5

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

2018



acetazolamide cap er 12hr 500 mg 2acetazolamide tab 125 mg 2acetazolamide tab 250 mg 2amiloride & hydrochlorothiazide tab 5-50 mg 2amiloride hcl tab 5 mg 2amiodarone hcl tab 200 mg 2amiodarone hcl tab 400 mg 2amlodipine besylate tab 2.5 mg 1amlodipine besylate tab 5 mg 1amlodipine besylate tab 10 mg 1amlodipine besylate-atorvastatin calcium tab 2.5-10 mg 2amlodipine besylate-atorvastatin calcium tab 2.5-20 mg 2amlodipine besylate-atorvastatin calcium tab 2.5-40 mg 2amlodipine besylate-atorvastatin calcium tab 5-10 mg 2amlodipine besylate-atorvastatin calcium tab 5-20 mg 2amlodipine besylate-atorvastatin calcium tab 5-40 mg 2amlodipine besylate-atorvastatin calcium tab 5-80 mg 2amlodipine besylate-atorvastatin calcium tab 10-10 mg 2amlodipine besylate-atorvastatin calcium tab 10-20 mg 2amlodipine besylate-atorvastatin calcium tab 10-40 mg 2amlodipine besylate-atorvastatin calcium tab 10-80 mg 2amlodipine besylate-benazepril hcl cap 2.5-10 mg 2amlodipine besylate-benazepril hcl cap 5-10 mg 2amlodipine besylate-benazepril hcl cap 5-20 mg 2amlodipine besylate-benazepril hcl cap 5-40 mg 2amlodipine besylate-benazepril hcl cap 10-20 mg 2amlodipine besylate-benazepril hcl cap 10-40 mg 2amlodipine besylate-olmesartan medoxomil tab 5-20 mg 2 QL (30 tablets/30 days)amlodipine besylate-olmesartan medoxomil tab 5-40 mg 2 QL (30 tablets/30 days)amlodipine besylate-olmesartan medoxomil tab 10-20 mg 2 QL (30 tablets/30 days)amlodipine besylate-olmesartan medoxomil tab 10-40 mg 2 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 5-160 mg 2 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 5-320 mg 2 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 10-160 mg 2 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 10-320 mg 2 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 5-160-12.5 mg 2 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 5-160-25 mg 2 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-160-12.5 mg 2 QL (30 tablets/30 days)

2018


57


amlodipine-valsartan-hydrochlorothiazide tab 10-160-25 mg 2 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-320-25 mg 2 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 1 QL (45 tablets/30 days)atorvastatin calcium tab 20 mg 1 QL (45 tablets/30 days)atorvastatin calcium tab 40 mg 1 QL (45 tablets/30 days)atorvastatin calcium tab 80 mg 1 QL (30 tablets/30 days)AZOR - amlodipine besylate-olmesartan medoxomil tab 5-20 mg 4 QL (30 tablets/30 days)AZOR - amlodipine besylate-olmesartan medoxomil tab 5-40 mg 4 QL (30 tablets/30 days)AZOR - amlodipine besylate-olmesartan medoxomil tab 10-20 mg 4 QL (30 tablets/30 days)AZOR - amlodipine besylate-olmesartan medoxomil tab 10-40 mg 4 QL (30 tablets/30 days)benazepril & hydrochlorothiazide tab 5-6.25 mg 2benazepril & hydrochlorothiazide tab 10-12.5 mg 2benazepril & hydrochlorothiazide tab 20-12.5 mg 2benazepril & hydrochlorothiazide tab 20-25 mg 2benazepril hcl tab 5 mg 1benazepril hcl tab 10 mg 1benazepril hcl tab 20 mg 1benazepril hcl tab 40 mg 1BENICAR - olmesartan medoxomil tab 5 mg 4 QL (60 tablets/30 days)BENICAR - olmesartan medoxomil tab 20 mg 4 QL (30 tablets/30 days)BENICAR - olmesartan medoxomil tab 40 mg 4 QL (30 tablets/30 days)BENICAR HCT - olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg4 QL (30 tablets/30 days)

BENICAR HCT - olmesartan medoxomil-hydrochlorothiazide tab40-12.5 mg


BENICAR HCT - olmesartan medoxomil-hydrochlorothiazide tab40-25 mg


betaxolol 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 2

2018



bumetanide 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 3BYSTOLIC - nebivolol hcl tab 5 mg 3BYSTOLIC - nebivolol hcl tab 10 mg 3BYSTOLIC - nebivolol hcl tab 20 mg 3candesartan cilexetil tab 4 mg 2 QL (60 tablets/30 days)candesartan cilexetil tab 8 mg 2 QL (60 tablets/30 days)candesartan cilexetil tab 16 mg 2 QL (60 tablets/30 days)candesartan cilexetil tab 32 mg 2 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg 2 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 32-12.5 mg 2 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 32-25 mg 2 QL (30 tablets/30 days)captopril tab 12.5 mg 2captopril tab 25 mg 2captopril tab 50 mg 2captopril tab 100 mg 2carvedilol tab 3.125 mg 1carvedilol tab 6.25 mg 1carvedilol tab 12.5 mg 1carvedilol tab 25 mg 1CHLOROTHIAZIDE - chlorothiazide tab 250 mg 4chlorothiazide tab 500 mg 2chlorthalidone tab 25 mg 2chlorthalidone tab 50 mg 2cholestyramine light powder packets 4 gm 2cholestyramine light powder 4 gm/dose 2cholestyramine powder packets 4 gm 2cholestyramine powder 4 gm/dose 2choline fenofibrate cap dr 45 mg 2 QL (60 capsules/30 days)choline fenofibrate cap dr 135 mg 2 QL (30 capsules/30 days)clonidine hcl tab 0.1 mg 1clonidine hcl tab 0.2 mg 1clonidine hcl tab 0.3 mg 1clonidine hcl td patch weekly 0.1 mg/24hr 2clonidine hcl td patch weekly 0.2 mg/24hr 2

2018


59


clonidine hcl td patch weekly 0.3 mg/24hr 2colesevelam hcl tab 625 mg 4colestipol 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# 4 QL (150 mls/30 days)digoxin tab 125 mcg (0.125 mg)# 2 QL (30 tablets/30 days)digoxin tab 250 mcg (0.25 mg)# 4 PA, QL (30 tablets/30 days)diltiazem hcl cap er 12hr 60 mg 3diltiazem hcl cap er 12hr 90 mg 3diltiazem hcl cap er 12hr 120 mg 3diltiazem hcl cap er 24hr 120 mg 3diltiazem hcl cap er 24hr 180 mg 3diltiazem hcl cap er 24hr 240 mg 3diltiazem hcl coated beads cap er 24hr 120 mg 3diltiazem hcl coated beads cap er 24hr 180 mg 3diltiazem hcl coated beads cap er 24hr 240 mg 3diltiazem hcl coated beads cap er 24hr 300 mg 3diltiazem hcl coated beads cap er 24hr 360 mg 2diltiazem hcl coated beads tab er 24hr 180 mg 2diltiazem hcl coated beads tab er 24hr 240 mg 2diltiazem hcl coated beads tab er 24hr 300 mg 2diltiazem hcl coated beads tab er 24hr 360 mg 2diltiazem hcl coated beads tab er 24hr 420 mg 2diltiazem hcl extended release beads cap er 24hr 120 mg 3diltiazem hcl extended release beads cap er 24hr 180 mg 3diltiazem hcl extended release beads cap er 24hr 240 mg 3diltiazem hcl extended release beads cap er 24hr 300 mg 3diltiazem hcl extended release beads cap er 24hr 360 mg 3diltiazem hcl extended release beads cap er 24hr 420 mg 3diltiazem hcl tab 30 mg 2diltiazem hcl tab 60 mg 2diltiazem hcl tab 90 mg 2diltiazem hcl tab 120 mg 2dofetilide cap 125 mcg (0.125 mg) 4

2018



dofetilide cap 250 mcg (0.25 mg) 4dofetilide cap 500 mcg (0.5 mg) 4doxazosin mesylate tab 1 mg 2 QL (60 tablets/30 days)doxazosin mesylate tab 2 mg 2 QL (60 tablets/30 days)doxazosin mesylate tab 4 mg 2 QL (60 tablets/30 days)doxazosin mesylate tab 8 mg 2 QL (60 tablets/30 days)enalapril maleate & hydrochlorothiazide tab 5-12.5 mg 1enalapril maleate & hydrochlorothiazide tab 10-25 mg 1enalapril maleate tab 2.5 mg 2enalapril maleate tab 5 mg 2enalapril maleate tab 10 mg 2enalapril maleate tab 20 mg 2ENTRESTO - sacubitril-valsartan tab 24-26 mg 3 PA, QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 49-51 mg 3 PA, QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 97-103 mg 3 PA, QL (60 tablets/30 days)eplerenone tab 25 mg 2eplerenone tab 50 mg 2ezetimibe tab 10 mg 3 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-10 mg 3 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-20 mg 3 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-40 mg 3 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-80 mg 3 QL (30 tablets/30 days)felodipine tab er 24hr 2.5 mg 2felodipine tab er 24hr 5 mg 2felodipine tab er 24hr 10 mg 2fenofibrate micronized cap 67 mg 2 QL (30 capsules/30 days)fenofibrate micronized cap 134 mg 2 QL (30 capsules/30 days)fenofibrate micronized cap 200 mg 2 QL (30 capsules/30 days)fenofibrate tab 48 mg 2 QL (60 tablets/30 days)fenofibrate tab 54 mg 2 QL (60 tablets/30 days)fenofibrate tab 145 mg 2 QL (30 tablets/30 days)fenofibrate tab 160 mg 2 QL (30 tablets/30 days)flecainide acetate tab 50 mg 2flecainide acetate tab 100 mg 2flecainide acetate tab 150 mg 2fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg 2fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg 2fosinopril sodium tab 10 mg 1

2018


61


fosinopril sodium tab 20 mg 1fosinopril sodium tab 40 mg 1furosemide 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 2 QL (30 tablets/30 days)irbesartan tab 150 mg 2 QL (30 tablets/30 days)irbesartan tab 300 mg 2 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 150-12.5 mg 2 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 300-12.5 mg 2 QL (30 tablets/30 days)isosorbide dinitrate tab 5 mg 2isosorbide dinitrate tab 10 mg 2isosorbide dinitrate tab 20 mg 2isosorbide dinitrate tab 30 mg 2isosorbide mononitrate tab er 24hr 30 mg 2isosorbide mononitrate tab er 24hr 60 mg 2isosorbide mononitrate tab er 24hr 120 mg 2isosorbide mononitrate tab 10 mg 2isosorbide mononitrate tab 20 mg 2isradipine cap 2.5 mg 2isradipine cap 5 mg 2JUXTAPID - lomitapide mesylate cap 5 mg* 5 PAJUXTAPID - lomitapide mesylate cap 10 mg* 5 PAJUXTAPID - lomitapide mesylate cap 20 mg* 5 PAJUXTAPID - lomitapide mesylate cap 30 mg* 5 PA

2018



JUXTAPID - 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 iv inj 10 mg/ml 4lisinopril & hydrochlorothiazide tab 10-12.5 mg 1lisinopril & hydrochlorothiazide tab 20-12.5 mg 1lisinopril & hydrochlorothiazide tab 20-25 mg 1lisinopril tab 2.5 mg 1lisinopril tab 5 mg 1lisinopril tab 10 mg 1lisinopril tab 20 mg 1lisinopril tab 30 mg 1lisinopril tab 40 mg 1losartan potassium & hydrochlorothiazide tab 50-12.5 mg 1 QL (30 tablets/30 days)losartan potassium & hydrochlorothiazide tab 100-12.5 mg 1 QL (30 tablets/30 days)losartan potassium & hydrochlorothiazide tab 100-25 mg 1 QL (30 tablets/30 days)losartan potassium tab 25 mg 1 QL (60 tablets/30 days)losartan potassium tab 50 mg 1 QL (60 tablets/30 days)losartan potassium tab 100 mg 1 QL (30 tablets/30 days)lovastatin tab 10 mg 1 QL (60 tablets/30 days)lovastatin tab 20 mg 1 QL (60 tablets/30 days)lovastatin tab 40 mg 1 QL (60 tablets/30 days)methazolamide tab 25 mg 3methazolamide tab 50 mg 4metolazone tab 2.5 mg 2metolazone tab 5 mg 2metolazone tab 10 mg 2metoprolol & hydrochlorothiazide tab 50-25 mg 2metoprolol & hydrochlorothiazide tab 100-25 mg 2metoprolol succinate tab er 24hr 25 mg 2metoprolol succinate tab er 24hr 50 mg 2metoprolol succinate tab er 24hr 100 mg 2metoprolol succinate tab er 24hr 200 mg 2metoprolol tartrate tab 25 mg 1

2018


63


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

2018



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

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

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

5 PA, QL (2 pens/28 days)

pravastatin sodium tab 10 mg 2 QL (45 tablets/30 days)pravastatin sodium tab 20 mg 2 QL (45 tablets/30 days)pravastatin sodium tab 40 mg 2 QL (45 tablets/30 days)pravastatin sodium tab 80 mg 2 QL (30 tablets/30 days)prazosin hcl cap 1 mg 2prazosin hcl cap 2 mg 2

2018


65


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

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

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

5 PA, QL (1 system/30 days)

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

5 PA, QL (2 pens/28 days)

2018



rosuvastatin calcium tab 5 mg 2 QL (45 tablets/30 days)rosuvastatin calcium tab 10 mg 2 QL (45 tablets/30 days)rosuvastatin calcium tab 20 mg 2 QL (45 tablets/30 days)rosuvastatin calcium tab 40 mg 2 QL (30 tablets/30 days)simvastatin tab 5 mg 1 QL (45 tablets/30 days)simvastatin tab 10 mg 1 QL (45 tablets/30 days)simvastatin tab 20 mg 1 QL (60 tablets/30 days)simvastatin tab 40 mg 1 QL (45 tablets/30 days)simvastatin tab 80 mg 1 QL (30 tablets/30 days)sotalol hcl (afib/afl) tab 80 mg 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 2 QL (30 tablets/30 days)telmisartan tab 40 mg 2 QL (30 tablets/30 days)telmisartan tab 80 mg 2 QL (30 tablets/30 days)telmisartan-hydrochlorothiazide tab 40-12.5 mg 2 QL (30 tablets/30 days)telmisartan-hydrochlorothiazide tab 80-12.5 mg 2 QL (60 tablets/30 days)telmisartan-hydrochlorothiazide tab 80-25 mg 2 QL (30 tablets/30 days)terazosin hcl cap 1 mg 1 QL (90 capsules/30 days)terazosin hcl cap 2 mg 1 QL (60 capsules/30 days)terazosin hcl cap 5 mg 1 QL (60 capsules/30 days)terazosin hcl cap 10 mg 1 QL (60 capsules/30 days)TIMOLOL MALEATE - timolol maleate tab 5 mg 4TIMOLOL MALEATE - timolol maleate tab 10 mg 4

2018


67


TIMOLOL MALEATE - timolol maleate tab 20 mg 4torsemide tab 5 mg 1torsemide tab 10 mg 1torsemide tab 20 mg 1torsemide tab 100 mg 1trandolapril tab 1 mg 2trandolapril tab 2 mg 2trandolapril tab 4 mg 2triamterene & hydrochlorothiazide cap 37.5-25 mg 1triamterene & hydrochlorothiazide tab 37.5-25 mg 1triamterene & hydrochlorothiazide tab 75-50 mg 1TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab

20-5-12.5 mg4 QL (30 tablets/30 days)

TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab40-5-12.5 mg


TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab40-5-25 mg


TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab40-10-12.5 mg


TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab40-10-25 mg


valsartan tab 40 mg 2 QL (60 tablets/30 days)valsartan tab 80 mg 2 QL (60 tablets/30 days)valsartan tab 160 mg 2 QL (60 tablets/30 days)valsartan tab 320 mg 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 80-12.5 mg 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 160-12.5 mg 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 160-25 mg 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 320-12.5 mg 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 320-25 mg 2 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 2

2018



verapamil hcl tab er 120 mg 2verapamil hcl tab er 180 mg 2verapamil hcl tab er 240 mg 2verapamil hcl tab 40 mg 1verapamil hcl tab 80 mg 1verapamil hcl tab 120 mg 1WELCHOL - colesevelam hcl packet for susp 3.75 gm 4WELCHOL - colesevelam hcl tab 625 mg 4Agentes del sistema nervioso centralamphetamine-dextroamphetamine cap er 24hr 5 mg 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 10 mg 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 15 mg 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 20 mg 3 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 25 mg 3 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 30 mg 3 QL (30 capsules/30 days)amphetamine-dextroamphetamine tab 5 mg 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 7.5 mg 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 10 mg 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 12.5 mg 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 15 mg 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 20 mg 2 QL (90 tablets/30 days)amphetamine-dextroamphetamine tab 30 mg 2 QL (60 tablets/30 days)AMPYRA - dalfampridine tab er 12hr 10 mg* 5 PAatomoxetine hcl cap 10 mg 4 QL (60 capsules/30 days)atomoxetine hcl cap 18 mg 4 QL (60 capsules/30 days)atomoxetine hcl cap 25 mg 4 QL (60 capsules/30 days)atomoxetine hcl cap 40 mg 4 QL (60 capsules/30 days)atomoxetine hcl cap 60 mg 4 QL (30 capsules/30 days)atomoxetine hcl cap 80 mg 4 QL (30 capsules/30 days)atomoxetine hcl cap 100 mg 4 QL (30 capsules/30 days)AVONEX - interferon beta-1a for im inj kit 30mcg (33mcg(6.6 mu)/

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

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

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

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

clonidine hcl tab er 12hr 0.1 mg 3 QL (120 tablets/30 days)COPAXONE - glatiramer acetate soln prefilled syringe 20 mg/ml 5 PA, QL (30 syringes/30 days)

2018


69


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

20-10 mg3

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

5 PA, QL (2 syringes/28 days)

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


REBIF - interferon beta-1a soln pref syr 22 mcg/0.5ml (12mu/ml) 5 PA, QL (12 syringes/28 days)REBIF - interferon beta-1a soln pref syr 44 mcg/0.5ml (24mu/ml) 5 PA, QL (12 syringes/28 days)REBIF REBIDOSE - interferon beta-1a soln auto-inj 22 mcg/0.5ml

(12mu/ml)5 PA, QL (12 syringes/28 days)

REBIF REBIDOSE - interferon beta-1a soln auto-inj 44 mcg/0.5ml(24mu/ml)


REBIF REBIDOSE TITRATION - interferon beta-1a auto-inj6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml


REBIF TITRATION PACK - interferon beta-1a pref syr6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml


riluzole tab 50 mg 4TECFIDERA - dimethyl fumarate capsule delayed release 120 mg 5 PA, QL (60 capsules/30 days)TECFIDERA - dimethyl fumarate capsule delayed release 240 mg 5 PA, QL (60 capsules/30 days)TECFIDERA STARTER PACK - dimethyl fumarate capsule dr

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

tetrabenazine tab 12.5 mg* 5 PA, QL (240 tablets/30 days)

2018



tetrabenazine tab 25 mg* 5 PA, QL (120 tablets/30 days)TYSABRI - natalizumab for iv inj conc 300 mg/15ml* 5 PAAgentes dentales y oraleschlorhexidine gluconate soln 0.12% 1KEPIVANCE - palifermin for iv inj 6.25 mg 5pilocarpine hcl tab 5 mg 2pilocarpine hcl tab 7.5 mg 2triamcinolone acetonide dental paste 0.1% 2Agentes dermatológicosacitretin cap 10 mg 4acitretin cap 17.5 mg 4acitretin cap 25 mg 4alclometasone dipropionate cream 0.05% 2alclometasone dipropionate oint 0.05% 2AZELEX - azelaic acid cream 20% 4benzoyl peroxide-erythromycin gel 5-3% 2betamethasone dipropionate augmented cream 0.05% 2betamethasone dipropionate augmented gel 0.05% 2betamethasone dipropionate augmented lotion 0.05% 2betamethasone dipropionate augmented oint 0.05% 2betamethasone dipropionate cream 0.05% 2betamethasone dipropionate lotion 0.05% 2betamethasone dipropionate oint 0.05% 2betamethasone valerate cream 0.1% 2betamethasone valerate lotion 0.1% 2betamethasone valerate oint 0.1% 2calcipotriene cream 0.005% 4calcipotriene oint 0.005% 4calcipotriene soln 0.005% (50 mcg/ml) 3CARAC - fluorouracil cream 0.5% 5clindamycin phosphate-benzoyl peroxide gel 1-5% 2clobetasol propionate cream 0.05% 2clobetasol propionate emollient base cream 0.05% 2clobetasol propionate gel 0.05% 3clobetasol propionate oint 0.05% 3clobetasol propionate soln 0.05% 2clotrimazole w/ betamethasone cream 1-0.05% 2clotrimazole w/ betamethasone lotion 1-0.05% 2

2018


71


desonide cream 0.05% 2desonide lotion 0.05% 2desonide oint 0.05% 2desoximetasone cream 0.05% 4desoximetasone cream 0.25% 2desoximetasone gel 0.05% 2desoximetasone oint 0.25% 2diclofenac sodium gel 3% 5DIFLORASONE DIACETATE - diflorasone diacetate oint 0.05% 4ELIDEL - pimecrolimus cream 1% 4 PAFINACEA - azelaic acid foam 15% 4FINACEA - azelaic acid gel 15% 4fluocinolone acetonide cream 0.01% 2fluocinonide cream 0.05% 2fluocinonide emulsified base cream 0.05% 2fluocinonide gel 0.05% 2fluocinonide oint 0.05% 2fluocinonide soln 0.05% 2fluorouracil cream 5% 3fluorouracil soln 2% 2fluorouracil soln 5% 2fluticasone propionate cream 0.05% 2fluticasone propionate oint 0.005% 2gentamicin sulfate cream 0.1% 2gentamicin sulfate oint 0.1% 2halobetasol propionate cream 0.05% 2halobetasol propionate oint 0.05% 2hydrocortisone butyrate cream 0.1% 2hydrocortisone butyrate hydrophilic lipo base cream 0.1% 2hydrocortisone butyrate oint 0.1% 2hydrocortisone butyrate soln 0.1% 2hydrocortisone cream 1% 1hydrocortisone cream 2.5% 1hydrocortisone lotion 2.5% 1hydrocortisone oint 1% 1hydrocortisone oint 2.5% 1hydrocortisone valerate cream 0.2% 2hydrocortisone valerate oint 0.2% 2

2018



imiquimod cream 5% 2 PAisotretinoin cap 10 mg 3isotretinoin cap 20 mg 4isotretinoin cap 30 mg 4isotretinoin cap 40 mg 4lactic acid (ammonium lactate) cream 12% 2lactic acid (ammonium lactate) lotion 12% 1methoxsalen rapid cap 10 mg 5metronidazole cream 0.75% 2metronidazole gel 0.75% 2metronidazole gel 1% 2metronidazole lotion 0.75% 2mometasone furoate cream 0.1% 2mometasone furoate oint 0.1% 2mometasone furoate solution 0.1% (lotion) 2mupirocin oint 2% 2nystatin-triamcinolone cream 100000-0.1 unit/gm-% 2nystatin-triamcinolone oint 100000-0.1 unit/gm-% 2ORACEA - doxycycline cap delayed release 40 mg 4PICATO - ingenol mebutate gel 0.015% 3 QL (3 tubes/30 days)PICATO - ingenol mebutate gel 0.05% 3 QL (2 tubes/30 days)podofilox soln 0.5% 2prednicarbate cream 0.1% 2prednicarbate oint 0.1% 2REGRANEX - becaplermin gel 0.01% 5 PA, QL (15 grams/30 days)SANTYL - collagenase oint 250 unit/gm 3selenium sulfide lotion 2.5% 1silver sulfadiazine cream 1% 2SOOLANTRA - ivermectin cream 1% 3tacrolimus oint 0.03% 2 PAtacrolimus oint 0.1% 2 PAtazarotene cream 0.1% 4TAZORAC - tazarotene cream 0.05% 4TAZORAC - tazarotene gel 0.05% 4TAZORAC - tazarotene gel 0.1% 4tretinoin cream 0.025% 2tretinoin cream 0.05% 2tretinoin cream 0.1% 2

2018


73


tretinoin gel 0.01% 2tretinoin gel 0.025% 2triamcinolone acetonide cream 0.025% 2triamcinolone acetonide cream 0.1% 2triamcinolone acetonide cream 0.5% 2triamcinolone acetonide lotion 0.025% 2triamcinolone acetonide lotion 0.1% 2triamcinolone acetonide oint 0.025% 2triamcinolone acetonide oint 0.1% 2triamcinolone acetonide oint 0.5% 2Electrolitos/Minerales/Metales/Vitaminasamino acid infusion 6% 2 BDamino acid infusion 15% 2 BDcalcium acetate cap 667 mg 2calcium acetate tab 667 mg 2CARBAGLU - carglumic acid tab 200 mg 5CHEMET - succimer cap 100 mg 4dextrose inj 5% 1dextrose inj 10% 1dextrose 5% in lactated ringers 2dextrose 2.5% w/ sodium chloride 0.45% 2dextrose 5% w/ sodium chloride 0.2% 2dextrose 5% w/ sodium chloride 0.33% 2dextrose 5% w/ sodium chloride 0.45% 2dextrose 5% w/ sodium chloride 0.9% 2EXJADE - deferasirox tab for oral susp 125 mg* 5EXJADE - deferasirox tab for oral susp 250 mg* 5EXJADE - deferasirox tab for oral susp 500 mg* 5fat emulsion iv soln 20% 3 BDfomepizole inj 1 gm/ml (for iv infusion) 5FOSRENOL - lanthanum carbonate chew tab 500 mg 5FOSRENOL - lanthanum carbonate chew tab 750 mg 5FOSRENOL - lanthanum carbonate chew tab 1000 mg 5FOSRENOL - lanthanum carbonate oral powder pack 750 mg 5FOSRENOL - lanthanum carbonate oral powder pack 1000 mg 5HEPATAMINE - amino acid infusion 8% 3 BDJADENU - deferasirox tab 90 mg 5JADENU - deferasirox tab 180 mg 5

2018



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

4

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

4

potassium citrate tab er 5 meq (540 mg) 2potassium citrate tab er 10 meq (1080 mg) 2potassium citrate tab er 15 meq (1620 mg) 2RENVELA - sevelamer carbonate tab 800 mg 5

2018


75


SAMSCA - tolvaptan tab 15 mg 5 PASAMSCA - tolvaptan tab 30 mg 5 PAsevelamer carbonate packet 0.8 gm 5sevelamer carbonate packet 2.4 gm 5sevelamer carbonate tab 800 mg 5sodium chloride inj 0.45% 2sodium chloride irrigation soln 0.9% 2sodium chloride iv soln 0.9% 2sodium polystyrene sulfonate oral susp 15 gm/60ml 2sodium polystyrene sulfonate powder 2sodium polystyrene sulfonate rectal susp 30 gm/120ml 2SYPRINE - trientine hcl cap 250 mg 5 PA, QL (240 capsules/30 days)trientine hcl cap 250 mg 5 PA, QL (240 capsules/30 days)water for irrigation, sterile irrigation soln 2Agentes gastrointestinalesalosetron hcl tab 0.5 mg 4alosetron hcl tab 1 mg 5AMITIZA - lubiprostone cap 8 mcg 3 PAAMITIZA - lubiprostone cap 24 mcg 3 PACHENODAL - chenodiol tab 250 mg* 5cimetidine hcl soln 300 mg/5ml 2cimetidine tab 200 mg 2cimetidine tab 300 mg 2cimetidine tab 400 mg 2cimetidine tab 800 mg 2cromolyn sodium oral conc 100 mg/5ml 2dicyclomine hcl cap 10 mg# 3 PAdicyclomine hcl tab 20 mg# 4 PAesomeprazole magnesium cap delayed release 20 mg 2 QL (30 capsules/30 days)esomeprazole magnesium cap delayed release 40 mg 2 QL (30 capsules/30 days)ESOMEPRAZOLE SODIUM - esomeprazole sodium for

intravenous soln 20 mg4

esomeprazole sodium for intravenous soln 40 mg 3famotidine for susp 40 mg/5ml 2famotidine inj 20 mg/2ml 1famotidine inj 40 mg/4ml 1famotidine inj 200 mg/20ml 1famotidine tab 20 mg 1

2018



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

100 gm4

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

packet 5 mg4 QL (30 packets/30 days)

NEXIUM - esomeprazole magnesium for delayed release susppacket 10 mg

4 QL (30 packets/30 days)





NEXIUM - esomeprazole magnesium for delayed release susppacket 2.5 mg


nizatidine cap 150 mg 2nizatidine cap 300 mg 2omeprazole cap delayed release 10 mg 1 QL (30 capsules/30 days)omeprazole cap delayed release 20 mg 1 QL (60 capsules/30 days)omeprazole cap delayed release 40 mg 1 QL (60 capsules/30 days)pantoprazole sodium ec tab 20 mg 1 QL (30 tablets/30 days)

2018


77


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

140-125-125 mg3

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

ml)5 PA

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

17.5-3.13-1.6 gm/180ml4

ursodiol cap 300 mg 4ursodiol tab 250 mg 2ursodiol tab 500 mg 2XIFAXAN - rifaximin tab 550 mg 5Trastorno genético o enzimático: Sustitución, Modificadores, TratamientoADAGEN - pegademase bovine inj 250 unit/ml* 5ALDURAZYME - laronidase soln for iv infusion 2.9 mg/5ml (500

unit/5ml)*5

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

unit3

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

3

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

3

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

3

2018



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

3

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

1000 mg*5 PA

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

5 PA

sodium phenylbutyrate oral powder 3 gm/teaspoonful 5sodium phenylbutyrate tab 500 mg 5STRENSIQ - asfotase alfa subcutaneous inj 18 mg/0.45ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 28 mg/0.7ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 40 mg/ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 80 mg/0.8ml* 5 PAVIOKACE - pancrelipase (lip-prot-amyl) tab 10440-39150-39150

unit4

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

4

VPRIV - velaglucerase alfa for inj 400 unit 5ZAVESCA - miglustat cap 100 mg* 5 PA, QL (90 capsules/30 days)

2018


79


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 2DEPEN TITRATABS - penicillamine tab 250 mg 5dutasteride cap 0.5 mg 2 QL (30 capsules/30 days)dutasteride-tamsulosin hcl cap 0.5-0.4 mg 2 QL (30 capsules/30 days)finasteride tab 5 mg 1 QL (30 tablets/30 days)methylergonovine maleate tab 0.2 mg 5oxybutynin chloride syrup 5 mg/5ml 2 QL (600 mls/30 days)oxybutynin chloride tab er 24hr 5 mg 2 QL (30 tablets/30 days)oxybutynin chloride tab er 24hr 10 mg 2 QL (60 tablets/30 days)oxybutynin chloride tab er 24hr 15 mg 2 QL (60 tablets/30 days)oxybutynin chloride tab 5 mg 2 QL (120 tablets/30 days)RAPAFLO - silodosin cap 4 mg 3 QL (30 capsules/30 days)RAPAFLO - silodosin cap 8 mg 3 QL (30 capsules/30 days)tamsulosin hcl cap 0.4 mg 2 QL (60 capsules/30 days)tolterodine tartrate cap er 24hr 2 mg 2 QL (30 capsules/30 days)tolterodine tartrate cap er 24hr 4 mg 2 QL (30 capsules/30 days)tolterodine tartrate tab 1 mg 2 QL (60 tablets/30 days)tolterodine tartrate tab 2 mg 2 QL (60 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 4 mg 3 QL (30 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 8 mg 3 QL (30 tablets/30 days)trospium chloride cap er 24hr 60 mg 2 QL (30 capsules/30 days)

2018



trospium chloride tab 20 mg 2 QL (60 tablets/30 days)Agentes hormonales, estimulantes/sustitutos/modificadores (suprarrenal)CORTISONE ACETATE - cortisone acetate tab 25 mg 4DEXAMETHASONE - dexamethasone tab 1 mg 4DEXAMETHASONE - dexamethasone tab 2 mg 4dexamethasone elixir 0.5 mg/5ml 2dexamethasone sodium phosphate inj 4 mg/ml 2dexamethasone sodium phosphate inj 20 mg/5ml 2dexamethasone sodium phosphate inj 120 mg/30ml 2dexamethasone tab 0.5 mg 1dexamethasone tab 0.75 mg 1dexamethasone tab 1.5 mg 1dexamethasone tab 4 mg 1dexamethasone tab 6 mg 1fludrocortisone acetate tab 0.1 mg 2H.P. ACTHAR - corticotropin inj gel 80 unit/ml* 5 PAhydrocortisone tab 5 mg 2hydrocortisone tab 10 mg 2hydrocortisone tab 20 mg 2methylprednisolone sod succ for inj 40 mg 2methylprednisolone sod succ for inj 125 mg 2methylprednisolone sod succ for inj 1000 mg 2methylprednisolone tab therapy pack 4 mg (21) 2methylprednisolone tab 4 mg 2methylprednisolone tab 8 mg 2methylprednisolone tab 16 mg 2methylprednisolone tab 32 mg 2prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) 2prednisolone sod phosphate oral soln 15 mg/5ml 2prednisolone syrup 15 mg/5ml 2PREDNISONE - prednisone oral soln 5 mg/5ml 3PREDNISONE - prednisone tab therapy pack 5 mg (21) 2PREDNISONE - prednisone tab therapy pack 5 mg (48) 2PREDNISONE - prednisone tab therapy pack 10 mg (21) 2PREDNISONE - prednisone tab therapy pack 10 mg (48) 2PREDNISONE - prednisone tab 50 mg 4prednisone tab 1 mg 1prednisone tab 2.5 mg 1

2018


81


prednisone tab 5 mg 2prednisone tab 10 mg 2prednisone tab 20 mg 1Agentes hormonales, estimulantes/sustitutos/modificadores (pituitarios)chorionic gonadotropin for im inj 10000

unit(chorionic gonadotropin, pregnyl)3 PA

desmopressin acetate inj 4 mcg/ml 3desmopressin acetate nasal soln 0.01% (refrigerated) 4desmopressin acetate nasal spray soln 0.01% 2desmopressin acetate nasal spray soln 0.01% (refrigerated) 3desmopressin acetate tab 0.1 mg 2desmopressin acetate tab 0.2 mg 2EGRIFTA - tesamorelin acetate for inj 1 mg* 5 PAEGRIFTA - tesamorelin acetate for inj 2 mg* 5 PAINCRELEX - mecasermin inj 40 mg/4ml (10 mg/ml)* 5OMNITROPE - somatropin for inj 5.8 mg 3 PAOMNITROPE - somatropin inj 5 mg/1.5ml 5 PAOMNITROPE - somatropin inj 10 mg/1.5ml 5 PASTIMATE - desmopressin acetate nasal soln 1.5 mg/ml 5Agentes hormonales, estimulantes/sustitutos/modificadores (hormonas/modificadores sexuales)ANADROL-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 25 mg/2.5gm (1%) 4 PA, QL (90 packets/30 days)ANDROGEL - testosterone td gel 50 mg/5gm (1%) 4 PA, QL (60 packets/30 days)ANDROGEL - testosterone td gel 20.25 mg/1.25gm (1.62%) 3 PA, QL (30 packets/30 days)ANDROGEL - testosterone td gel 40.5 mg/2.5gm (1.62%) 3 PA, QL (60 packets/30 days)ANDROGEL PUMP - testosterone td gel 20.25 mg/act (1.62%) 3 PA, QL (2 pump

bottles/30 days)danazol cap 50 mg 2 PAdanazol cap 100 mg 3 PAdanazol cap 200 mg 4 PADEPO-PROVERA - medroxyprogesterone acetate im susp

400 mg/ml4

desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) 2desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg 2desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg 2DIVIGEL - estradiol td gel 0.25 mg/0.25gm (0.1%)# 4 PADIVIGEL - estradiol td gel 0.5 mg/0.5gm (0.1%)# 4 PA

2018



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

caproate im in oil 1.25 gm/5ml5

levonorg-eth est tab 0.1-0.02mg(84) & eth est tab 0.01mg(7) 2levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7) 2levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg 2levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg 2levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg 2levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg 2levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg 2medroxyprogesterone acetate im susp prefilled syr 150 mg/ml 2medroxyprogesterone acetate im susp 150 mg/ml 2medroxyprogesterone acetate tab 2.5 mg 1medroxyprogesterone acetate tab 5 mg 1

2018


83


medroxyprogesterone acetate tab 10 mg 1megestrol acetate susp 40 mg/ml# 4 PAmegestrol acetate tab 20 mg# 4 PAmegestrol acetate tab 40 mg# 4 PAMENEST - esterified estrogens tab 0.3 mg# 4 PAMENEST - esterified estrogens tab 0.625 mg# 4 PAMENEST - esterified estrogens tab 1.25 mg# 4 PAmethyltestosterone cap 10 mg 4 PAnorethindrone & ethinyl estradiol tab 0.4 mg-35 mcg 2norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg 2norethindrone & ethinyl estradiol tab 1 mg-35 mcg 2norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg 2norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25 mcg 2norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35 mg-mcg 2norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg 2norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg 2norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg 2norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg 2norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24) 2norethindrone acetate tab 5 mg 2norethindrone tab 0.35 mg 2norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg 2norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg 2norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg 2norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25 mg-mcg 2norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg 2norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg 2oxandrolone tab 2.5 mg 3 PAoxandrolone tab 10 mg 5 PAPREMARIN - estrogens, conjugated vaginal cream 0.625 mg/gm 3PREMARIN - estrogens, conjugated tab 0.3 mg# 4 PAPREMARIN - estrogens, conjugated tab 0.45 mg# 4 PAPREMARIN - estrogens, conjugated tab 0.625 mg# 4 PAPREMARIN - estrogens, conjugated tab 0.9 mg# 4 PAPREMARIN - estrogens, conjugated tab 1.25 mg# 4 PAPREMPHASE - conj est 0.625(14)/conj est-medroxypro ac tab

0.625-5mg(14)#4 PA

2018



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

4 PA


4 PA


4 PA

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

4 PA

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

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

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

2018


85


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

22.5mg4

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

4

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

4

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

3.75 mg5

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

5

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

5

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

5

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

5

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

5

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

5

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

2018



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

5

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

60 mg/0.2ml5 PA

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

5 PA

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

5 PA

SOMAVERT - pegvisomant for inj 10 mg* 5 PASOMAVERT - pegvisomant for inj 15 mg* 5 PASOMAVERT - pegvisomant for inj 20 mg* 5 PASOMAVERT - pegvisomant for inj 25 mg* 5 PASOMAVERT - pegvisomant for inj 30 mg* 5 PASYNAREL - nafarelin acetate nasal soln 2 mg/ml (200 mcg/act) 5TRELSTAR - triptorelin pamoate for im susp 3.75 mg 5TRELSTAR - triptorelin pamoate for im susp 11.25 mg 5TRELSTAR MIXJECT - triptorelin pamoate for im susp 3.75 mg 5TRELSTAR MIXJECT - triptorelin pamoate for im susp 11.25 mg 5TRELSTAR MIXJECT - triptorelin pamoate for im susp 22.5 mg 5Agentes hormonales, supresores (tiroides)methimazole tab 5 mg 1methimazole tab 10 mg 1propylthiouracil tab 50 mg 2Agentes inmunológicosACTHIB - haemophilus b polysaccharide conjugate vaccine for inj 4ACTIMMUNE - interferon gamma-1b inj 100 mcg/0.5ml (2000000

unit/0.5ml)*5

ADACEL - tet tox-diph-acell pertuss ad inj 5-2-15.5 lf-lf-mcg/0.5ml 4

2018


87


ARCALYST - rilonacept for inj 220 mg* 5 PAATGAM - lymphocyte immune globulin anti-thymocyte g inj 50 mg/

ml(eq)5 BD

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

200 mg/ml5 PA

BENLYSTA - belimumab subcutaneous solution prefilled syringe200 mg/ml

5 PA

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

4

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

4

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

150 mg/ml5 PA

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

5 PA

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

lf/0.5ml4

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

4

DUPIXENT - dupilumab subcutaneous soln prefilled syringe300 mg/2ml

5 PA

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

2018



ENBREL MINI - etanercept subcutaneous solution cartridge50 mg/ml

5 PA

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

5 PA

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

4 BD

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

subcutaneous soln 1 gm/10ml5 BD, PA

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

5 BD, PA

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

5 BD, PA


5 BD, PA


5 BD, PA


5 BD, PA

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

1 gm/10ml5 BD, PA

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

5 BD, PA

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

5 BD, PA


5 BD, PA


5 BD, PA


5 BD, PA

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

4

2018


89


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

4

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


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


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

10 mcg4

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

adalimumab prefilled syringe kit 40 mg/0.8ml5 PA

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

5 PA

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

5 PA

HUMIRA PEN - adalimumab pen-injector kit 40 mg/0.8ml 5 PAHUMIRA PEN - adalimumab pen-injector kit 40 mg/0.4ml 5 PAHUMIRA PEN-CROHNS DISEASE STARTER - adalimumab pen-

injector kit 40 mg/0.8ml5 PA

HUMIRA PEN-PSORIASIS STARTER - adalimumab pen-injectorkit 40 mg/0.8ml

5 PA

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

lf/0.5ml4

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

100 mg/0.67ml5 PA

KINRIX - diph-tetanus tox ad-acell pert & polio virus, ipv vac inj 4leflunomide tab 10 mg 2leflunomide tab 20 mg 2M-M-R II - measles, mumps & rubella virus vaccines for inj 4

2018



MENACTRA - meningococcal (a, c, y, and w-135) conjugatevaccine inj

4

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

4

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

2

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

50 mg/0.4ml5 PA

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

5 PA

ORENCIA - abatacept subcutaneous soln prefilled syringe125 mg/ml

5 PA

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

5 PA

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

5 PA

OTEZLA - apremilast tab 30 mg 5 PAPEDIARIX - diph-tetanus tox-acell pert-hepatitis b-polio ipv vac inj 4PEDVAX HIB - haemophilus b polysaccharide conj vac im susp

7.5 mcg/0.5 ml4

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

4

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

inj4

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

4

2018


91


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

5 mcg/0.5ml4 BD

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

4 BD

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

4 BD

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

50 mcg4 QL (2 vaccines/lifetime)

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

infusion)5 PA

STELARA - ustekinumab soln prefilled syringe 45 mg/0.5ml 5 PASTELARA - ustekinumab soln prefilled syringe 90 mg/ml 5 PASYLVANT - siltuximab for iv infusion 100 mg 5SYLVANT - siltuximab for iv infusion 400 mg 5SYNAGIS - palivizumab im soln 50 mg/0.5ml* 5SYNAGIS - palivizumab im soln 100 mg/ml* 5tacrolimus cap 0.5 mg 2 BDtacrolimus cap 1 mg 2 BDtacrolimus cap 5 mg 4 BDTENIVAC - tetanus-diphtheria toxoids (td) inj 5-2 lfu 3TETANUS/DIPHTHERIA TOXOIDS ADSORBED - tetanus-

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

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

5 BD

2018



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

4

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

4

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

4

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

pfu/0.5ml4

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

unit/0.65ml4 QL (1 vaccine/lifetime)

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

2018


93


alendronate sodium tab 10 mg 1 QL (120 tablets/30 days)alendronate sodium tab 35 mg 1 QL (4 tablets/28 days)alendronate sodium tab 70 mg 1 QL (4 tablets/28 days)calcitonin (salmon) nasal soln 200 unit/act 2calcitriol cap 0.25 mcg 2calcitriol cap 0.5 mcg 2calcitriol inj 1 mcg/ml 2calcitriol oral soln 1 mcg/ml 3ETIDRONATE DISODIUM - etidronate disodium tab 200 mg 4ETIDRONATE DISODIUM - etidronate disodium tab 400 mg 4FORTEO - teriparatide (recombinant) inj 600 mcg/2.4ml 5 PAibandronate sodium iv soln 3 mg/3ml 2ibandronate sodium tab 150 mg 2 QL (1 tablet/28 days)MIACALCIN - calcitonin (salmon) inj 200 unit/ml 4NATPARA - parathyroid hormone (recombinant) for inj cartridge

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

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

5 PA, QL (2 cartridges/28 days)





paricalcitol cap 1 mcg 2paricalcitol cap 2 mcg 4paricalcitol cap 4 mcg 4paricalcitol iv soln 2 mcg/ml 2paricalcitol iv soln 5 mcg/ml 2PROLIA - denosumab inj 60 mg/ml 4 PArisedronate sodium tab delayed release 35 mg 2 QL (4 tablets/28 days)risedronate sodium tab 5 mg 2 QL (30 tablets/30 days)risedronate sodium tab 30 mg 2 QL (30 tablets/30 days)risedronate sodium tab 35 mg 2 QL (4 tablets/28 days)risedronate sodium tab 150 mg 2 QL (1 tablet/28 days)SENSIPAR - cinacalcet hcl tab 30 mg 5 PASENSIPAR - cinacalcet hcl tab 60 mg 5 PASENSIPAR - cinacalcet hcl tab 90 mg 5 PAXGEVA - denosumab inj 120 mg/1.7ml 5zoledronic acid inj conc for iv infusion 4 mg/5ml 3zoledronic acid iv soln 5 mg/100ml 3

2018



ZOMETA - zoledronic acid iv soln 4 mg/100ml 5Agentes oftálmicosALPHAGAN P - brimonidine tartrate ophth soln 0.1% 4azelastine hcl ophth soln 0.05% 2AZOPT - brinzolamide ophth susp 1% 4BACITRACIN - bacitracin ophth oint 500 unit/gm 3bacitracin-polymyxin b ophth oint 2bacitracin-polymyxin-neomycin-hc ophth oint 1% 2BESIVANCE - besifloxacin hcl ophth susp 0.6% 4betaxolol hcl ophth soln 0.5% 2BETOPTIC-S - betaxolol hcl ophth susp 0.25% 4brimonidine tartrate ophth soln 0.15% 2brimonidine tartrate ophth soln 0.2% 1bromfenac sodium ophth soln 0.09% (once-daily) 2carteolol hcl ophth soln 1% 1ciprofloxacin hcl ophth soln 0.3% 1COMBIGAN - brimonidine tartrate-timolol maleate ophth soln

0.2-0.5%3

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

sodium phosphate ophth soln 0.1%4

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

2018


95


levobunolol hcl ophth soln 0.5% 1LOTEMAX - loteprednol etabonate ophth gel 0.5% 3LOTEMAX - loteprednol etabonate ophth oint 0.5% 3LOTEMAX - loteprednol etabonate ophth susp 0.5% 3LUMIGAN - bimatoprost ophth soln 0.01% 3MOXEZA - moxifloxacin hcl ophth soln 0.5% (2 times daily) 4moxifloxacin hcl ophth soln 0.5% 2NATACYN - natamycin ophth susp 5% 4neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin 2neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml 2neomycin-polymyxin-dexamethasone ophth oint 0.1% 2neomycin-polymyxin-dexamethasone ophth susp 0.1% 2ofloxacin ophth soln 0.3% 2olopatadine hcl ophth soln 0.1% 2olopatadine hcl ophth soln 0.2% 3PATANOL - olopatadine hcl ophth soln 0.1% 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% 2

2018



tobramycin-dexamethasone ophth susp 0.3-0.1% 2TRAVATAN Z - travoprost ophth soln 0.004% 3trifluridine ophth soln 1% 2VIGAMOX - moxifloxacin hcl ophth soln 0.5% 3Agentes óticosacetic acid otic soln 2% 2ACETIC ACID/ALUMINUM ACETATE - acetic acid 2% in

aluminum acetate otic soln4

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

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

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

3 QL (1 inhaler/30 days)

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


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

act3 QL (1 canister/30 days)

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

3 QL (1 canister/30 days)

albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) 2 BDalbuterol sulfate soln nebu 0.5% (5 mg/ml) 2 BDalbuterol sulfate soln nebu 0.63 mg/3ml 2 BDalbuterol sulfate soln nebu 1.25 mg/3ml 2 BDalbuterol sulfate syrup 2 mg/5ml 1albuterol sulfate tab er 12hr 4 mg 2

2018


97


albuterol sulfate tab er 12hr 8 mg 2albuterol sulfate tab 2 mg 4albuterol sulfate tab 4 mg 4ANORO ELLIPTA - umeclidinium-vilanterol aero powd ba

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

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

3 QL (30 blisters/30 days)





ASMANEX HFA - mometasone furoate inhal aerosol suspension100 mcg/act


ASMANEX HFA - mometasone furoate inhal aerosol suspension200 mcg/act


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












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

4 QL (2 canisters/30 days)

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

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

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

3 QL (1 package/30 days)

budesonide inhalation susp 0.25 mg/2ml 3 BDbudesonide inhalation susp 0.5 mg/2ml 3 BDbudesonide inhalation susp 1 mg/2ml 4 BDcaffeine citrate oral soln 60 mg/3ml 2CLEMASTINE FUMARATE - clemastine fumarate tab 2.68 mg# 4 PACOMBIVENT RESPIMAT - ipratropium-albuterol inhal aerosol soln

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

2018



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

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

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


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

3

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

3

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

3

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

3

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

blister3 QL (1 inhaler/30 days)

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


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

3 QL (4 inhalers/30 days)

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


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


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


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

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

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


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)

2018


99


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

valve)3 QL (2 canisters/30 days)

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


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


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

2018



SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 1.25 mcg/act


SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 2.5 mcg/act


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


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


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


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


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

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

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

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

tablets)/28 days)UPTRAVI - selexipag tab 200 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 400 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 600 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 800 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1000 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1200 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1400 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1600 mcg* 5 PA, QL (60 tablets/30 days)VENTAVIS - iloprost inhalation solution 10 mcg/ml 5 BD, PA, QL (270 mls/30 days)VENTAVIS - iloprost inhalation solution 20 mcg/ml 5 BD, PA, QL (270 mls/30 days)VENTOLIN HFA - albuterol sulfate inhal aero 108 mcg/act 3 QL (36 grams/30 days)

2018


101


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

2018

102

ÍNDICE

Aabacavir sulfate-lamivudine tab 600-300

mg................................................................................43abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg........................................................43abacavir sulfate soln 20 mg/ml.................................. 43abacavir sulfate tab 300 mg.......................................43ABRAXANE...................................................................26ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1acamprosate calcium tab delayed release 333

mg..................................................................................5acarbose tab 100 mg.................................................. 49acarbose tab 25 mg.................................................... 49acarbose tab 50 mg.................................................... 49acebutolol hcl cap 200 mg..........................................55acebutolol hcl cap 400 mg..........................................55acetaminophen w/ codeine soln 120-12

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

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

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

mg..................................................................................1acetazolamide cap er 12hr 500 mg...........................56acetazolamide tab 125 mg......................................... 56acetazolamide tab 250 mg......................................... 56ACETIC ACID/ALUMINUM ACETATE...................... 96acetic acid otic soln 2%.............................................. 96acetylcysteine inhal soln 10%.................................... 96acetylcysteine inhal soln 20%.................................... 96acitretin cap 10 mg......................................................70acitretin cap 17.5 mg...................................................70acitretin cap 25 mg......................................................70ACTHIB..........................................................................86ACTIMMUNE................................................................ 86acyclovir cap 200 mg.................................................. 43acyclovir oint 5%..........................................................43acyclovir sodium iv soln 50 mg/ml.............................43acyclovir susp 200 mg/5ml......................................... 43acyclovir tab 400 mg................................................... 43acyclovir tab 800 mg................................................... 43ADACEL........................................................................ 86ADAGEN........................................................................77ADASUVE..................................................................... 38

ADCIRCA...................................................................... 96adefovir dipivoxil tab 10 mg........................................43ADEMPAS..................................................................... 96ADEMPAS..................................................................... 96ADEMPAS..................................................................... 96ADEMPAS..................................................................... 96ADEMPAS..................................................................... 96ADVAIR DISKUS..........................................................96ADVAIR DISKUS..........................................................96ADVAIR DISKUS..........................................................96ADVAIR HFA.................................................................96ADVAIR HFA.................................................................96ADVAIR HFA.................................................................96AFINITOR......................................................................26AFINITOR......................................................................26AFINITOR......................................................................26AFINITOR......................................................................26AFINITOR DISPERZ................................................... 26AFINITOR DISPERZ................................................... 26AFINITOR DISPERZ................................................... 26ALBENZA...................................................................... 36albuterol sulfate soln nebu 0.083% (2.5

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

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

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

mg/3ml........................................................................ 96albuterol sulfate syrup 2 mg/5ml................................96albuterol sulfate tab 2 mg...........................................97albuterol sulfate tab 4 mg...........................................97albuterol sulfate tab er 12hr 4 mg..............................96albuterol sulfate tab er 12hr 8 mg..............................97alclometasone dipropionate cream

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

0.05%..........................................................................70ALCOHOL SWABS......................................................49ALDURAZYME............................................................. 77ALECENSA................................................................... 26alendronate sodium tab 10 mg.................................. 93alendronate sodium tab 35 mg.................................. 93alendronate sodium tab 5 mg.................................... 92alendronate sodium tab 70 mg.................................. 93alfuzosin hcl tab er 24hr 10 mg................................. 79ALIMTA.......................................................................... 26ALIMTA.......................................................................... 26ALINIA............................................................................36ALINIA............................................................................36ALIQOPA....................................................................... 26allopurinol sodium for inj 500 mg...............................25

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allopurinol tab 100 mg.................................................25allopurinol tab 300 mg.................................................25alosetron hcl tab 0.5 mg............................................. 75alosetron hcl tab 1 mg................................................ 75ALOXI.............................................................................22ALPHAGAN P...............................................................94alprazolam tab 0.25 mg.............................................. 48alprazolam tab 0.5 mg................................................ 48alprazolam tab 1 mg....................................................48alprazolam tab 2 mg....................................................48ALUNBRIG....................................................................26ALUNBRIG....................................................................26ALUNBRIG....................................................................26ALUNBRIG....................................................................26amantadine hcl cap 100 mg.......................................37amantadine hcl syrup 50 mg/5ml...............................37amantadine hcl tab 100 mg........................................37AMBISOME...................................................................23amikacin sulfate inj 1 gm/4ml (250 mg/

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

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

mg................................................................................56amiloride hcl tab 5 mg.................................................56amino acid infusion 15%.............................................73amino acid infusion 6%...............................................73amiodarone hcl tab 200 mg........................................56amiodarone hcl tab 400 mg........................................56AMITIZA.........................................................................75AMITIZA.........................................................................75amitriptyline hcl tab 100 mg....................................... 19amitriptyline hcl tab 10 mg..........................................18amitriptyline 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................................................................................56amlodipine besylate-atorvastatin calcium tab 10-20



mg................................................................................56amlodipine besylate-atorvastatin calcium tab 2.5-10



mg................................................................................56

amlodipine besylate-atorvastatin calcium tab 5-10mg................................................................................56




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


amlodipine besylate-benazepril hcl cap 2.5-10mg................................................................................56




amlodipine besylate-olmesartan medoxomil tab10-20 mg....................................................................56

amlodipine besylate-olmesartan medoxomil tab10-40 mg....................................................................56

amlodipine besylate-olmesartan medoxomil tab 5-20mg................................................................................56

amlodipine besylate-olmesartan medoxomil tab 5-40mg................................................................................56

amlodipine besylate tab 10 mg..................................56amlodipine besylate tab 2.5 mg.................................56amlodipine besylate tab 5 mg.................................... 56amlodipine besylate-valsartan tab 10-160

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



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

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

10-160-25 mg............................................................57amlodipine-valsartan-hydrochlorothiazide tab

10-320-25 mg............................................................57amlodipine-valsartan-hydrochlorothiazide tab

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

5-160-25 mg.............................................................. 56AMOXAPINE.................................................................19AMOXAPINE.................................................................19AMOXAPINE.................................................................19

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AMOXAPINE.................................................................19AMOXICILLIN/CLAVULANATE

POTASSIUM................................................................ 7AMOXICILLIN/CLAVULANATE

POTASSIUM................................................................ 7amoxicillin (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................................................................................68amphetamine-dextroamphetamine cap er 24hr 15





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

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




mg................................................................................68

amphetamine-dextroamphetamine tab 5mg................................................................................68

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

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

gm..................................................................................7ampicillin cap 500 mg....................................................7AMPICILLIN SODIUM................................................... 7ampicillin sodium for inj 1 gm.......................................7ampicillin sodium for inj 250 mg...................................7ampicillin sodium for inj 2 gm.......................................7ampicillin sodium for inj 500 mg...................................7ampicillin sodium for iv soln 10 gm..............................7ampicillin sodium for iv soln 2 gm................................7AMPICILLIN-SULBACTAM........................................... 7AMPYRA........................................................................68ANADROL-50............................................................... 81anagrelide hcl cap 0.5 mg.......................................... 52anagrelide hcl cap 1 mg............................................. 53anastrozole tab 1 mg...................................................26ANDRODERM.............................................................. 81ANDRODERM.............................................................. 81ANDROGEL.................................................................. 81ANDROGEL.................................................................. 81ANDROGEL.................................................................. 81ANDROGEL.................................................................. 81ANDROGEL PUMP..................................................... 81ANORO ELLIPTA.........................................................97APOKYN........................................................................37aprepitant capsule 125 mg.........................................22aprepitant capsule 40 mg........................................... 22aprepitant capsule 80 mg........................................... 22aprepitant capsule therapy pack 80 & 125

mg................................................................................22APRISO......................................................................... 92APTIOM......................................................................... 14APTIOM......................................................................... 14APTIOM......................................................................... 14APTIOM......................................................................... 14APTIVUS....................................................................... 43APTIVUS....................................................................... 43ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53

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ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARANESP ALBUMIN FREE.......................................53ARCALYST....................................................................87aripiprazole orally disintegrating tab 10

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

mg................................................................................38aripiprazole oral solution 1 mg/ml..............................38aripiprazole tab 10 mg................................................ 38aripiprazole tab 15 mg................................................ 38aripiprazole tab 20 mg................................................ 38aripiprazole tab 2 mg...................................................38aripiprazole tab 30 mg................................................ 38aripiprazole tab 5 mg...................................................38ARISTADA.....................................................................39ARISTADA.....................................................................39ARISTADA.....................................................................39ARISTADA.....................................................................39armodafinil tab 150 mg............................................. 101armodafinil tab 200 mg............................................. 101armodafinil tab 250 mg............................................. 101armodafinil tab 50 mg............................................... 101ARNUITY ELLIPTA......................................................97ARNUITY ELLIPTA......................................................97ARNUITY ELLIPTA......................................................97ARRANON.................................................................... 26ARZERRA..................................................................... 27ARZERRA..................................................................... 27ASACOL HD.................................................................92ASMANEX HFA............................................................97ASMANEX HFA............................................................97ASMANEX TWISTHALER 120 METERED

DOSES....................................................................... 97ASMANEX TWISTHALER 14 METERED





DOSES....................................................................... 97aspirin-dipyridamole cap er 12hr 25-200

mg................................................................................53atazanavir sulfate cap 150 mg...................................43atazanavir sulfate cap 200 mg...................................43atazanavir sulfate cap 300 mg...................................43

atenolol & chlorthalidone tab 100-25mg................................................................................57

atenolol & chlorthalidone tab 50-25 mg.................... 57atenolol tab 100 mg.....................................................57atenolol tab 25 mg.......................................................57atenolol tab 50 mg.......................................................57ATGAM.......................................................................... 87atomoxetine hcl cap 100 mg...................................... 68atomoxetine hcl cap 10 mg........................................ 68atomoxetine hcl cap 18 mg........................................ 68atomoxetine hcl cap 25 mg........................................ 68atomoxetine hcl cap 40 mg........................................ 68atomoxetine hcl cap 60 mg........................................ 68atomoxetine hcl cap 80 mg........................................ 68atorvastatin calcium tab 10 mg.................................. 57atorvastatin calcium tab 20 mg.................................. 57atorvastatin calcium tab 40 mg.................................. 57atorvastatin calcium tab 80 mg.................................. 57atovaquone-proguanil hcl tab 250-100

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

mg................................................................................36atovaquone susp 750 mg/5ml....................................36ATRIPLA........................................................................ 43ATROVENT HFA..........................................................97AVASTIN........................................................................27AVASTIN........................................................................27AVELOX...........................................................................7AVONEX........................................................................ 68AVONEX........................................................................ 68AVONEX PEN.............................................................. 68azacitidine for inj 100 mg............................................53AZACTAM........................................................................7AZACTAM........................................................................7AZACTAM IN ISO-OSMOTIC

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

DEXTROSE................................................................. 7AZASAN........................................................................ 87AZASAN........................................................................ 87AZATHIOPRINE........................................................... 87azathioprine tab 50 mg............................................... 87azelastine hcl nasal spray 0.1% (137 mcg/

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

spray)..........................................................................97azelastine hcl ophth soln 0.05%................................ 94AZELEX......................................................................... 70AZITHROMYCIN............................................................ 7azithromycin for susp 100 mg/5ml...............................7azithromycin for susp 200 mg/5ml...............................7azithromycin iv for soln 500 mg................................... 7

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azithromycin tab 250 mg...............................................7azithromycin tab 500 mg...............................................7azithromycin tab 600 mg...............................................7AZOPT........................................................................... 94AZOR............................................................................. 57AZOR............................................................................. 57AZOR............................................................................. 57AZOR............................................................................. 57aztreonam for inj 1 gm.................................................. 7aztreonam for inj 2 gm.................................................. 7BBACITRACIN................................................................ 94bacitracin-polymyxin b ophth oint.............................. 94bacitracin-polymyxin-neomycin-hc ophth oint

1%............................................................................... 94baclofen tab 10 mg......................................................43baclofen tab 20 mg......................................................43balsalazide disodium cap 750 mg............................. 92BANZEL.........................................................................14BANZEL.........................................................................14BANZEL.........................................................................14BARACLUDE................................................................ 43BAVENCIO.................................................................... 27BCG VACCINE.............................................................87BELEODAQ.................................................................. 27benazepril & hydrochlorothiazide tab 10-12.5

mg................................................................................57benazepril & hydrochlorothiazide tab 20-12.5

mg................................................................................57benazepril & hydrochlorothiazide tab 20-25

mg................................................................................57benazepril & hydrochlorothiazide tab 5-6.25

mg................................................................................57benazepril hcl tab 10 mg............................................ 57benazepril hcl tab 20 mg............................................ 57benazepril hcl tab 40 mg............................................ 57benazepril hcl tab 5 mg.............................................. 57BENDEKA..................................................................... 27BENICAR.......................................................................57BENICAR.......................................................................57BENICAR.......................................................................57BENICAR HCT............................................................. 57BENICAR HCT............................................................. 57BENICAR HCT............................................................. 57BENLYSTA.................................................................... 87BENLYSTA.................................................................... 87BENLYSTA.................................................................... 87BENLYSTA.................................................................... 87BENZNIDAZOLE..........................................................36BENZNIDAZOLE..........................................................36

benzoyl peroxide-erythromycin gel5-3%............................................................................70

benztropine mesylate tab 0.5 mg.............................. 37benztropine mesylate tab 1 mg..................................37benztropine mesylate tab 2 mg..................................37BESIVANCE..................................................................94BESPONSA.................................................................. 27betamethasone dipropionate augmented cream

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

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

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

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

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

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

0.05%..........................................................................70betamethasone valerate cream 0.1%....................... 70betamethasone valerate lotion 0.1%.........................70betamethasone valerate oint 0.1%............................70BETASERON................................................................ 68betaxolol hcl ophth soln 0.5%.................................... 94betaxolol hcl tab 10 mg...............................................57betaxolol hcl tab 20 mg...............................................57bethanechol chloride tab 10 mg.................................79bethanechol chloride tab 25 mg.................................79bethanechol chloride tab 50 mg.................................79bethanechol chloride tab 5 mg...................................79BETOPTIC-S.................................................................94BEVYXXA......................................................................53BEVYXXA......................................................................53bexarotene cap 75 mg................................................ 27BEXSERO..................................................................... 87bicalutamide tab 50 mg...............................................27BICILLIN L-A...................................................................7BICILLIN L-A...................................................................7BICILLIN L-A...................................................................7BICNU............................................................................27BIKTARVY..................................................................... 43BILTRICIDE...................................................................36bisoprolol & hydrochlorothiazide tab 10-6.25

mg................................................................................57bisoprolol & hydrochlorothiazide tab 2.5-6.25

mg................................................................................57bisoprolol & hydrochlorothiazide tab 5-6.25

mg................................................................................57bisoprolol fumarate tab 10 mg................................... 57bisoprolol fumarate tab 5 mg..................................... 57

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107

bleomycin sulfate for inj 15 unit................................. 27bleomycin sulfate for inj 30 unit................................. 27BLINCYTO.....................................................................27BOOSTRIX....................................................................87BOSULIF....................................................................... 27BOSULIF....................................................................... 27BOSULIF....................................................................... 27BREO ELLIPTA............................................................ 97BREO ELLIPTA............................................................ 97BRILINTA.......................................................................53BRILINTA.......................................................................53brimonidine tartrate ophth soln 0.15%...................... 94brimonidine tartrate ophth soln 0.2%........................ 94BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14bromfenac sodium ophth soln 0.09% (once-

daily)............................................................................94bromocriptine mesylate cap 5 mg..............................37bromocriptine mesylate tab 2.5 mg........................... 37budesonide delayed release particles cap 3

mg................................................................................92budesonide inhalation susp 0.25

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

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

mg..................................................................................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............................. 19bupropion 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............................................. 48

buspirone hcl tab 15 mg............................................. 48buspirone hcl tab 30 mg............................................. 48buspirone hcl tab 5 mg............................................... 48buspirone hcl tab 7.5 mg............................................ 48busulfan inj 6 mg/ml.................................................... 27butalbital-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..................................................................49BYDUREON BCISE.....................................................49BYDUREON PEN........................................................ 49BYETTA......................................................................... 49BYETTA......................................................................... 49BYSTOLIC.....................................................................58BYSTOLIC.....................................................................58BYSTOLIC.....................................................................58BYSTOLIC.....................................................................58Ccabergoline tab 0.5 mg............................................... 85CABOMETYX............................................................... 27CABOMETYX............................................................... 27CABOMETYX............................................................... 27caffeine citrate oral soln 60 mg/3ml...........................97calcipotriene cream 0.005%.......................................70calcipotriene oint 0.005%............................................70calcipotriene soln 0.005% (50 mcg/ml).....................70calcitonin (salmon) nasal soln 200 unit/

act................................................................................93calcitriol cap 0.25 mcg................................................ 93calcitriol cap 0.5 mcg...................................................93calcitriol inj 1 mcg/ml...................................................93calcitriol oral soln 1 mcg/ml........................................93calcium acetate cap 667 mg...................................... 73calcium acetate tab 667 mg....................................... 73CALQUENCE................................................................27CANASA........................................................................92CANCIDAS....................................................................23CANCIDAS....................................................................23candesartan cilexetil-hydrochlorothiazide tab 16-12.5

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

2018

108

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

candesartan cilexetil-hydrochlorothiazide tab 32-25mg................................................................................58

candesartan cilexetil tab 16 mg................................. 58candesartan cilexetil tab 32 mg................................. 58candesartan cilexetil tab 4 mg................................... 58candesartan cilexetil tab 8 mg................................... 58CAPASTAT SULFATE..................................................26CAPRELSA................................................................... 27CAPRELSA................................................................... 27captopril tab 100 mg....................................................58captopril tab 12.5 mg...................................................58captopril tab 25 mg......................................................58captopril tab 50 mg......................................................58CARAC.......................................................................... 70CARBAGLU.................................................................. 73carbamazepine 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..........................................................37CARBIDOPA/LEVODOPA/





ENTACAPONE..........................................................38carbidopa & levodopa orally disintegrating tab

10-100 mg..................................................................37carbidopa & levodopa orally disintegrating tab

25-100 mg..................................................................37carbidopa & levodopa orally disintegrating tab

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

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

mg................................................................................37carbidopa tab 25 mg................................................... 37

carboplatin iv soln 150 mg/15ml................................ 27carboplatin iv soln 450 mg/45ml................................ 27carboplatin iv soln 50 mg/5ml.................................... 27carboplatin iv soln 600 mg/60ml................................ 27carteolol hcl ophth soln 1%........................................ 94carvedilol tab 12.5 mg.................................................58carvedilol tab 25 mg....................................................58carvedilol tab 3.125 mg...............................................58carvedilol tab 6.25 mg.................................................58caspofungin 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...................................................8cefadroxil for susp 250 mg/5ml....................................8cefadroxil for susp 500 mg/5ml....................................8cefadroxil tab 1 gm........................................................ 8CEFAZOLIN SODIUM................................................... 8cefazolin sodium for inj 10 gm..................................... 8cefazolin sodium for inj 1 gm....................................... 8cefazolin sodium for inj 500 mg................................... 8cefdinir cap 300 mg....................................................... 8cefdinir for susp 125 mg/5ml........................................8cefdinir for susp 250 mg/5ml........................................8cefepime hcl for inj 1 gm.............................................. 8cefepime hcl for inj 2 gm.............................................. 8CEFOTAXIME SODIUM................................................8CEFOTAXIME SODIUM................................................8CEFOTAXIME SODIUM................................................8cefotaxime sodium for inj 1 gm.................................... 8cefoxitin sodium for inj 10 gm...................................... 8cefoxitin sodium for iv soln 1 gm................................. 8cefoxitin sodium for iv soln 2 gm................................. 8cefpodoxime proxetil for susp 100

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

mg/5ml.......................................................................... 8cefpodoxime proxetil tab 100 mg.................................8cefpodoxime proxetil tab 200 mg.................................8cefprozil for susp 125 mg/5ml...................................... 8cefprozil for susp 250 mg/5ml...................................... 8cefprozil tab 250 mg......................................................8cefprozil tab 500 mg......................................................8ceftazidime for inj 1 gm.................................................8ceftazidime for inj 2 gm.................................................8ceftazidime for inj 6 gm.................................................8ceftazidime for iv soln 1 gm..........................................8ceftazidime for iv soln 2 gm..........................................8CEFTRIAXONE/DEXTROSE....................................... 9CEFTRIAXONE/DEXTROSE....................................... 9CEFTRIAXONE IN ISO-OSMOTIC

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

2018

109

CEFTRIAXONE IN ISO-OSMOTICDEXTROSE................................................................. 8

ceftriaxone sodium for inj 10 gm..................................9ceftriaxone sodium for inj 1 gm....................................9ceftriaxone sodium for inj 250 mg................................8ceftriaxone sodium for inj 2 gm....................................9ceftriaxone sodium for inj 500 mg................................9ceftriaxone sodium for iv soln 1 gm.............................9ceftriaxone sodium for iv soln 2 gm.............................9cefuroxime axetil tab 250 mg....................................... 9cefuroxime axetil tab 500 mg....................................... 9cefuroxime sodium for inj 7.5 gm.................................9cefuroxime sodium for inj 750 mg................................9cefuroxime sodium for iv soln 1.5 gm..........................9celecoxib cap 100 mg................................................... 1celecoxib cap 200 mg................................................... 1celecoxib cap 400 mg................................................... 1celecoxib cap 50 mg......................................................1CELONTIN.................................................................... 14cephalexin cap 250 mg.................................................9cephalexin cap 500 mg.................................................9cephalexin cap 750 mg.................................................9cephalexin for susp 125 mg/5ml..................................9cephalexin for susp 250 mg/5ml..................................9CEREZYME.................................................................. 77CHANTIX......................................................................... 5CHANTIX......................................................................... 5CHANTIX CONTINUING MONTH

PACK.............................................................................5CHANTIX STARTING MONTH PACK.........................6CHEMET........................................................................73CHENODAL.................................................................. 75CHLORAMPHENICOL SODIUM

SUCCINATE.................................................................9chlorhexidine gluconate soln 0.12%..........................70CHLOROQUINE PHOSPHATE................................. 36chloroquine phosphate tab 500 mg...........................36CHLOROTHIAZIDE..................................................... 58chlorothiazide tab 500 mg.......................................... 58CHLORPROMAZINE 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............................................ 58chlorthalidone tab 50 mg............................................ 58cholestyramine light powder 4 gm/

dose............................................................................ 58cholestyramine light powder packets 4

gm................................................................................58

cholestyramine powder 4 gm/dose............................58cholestyramine powder packets 4 gm.......................58choline fenofibrate cap dr 135 mg............................. 58choline fenofibrate cap dr 45 mg............................... 58chorionic gonadotropin for im inj 10000 unit(chorionic

gonadotropin, pregnyl)............................................. 81ciclopirox gel 0.77%.................................................... 23ciclopirox olamine cream 0.77%................................23ciclopirox olamine susp 0.77%...................................23ciclopirox shampoo 1%............................................... 23ciclopirox solution 8%..................................................23cidofovir iv inj 75 mg/ml.............................................. 43cilostazol tab 100 mg.................................................. 53cilostazol tab 50 mg.................................................... 53cimetidine hcl soln 300 mg/5ml..................................75cimetidine tab 200 mg.................................................75cimetidine tab 300 mg.................................................75cimetidine tab 400 mg.................................................75cimetidine tab 800 mg.................................................75CINRYZE.......................................................................87CIPRODEX....................................................................96ciprofloxacin 200 mg/100ml in d5w............................. 9ciprofloxacin 400 mg/200ml in d5w............................. 9ciprofloxacin for oral susp 250 mg/5ml (5%) (5

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

gm/100ml).....................................................................9CIPROFLOXACIN HCL.................................................9ciprofloxacin hcl ophth soln 0.3%.............................. 94ciprofloxacin hcl tab 250 mg.........................................9ciprofloxacin hcl tab 500 mg.........................................9ciprofloxacin hcl tab 750 mg.........................................9ciprofloxacin hcl tab er 24hr 1000 mg......................... 9ciprofloxacin hcl tab er 24hr 500 mg........................... 9CISPLATIN.................................................................... 27cisplatin inj 100 mg/100ml (1 mg/ml).........................27cisplatin inj 50 mg/50ml (1 mg/ml).............................27citalopram hydrobromide oral soln 10

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

ml)................................................................................27clarithromycin for susp 125 mg/5ml.............................9clarithromycin for susp 250 mg/5ml.............................9clarithromycin tab 250 mg............................................ 9clarithromycin tab 500 mg............................................ 9clarithromycin tab er 24hr 500 mg...............................9CLEMASTINE FUMARATE........................................ 97clindamycin hcl cap 150 mg......................................... 9clindamycin hcl cap 300 mg.......................................10

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clindamycin hcl cap 75 mg........................................... 9clindamycin phosphate-benzoyl peroxide gel

1-5%............................................................................70clindamycin phosphate gel 1%.................................. 10clindamycin phosphate in d5w iv soln 300

mg/50ml......................................................................10clindamycin phosphate in d5w iv soln 600

mg/50ml......................................................................10clindamycin phosphate in d5w iv soln 900

mg/50ml......................................................................10clindamycin phosphate inj 300 mg/2ml.....................10clindamycin phosphate inj 600 mg/4ml.....................10clindamycin phosphate inj 900 mg/6ml.....................10clindamycin phosphate inj 9 gm/60ml....................... 10clindamycin phosphate iv soln 300

mg/2ml........................................................................ 10clindamycin phosphate iv soln 600

mg/4ml........................................................................ 10clindamycin phosphate iv soln 900

mg/6ml........................................................................ 10clindamycin phosphate lotion 1%.............................. 10clindamycin phosphate soln 1%................................ 10clindamycin phosphate swab 1%.............................. 10clindamycin phosphate vaginal cream

2%............................................................................... 10clobetasol propionate cream 0.05%..........................70clobetasol propionate emollient base cream

0.05%..........................................................................70clobetasol propionate gel 0.05%................................70clobetasol propionate oint 0.05%.............................. 70clobetasol propionate soln 0.05%..............................70clofarabine iv soln 1 mg/ml.........................................27clomipramine hcl cap 25 mg...................................... 19clomipramine hcl cap 50 mg...................................... 19clomipramine hcl cap 75 mg...................................... 19clonazepam orally disintegrating tab 0.125

mg................................................................................48clonazepam orally disintegrating tab 0.25

mg................................................................................48clonazepam orally disintegrating tab 0.5

mg................................................................................48clonazepam orally disintegrating tab 1

mg................................................................................48clonazepam orally disintegrating tab 2

mg................................................................................48clonazepam tab 0.5 mg.............................................. 48clonazepam tab 1 mg..................................................48clonazepam tab 2 mg..................................................48clonidine hcl tab 0.1 mg..............................................58clonidine hcl tab 0.2 mg..............................................58clonidine hcl tab 0.3 mg..............................................58clonidine hcl tab er 12hr 0.1 mg................................ 68

clonidine hcl td patch weekly 0.1mg/24hr...................................................................... 58



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

1-0.05%...................................................................... 70clotrimazole w/ betamethasone lotion

1-0.05%...................................................................... 70clozapine orally disintegrating tab 100

mg................................................................................39clozapine orally disintegrating tab 12.5

mg................................................................................39clozapine orally disintegrating tab 25

mg................................................................................39clozapine tab 100 mg..................................................39clozapine tab 200 mg..................................................39clozapine tab 25 mg....................................................39clozapine tab 50 mg....................................................39COARTEM.....................................................................36codeine sulfate tab 15 mg............................................ 1codeine sulfate tab 30 mg............................................ 1codeine sulfate tab 60 mg............................................ 1colchicine w/ probenecid tab 0.5-500

mg................................................................................25COLCRYS..................................................................... 25colesevelam hcl tab 625 mg.......................................59colestipol hcl granule packets 5 gm.......................... 59colestipol hcl granules 5 gm.......................................59colestipol hcl tab 1 gm................................................ 59colistimethate sod for inj 150 mg...............................10COMBIGAN...................................................................94COMBIVENT RESPIMAT........................................... 97COMETRIQ...................................................................27COMETRIQ...................................................................27COMETRIQ...................................................................28COMPLERA.................................................................. 43COPAXONE.................................................................. 68COPAXONE.................................................................. 69CORLANOR..................................................................59CORLANOR..................................................................59CORTISONE ACETATE..............................................80COSENTYX.................................................................. 87COSENTYX SENSOREADY PEN............................ 87COSMEGEN................................................................. 28

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COTELLIC.....................................................................28COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................54COUMADIN...................................................................54COUMADIN...................................................................54CREON..........................................................................77CREON..........................................................................77CREON..........................................................................77CREON..........................................................................77CREON..........................................................................78CRESEMBA.................................................................. 24CRESEMBA.................................................................. 24CRIXIVAN......................................................................43CRIXIVAN......................................................................43cromolyn sodium ophth soln 4%................................94cromolyn sodium oral conc 100

mg/5ml........................................................................ 75cromolyn sodium soln nebu 20 mg/2ml.................... 98cyclobenzaprine hcl tab 10 mg................................ 101cyclobenzaprine hcl tab 5 mg.................................. 101cyclobenzaprine hcl tab 7.5 mg...............................101cyclophosphamide cap 25 mg................................... 28cyclophosphamide cap 50 mg................................... 28cyclophosphamide for inj 1 gm.................................. 28cyclophosphamide for inj 2 gm.................................. 28cyclophosphamide for inj 500 mg..............................28CYCLOSERINE............................................................26CYCLOSET...................................................................49cyclosporine cap 100 mg............................................87cyclosporine cap 25 mg..............................................87cyclosporine iv soln 50 mg/ml....................................87cyclosporine modified cap 100 mg............................ 87cyclosporine modified cap 25 mg.............................. 87cyclosporine modified cap 50 mg.............................. 87cyclosporine modified oral soln 100 mg/

ml.................................................................................87CYRAMZA.....................................................................28CYRAMZA.....................................................................28CYSTADANE................................................................ 78CYSTAGON.................................................................. 78CYSTAGON.................................................................. 78CYSTARAN...................................................................94CYTARABINE............................................................... 28cytarabine inj pf 100 mg/ml........................................ 28cytarabine inj pf 20 mg/ml.......................................... 28

DDACARBAZINE............................................................ 28dacarbazine for inj 200 mg.........................................28dactinomycin for inj 0.5 mg........................................ 28DAKLINZA.....................................................................43DAKLINZA.....................................................................44DAKLINZA.....................................................................44DALIRESP.....................................................................98DALIRESP.....................................................................98DALVANCE................................................................... 10danazol cap 100 mg....................................................81danazol cap 200 mg....................................................81danazol cap 50 mg......................................................81dantrolene sodium cap 100 mg................................. 43dantrolene sodium cap 25 mg....................................43dantrolene sodium cap 50 mg....................................43dapsone tab 100 mg................................................... 26dapsone tab 25 mg......................................................26DAPTACEL....................................................................87daptomycin for iv soln 500 mg...................................10DARAPRIM................................................................... 36DARZALEX................................................................... 28DARZALEX................................................................... 28daunorubicin hcl inj 5 mg/ml.......................................28DAUNORUBICIN HYDROCHLORIDE......................28DAUNORUBICIN HYDROCHLORIDE......................28decitabine for inj 50 mg.............................................. 28DELZICOL.....................................................................92demeclocycline hcl tab 150 mg..................................10demeclocycline hcl tab 300 mg..................................10DEMSER....................................................................... 59DENAVIR.......................................................................44DEPEN TITRATABS.................................................... 79DEPO-PROVERA........................................................ 81DESCOVY.....................................................................44desipramine 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...........................81desmopressin acetate nasal soln 0.01%

(refrigerated).............................................................. 81desmopressin acetate nasal spray soln

0.01%..........................................................................81desmopressin acetate nasal spray soln 0.01%

(refrigerated).............................................................. 81desmopressin acetate tab 0.1 mg............................. 81desmopressin acetate tab 0.2 mg............................. 81

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112

desogest-eth estrad & eth estrad tab 0.15-0.02/0.01mg(21/5)..................................................................... 81

desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg................................................................................81

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

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

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

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

mg................................................................................19DEXAMETHASONE.................................................... 80DEXAMETHASONE.................................................... 80dexamethasone elixir 0.5 mg/5ml..............................80DEXAMETHASONE SODIUM

PHOSPHATE.............................................................94dexamethasone sodium phosphate inj 120

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

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

ml.................................................................................80dexamethasone tab 0.5 mg........................................80dexamethasone tab 0.75 mg......................................80dexamethasone tab 1.5 mg........................................80dexamethasone tab 4 mg...........................................80dexamethasone tab 6 mg...........................................80dexmethylphenidate hcl tab 10 mg............................69dexmethylphenidate hcl tab 2.5 mg...........................69dexmethylphenidate hcl tab 5 mg..............................69dexrazoxane for inj 250 mg........................................28dexrazoxane for inj 500 mg........................................28dextroamphetamine sulfate cap er 24hr 10

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

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

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

0.45%..........................................................................73dextrose 5% in lactated ringers................................. 73

dextrose 5% w/ sodium chloride 0.2%...................... 73dextrose 5% w/ sodium chloride

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

0.45%..........................................................................73dextrose 5% w/ sodium chloride 0.9%...................... 73dextrose inj 10%.......................................................... 73dextrose inj 5%.............................................................73DIASTAT ACUDIAL......................................................15DIASTAT ACUDIAL......................................................15DIASTAT PEDIATRIC..................................................15DIAZEPAM.................................................................... 48diazepam conc 5 mg/ml..............................................48DIAZEPAM RECTAL GEL.......................................... 15DIAZEPAM RECTAL GEL.......................................... 15DIAZEPAM RECTAL GEL.......................................... 15diazepam tab 10 mg....................................................48diazepam tab 2 mg......................................................48diazepam tab 5 mg......................................................48diclofenac potassium tab 50 mg.................................. 1diclofenac sodium gel 1%.............................................1diclofenac sodium gel 3%...........................................71diclofenac sodium ophth soln 0.1%...........................94diclofenac 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................................ 10dicloxacillin sodium cap 500 mg................................ 10dicyclomine hcl cap 10 mg......................................... 75dicyclomine hcl tab 20 mg..........................................75didanosine delayed release capsule 200

mg................................................................................44didanosine delayed release capsule 250

mg................................................................................44didanosine delayed release capsule 400

mg................................................................................44DIFICID..........................................................................10DIFLORASONE DIACETATE.....................................71DIGOXIN........................................................................59digoxin tab 125 mcg (0.125 mg)................................59digoxin tab 250 mcg (0.25 mg).................................. 59DILANTIN...................................................................... 15diltiazem hcl cap er 12hr 120 mg.............................. 59diltiazem hcl cap er 12hr 60 mg.................................59

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113

diltiazem hcl cap er 12hr 90 mg.................................59diltiazem hcl cap er 24hr 120 mg.............................. 59diltiazem hcl cap er 24hr 180 mg.............................. 59diltiazem hcl cap er 24hr 240 mg.............................. 59diltiazem hcl coated beads cap er 24hr 120

mg................................................................................59diltiazem hcl coated beads cap er 24hr 180




mg................................................................................59diltiazem hcl coated beads tab er 24hr 180





mg................................................................................59diltiazem hcl extended release beads cap er 24hr

120 mg....................................................................... 59diltiazem hcl extended release beads cap er 24hr





420 mg....................................................................... 59diltiazem hcl tab 120 mg.............................................59diltiazem hcl tab 30 mg...............................................59diltiazem hcl tab 60 mg...............................................59diltiazem hcl tab 90 mg...............................................59DIPENTUM....................................................................92diphenhydramine hcl inj 50 mg/ml.............................98DIPHTHERIA/TETANUS TOXOIDS

ADSORBED...............................................................87dipyridamole tab 25 mg.............................................. 54dipyridamole tab 50 mg.............................................. 54dipyridamole tab 75 mg.............................................. 54disulfiram tab 250 mg....................................................6disulfiram tab 500 mg....................................................6divalproex sodium cap delayed release sprinkle 125

mg................................................................................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.........................................................................81DIVIGEL.........................................................................81DIVIGEL.........................................................................82DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28docetaxel for inj conc 20 mg/ml................................. 28docetaxel for inj conc 80 mg/4ml (20 mg/

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

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

mg/2ml........................................................................ 28docetaxel soln for iv infusion 80

mg/8ml........................................................................ 28dofetilide cap 125 mcg (0.125 mg)............................59dofetilide cap 250 mcg (0.25 mg).............................. 60dofetilide cap 500 mcg (0.5 mg)................................ 60donepezil 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%..................................94dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml.......................................................................... 94doxazosin mesylate tab 1 mg.................................... 60doxazosin mesylate tab 2 mg.................................... 60doxazosin mesylate tab 4 mg.................................... 60doxazosin mesylate tab 8 mg.................................... 60doxepin hcl cap 100 mg..............................................19doxepin hcl cap 10 mg................................................19doxepin hcl cap 150 mg..............................................19doxepin hcl cap 25 mg................................................19doxepin hcl cap 50 mg................................................19doxepin hcl cap 75 mg................................................19doxepin hcl conc 10 mg/ml.........................................20

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DOXORUBICIN HCL...................................................29DOXORUBICIN HCL...................................................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.........................10dronabinol cap 10 mg................................................. 22dronabinol cap 2.5 mg................................................ 22dronabinol cap 5 mg....................................................22drospirenone-ethinyl estradiol tab 3-0.02

mg................................................................................82drospirenone-ethinyl estradiol tab 3-0.03

mg................................................................................82drospirenone-ethinyl estrad-levomefolate tab

3-0.02-0.451 mg........................................................82drospirenone-ethinyl estrad-levomefolate tab

3-0.03-0.451 mg........................................................82DULERA........................................................................ 98DULERA........................................................................ 98duloxetine hcl enteric coated pellets cap 20

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

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

mg................................................................................20DUPIXENT.................................................................... 87DUREZOL..................................................................... 94dutasteride cap 0.5 mg............................................... 79dutasteride-tamsulosin hcl cap 0.5-0.4

mg................................................................................79Eeconazole nitrate cream 1%.......................................24EDURANT..................................................................... 44efavirenz cap 200 mg..................................................44efavirenz cap 50 mg....................................................44efavirenz tab 600 mg...................................................44EFFIENT........................................................................54EFFIENT........................................................................54EGRIFTA....................................................................... 81

EGRIFTA....................................................................... 81ELAPRASE................................................................... 78ELELYSO.......................................................................78ELIDEL...........................................................................71ELIGARD.......................................................................85ELIGARD.......................................................................85ELIGARD.......................................................................85ELIGARD.......................................................................85ELIQUIS.........................................................................54ELIQUIS.........................................................................54ELIQUIS STARTER PACK......................................... 54ELITEK...........................................................................29ELITEK...........................................................................29ELLA...............................................................................82EMCYT.......................................................................... 29EMEND..........................................................................22EMPLICITI.....................................................................29EMPLICITI.....................................................................29EMSAM..........................................................................20EMSAM..........................................................................20EMSAM..........................................................................20EMTRIVA.......................................................................44EMTRIVA.......................................................................44enalapril maleate & hydrochlorothiazide tab 10-25

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

mg................................................................................60enalapril maleate tab 10 mg.......................................60enalapril maleate tab 2.5 mg......................................60enalapril maleate tab 20 mg.......................................60enalapril maleate tab 5 mg.........................................60ENBREL........................................................................ 87ENBREL........................................................................ 87ENBREL........................................................................ 87ENBREL MINI...............................................................88ENBREL SURECLICK................................................ 88ENGERIX-B.................................................................. 88ENGERIX-B.................................................................. 88enoxaparin sodium inj 100 mg/ml..............................54enoxaparin sodium inj 120 mg/0.8ml........................ 54enoxaparin sodium inj 150 mg/ml..............................54enoxaparin sodium inj 300 mg/3ml............................54enoxaparin sodium inj 30 mg/0.3ml...........................54enoxaparin sodium inj 40 mg/0.4ml...........................54enoxaparin sodium inj 60 mg/0.6ml...........................54enoxaparin sodium inj 80 mg/0.8ml...........................54entacapone tab 200 mg..............................................38entecavir tab 0.5 mg....................................................44entecavir tab 1 mg.......................................................44ENTRESTO...................................................................60ENTRESTO...................................................................60ENTRESTO...................................................................60

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EPCLUSA......................................................................44epinastine hcl ophth soln 0.05%................................94EPINEPHRINE............................................................. 98EPINEPHRINE............................................................. 98EPIPEN 2-PAK............................................................. 98EPIPEN-JR 2-PAK....................................................... 98epirubicin hcl iv soln 200 mg/100ml (2 mg/

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

ml)................................................................................29EPIVIR HBV..................................................................44eplerenone tab 25 mg.................................................60eplerenone tab 50 mg.................................................60EPOGEN....................................................................... 54EPOGEN....................................................................... 54EPOGEN....................................................................... 54EPOGEN....................................................................... 54EPOGEN....................................................................... 54ERBITUX....................................................................... 29ERBITUX....................................................................... 29ERGOLOID MESYLATES...........................................18ERIVEDGE....................................................................29ERLEADA......................................................................29ERWINAZE................................................................... 29ERYPED 400................................................................11ERY-TAB....................................................................... 10ERY-TAB....................................................................... 11ERY-TAB....................................................................... 11ERYTHROCIN LACTOBIONATE...............................11ERYTHROCIN STEARATE........................................ 11erythromycin ethylsuccinate for susp 200

mg/5ml........................................................................ 11erythromycin ophth oint 5 mg/gm.............................. 94erythromycin pads 2%.................................................11erythromycin soln 2%..................................................11erythromycin tab 250 mg............................................ 11erythromycin tab 500 mg............................................ 11ESBRIET....................................................................... 98ESBRIET....................................................................... 98ESBRIET....................................................................... 98escitalopram 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................................................................................75esomeprazole magnesium cap delayed release 40

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

mg................................................................................75ESTRACE......................................................................82

estradiol & norethindrone acetate tab 0.5-0.1mg................................................................................82

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

estradiol tab 0.5 mg.....................................................82estradiol tab 1 mg........................................................82estradiol tab 2 mg........................................................82estradiol td patch weekly 0.025

mg/24hr...................................................................... 82estradiol td patch weekly 0.0375 mg/24hr (37.5

mcg/24hr)................................................................... 82estradiol td patch weekly 0.05 mg/24hr.................... 82estradiol td patch weekly 0.06 mg/24hr.................... 82estradiol td patch weekly 0.075

mg/24hr...................................................................... 82estradiol td patch weekly 0.1 mg/24hr...................... 82estradiol vaginal cream 0.1 mg/gm........................... 82estradiol vaginal tab 10 mcg...................................... 82ESTROPIPATE............................................................. 82ESTROPIPATE............................................................. 82ESTROPIPATE............................................................. 82ethambutol 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..............................................................................82ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg..............................................................................82ETHYOL........................................................................ 29ETIDRONATE DISODIUM..........................................93ETIDRONATE DISODIUM..........................................93etodolac cap 200 mg.....................................................1etodolac cap 300 mg.....................................................1etodolac tab 400 mg......................................................2etodolac tab 500 mg......................................................2etodolac tab er 24hr 400 mg........................................ 1etodolac tab er 24hr 500 mg........................................ 1etodolac tab er 24hr 600 mg........................................ 2ETOPOPHOS............................................................... 29etoposide inj 100 mg/5ml (20 mg/ml)........................29etoposide inj 1 gm/50ml (20 mg/ml).......................... 29etoposide inj 500 mg/25ml (20 mg/ml)......................29EVOMELA..................................................................... 29EVOTAZ.........................................................................44EXELON........................................................................ 18EXELON........................................................................ 18EXELON........................................................................ 18exemestane tab 25 mg............................................... 29EXJADE.........................................................................73EXJADE.........................................................................73EXJADE.........................................................................73

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ezetimibe-simvastatin tab 10-10 mg..........................60ezetimibe-simvastatin tab 10-20 mg..........................60ezetimibe-simvastatin tab 10-40 mg..........................60ezetimibe-simvastatin tab 10-80 mg..........................60ezetimibe tab 10 mg....................................................60FFABRAZYME................................................................ 78FABRAZYME................................................................ 78famciclovir tab 125 mg................................................44famciclovir tab 250 mg................................................44famciclovir tab 500 mg................................................44famotidine for susp 40 mg/5ml...................................75famotidine inj 200 mg/20ml........................................ 75famotidine inj 20 mg/2ml.............................................75famotidine inj 40 mg/4ml.............................................75famotidine tab 20 mg...................................................75famotidine tab 40 mg...................................................76FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT TITRATION PACK....................................... 39FARESTON...................................................................29FARYDAK......................................................................29FARYDAK......................................................................29FARYDAK......................................................................29FASLODEX................................................................... 29fat emulsion iv soln 20%.............................................73felbamate susp 600 mg/5ml....................................... 15felbamate tab 400 mg................................................. 15felbamate tab 600 mg................................................. 15felodipine tab er 24hr 10 mg...................................... 60felodipine tab er 24hr 2.5 mg..................................... 60felodipine tab er 24hr 5 mg........................................ 60fenofibrate micronized cap 134 mg........................... 60fenofibrate micronized cap 200 mg........................... 60fenofibrate micronized cap 67 mg............................. 60fenofibrate tab 145 mg................................................60fenofibrate tab 160 mg................................................60fenofibrate tab 48 mg.................................................. 60fenofibrate tab 54 mg.................................................. 60fentanyl citrate lozenge on a handle 1200

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

mcg................................................................................2fentanyl citrate lozenge on a handle 200

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

fentanyl citrate lozenge on a handle 400mcg................................................................................2



fentanyl td patch 72hr 100 mcg/hr...............................2fentanyl td patch 72hr 12 mcg/hr................................. 2fentanyl td patch 72hr 25 mcg/hr................................. 2fentanyl td patch 72hr 37.5 mcg/hr..............................2fentanyl td patch 72hr 50 mcg/hr................................. 2fentanyl td patch 72hr 62.5 mcg/hr..............................2fentanyl td patch 72hr 75 mcg/hr................................. 2fentanyl td patch 72hr 87.5 mcg/hr..............................2FETZIMA....................................................................... 20FETZIMA....................................................................... 20FETZIMA....................................................................... 20FETZIMA....................................................................... 20FETZIMA TITRATION PACK......................................20FINACEA....................................................................... 71FINACEA....................................................................... 71finasteride tab 5 mg.....................................................79FIRAZYR....................................................................... 88FIRMAGON...................................................................85FIRMAGON...................................................................85flecainide acetate tab 100 mg....................................60flecainide acetate tab 150 mg....................................60flecainide acetate tab 50 mg...................................... 60FLOVENT DISKUS......................................................98FLOVENT DISKUS......................................................98FLOVENT DISKUS......................................................98FLOVENT HFA.............................................................98FLOVENT HFA.............................................................98FLOVENT HFA.............................................................98fluconazole 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...............................................24fluconazole 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..........................29fludarabine phosphate inj 25 mg/ml.......................... 29

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fludrocortisone acetate tab 0.1 mg............................ 80fluocinolone acetonide (otic) oil 0.01%..................... 96fluocinolone acetonide cream 0.01%........................ 71fluocinonide cream 0.05%.......................................... 71fluocinonide emulsified base cream

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

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

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

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

ml)................................................................................29fluorouracil soln 2%..................................................... 71fluorouracil soln 5%..................................................... 71FLUOXETINE 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........................39FLUPHENAZINE HCL.................................................39FLUPHENAZINE HCL.................................................39FLUPHENAZINE HCL.................................................39fluphenazine hcl tab 10 mg........................................ 39fluphenazine hcl tab 1 mg.......................................... 39fluphenazine hcl tab 2.5 mg....................................... 39fluphenazine hcl tab 5 mg.......................................... 39flurbiprofen sodium ophth soln 0.03%.......................94flurbiprofen tab 100 mg.................................................2flurbiprofen tab 50 mg................................................... 2flutamide cap 125 mg..................................................29FLUTICASONE PROPIONATE/

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

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

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

act................................................................................98fluticasone propionate oint 0.005%........................... 71fluvoxamine maleate tab 100 mg...............................20fluvoxamine maleate tab 25 mg.................................20

fluvoxamine maleate tab 50 mg.................................20FOLOTYN......................................................................29FOLOTYN......................................................................30fomepizole inj 1 gm/ml (for iv infusion)......................73fondaparinux sodium subcutaneous inj 10

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

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

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

mg/0.6ml.....................................................................54FORTEO........................................................................93fosamprenavir calcium tab 700 mg........................... 44fosinopril sodium & hydrochlorothiazide tab 10-12.5

mg................................................................................60fosinopril sodium & hydrochlorothiazide tab 20-12.5

mg................................................................................60fosinopril sodium tab 10 mg....................................... 60fosinopril sodium tab 20 mg....................................... 61fosinopril sodium tab 40 mg....................................... 61fosphenytoin sodium inj 100 mg/2ml.........................15fosphenytoin sodium inj 500 mg/10ml.......................15FOSRENOL.................................................................. 73FOSRENOL.................................................................. 73FOSRENOL.................................................................. 73FOSRENOL.................................................................. 73FOSRENOL.................................................................. 73furosemide inj 10 mg/ml..............................................61furosemide oral soln 10 mg/ml...................................61furosemide tab 20 mg................................................. 61furosemide tab 40 mg................................................. 61furosemide tab 80 mg................................................. 61FUZEON........................................................................44FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15Ggabapentin cap 100 mg.............................................. 15gabapentin cap 300 mg.............................................. 15gabapentin cap 400 mg.............................................. 15gabapentin oral soln 250 mg/5ml.............................. 15gabapentin tab 600 mg............................................... 15gabapentin tab 800 mg............................................... 15GABITRIL...................................................................... 15GABITRIL...................................................................... 15GALANTAMINE HYDROBROMIDE.......................... 18

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galantamine hydrobromide cap er 24hr 16mg................................................................................18



galantamine hydrobromide tab 12 mg...................... 18galantamine hydrobromide tab 4 mg.........................18galantamine hydrobromide tab 8 mg.........................18GAMMAGARD LIQUID............................................... 88GAMMAGARD LIQUID............................................... 88GAMMAGARD LIQUID............................................... 88GAMMAGARD LIQUID............................................... 88GAMMAGARD LIQUID............................................... 88GAMMAGARD LIQUID............................................... 88GAMMAGARD S/D......................................................88GAMMAGARD S/D......................................................88GAMMAPLEX............................................................... 88GAMMAPLEX............................................................... 88GAMMAPLEX............................................................... 88GAMMAPLEX............................................................... 88GAMMAPLEX............................................................... 88GAMMAPLEX............................................................... 88GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88ganciclovir sodium for inj 500 mg.............................. 44GARDASIL 9.................................................................88GARDASIL 9.................................................................89GATTEX.........................................................................76GAUZE PADS 2" X 2".................................................49GAZYVA.........................................................................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............................................... 61gentamicin in saline inj 0.8 mg/ml............................. 11gentamicin in saline inj 1.2 mg/ml............................. 11gentamicin in saline inj 1.6 mg/ml............................. 11gentamicin in saline inj 1 mg/ml.................................11gentamicin sulfate cream 0.1%..................................71gentamicin sulfate inj 10 mg/ml................................. 11gentamicin sulfate inj 40 mg/ml................................. 11

gentamicin sulfate oint 0.1%...................................... 71gentamicin sulfate ophth oint 0.3%........................... 94gentamicin sulfate ophth soln 0.3%...........................94GENVOYA.....................................................................44GEODON.......................................................................39GILOTRIF......................................................................30GILOTRIF......................................................................30GILOTRIF......................................................................30glatiramer acetate soln prefilled syringe 20 mg/

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

ml.................................................................................69GLEEVEC......................................................................30GLEEVEC......................................................................30GLEOSTINE..................................................................30GLEOSTINE..................................................................30GLEOSTINE..................................................................30GLEOSTINE..................................................................30glimepiride tab 1 mg....................................................49glimepiride tab 2 mg....................................................49glimepiride tab 4 mg....................................................49glipizide-metformin hcl tab 2.5-250 mg.....................49glipizide-metformin hcl tab 2.5-500 mg.....................49glipizide-metformin hcl tab 5-500 mg........................ 49glipizide tab 10 mg...................................................... 49glipizide tab 5 mg.........................................................49glipizide tab er 24hr 10 mg.........................................49glipizide tab er 24hr 2.5 mg........................................49glipizide tab er 24hr 5 mg...........................................49GLUCAGEN HYPOKIT............................................... 49GLUCAGON EMERGENCY KIT............................... 49glycopyrrolate tab 1 mg.............................................. 76glycopyrrolate tab 2 mg.............................................. 76granisetron hcl inj 1 mg/ml......................................... 22granisetron hcl inj 4 mg/4ml (1 mg/ml)......................22granisetron hcl tab 1 mg.............................................22GRANIX......................................................................... 54GRANIX......................................................................... 54griseofulvin microsize susp 125

mg/5ml........................................................................ 24griseofulvin ultramicrosize tab 125 mg......................24griseofulvin ultramicrosize tab 250 mg......................24GUANIDINE HCL.........................................................25HH.P. ACTHAR............................................................... 80HAEGARDA.................................................................. 89HAEGARDA.................................................................. 89HALAVEN...................................................................... 30halobetasol propionate cream 0.05%........................71halobetasol propionate oint 0.05%............................ 71

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haloperidol decanoate im soln 100 mg/ml.................................................................................39

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

haloperidol lactate inj 5 mg/ml................................... 39haloperidol lactate oral conc 2 mg/ml........................39haloperidol tab 0.5 mg................................................ 39haloperidol tab 10 mg................................................. 40haloperidol tab 1 mg....................................................39haloperidol tab 20 mg................................................. 40haloperidol tab 2 mg....................................................40haloperidol tab 5 mg....................................................40HARVONI...................................................................... 44HAVRIX..........................................................................89HAVRIX..........................................................................89heparin sodium (porcine) 40 unit/ml in

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

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



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

unit/0.5ml....................................................................54HEPATAMINE............................................................... 73HERCEPTIN................................................................. 30HERCEPTIN................................................................. 30HETLIOZ..................................................................... 101HEXALEN......................................................................30HIBERIX........................................................................ 89HUMALOG.................................................................... 49HUMALOG.................................................................... 50HUMALOG JUNIOR KWIKPEN.................................50HUMALOG KWIKPEN.................................................50HUMALOG KWIKPEN.................................................50HUMALOG MIX 50/50.................................................50HUMALOG MIX 50/50 KWIKPEN............................. 50HUMALOG MIX 75/25.................................................50HUMALOG MIX 75/25 KWIKPEN............................. 50HUMIRA.........................................................................89HUMIRA.........................................................................89HUMIRA.........................................................................89HUMIRA.........................................................................89HUMIRA.........................................................................89HUMIRA.........................................................................89HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................89HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................89

HUMIRA PEDIATRIC CROHNS DISEASESTARTER PACK.......................................................89

HUMIRA PEN............................................................... 89HUMIRA PEN............................................................... 89HUMIRA PEN-CROHNS DISEASE

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

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

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



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

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

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

0.1%............................................................................71hydrocortisone butyrate oint 0.1%.............................71hydrocortisone butyrate soln 0.1%............................ 71hydrocortisone cream 1%...........................................71hydrocortisone cream 2.5%........................................71hydrocortisone enema 100 mg/60ml.........................92hydrocortisone lotion 2.5%......................................... 71hydrocortisone oint 1%............................................... 71hydrocortisone oint 2.5%............................................ 71hydrocortisone rectal cream 1%................................ 92hydrocortisone rectal cream 2.5%.............................92

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hydrocortisone tab 10 mg...........................................80hydrocortisone tab 20 mg...........................................80hydrocortisone tab 5 mg............................................. 80hydrocortisone valerate cream 0.2%.........................71hydrocortisone valerate oint 0.2%............................. 71hydrocortisone w/ acetic acid otic soln

1-2%............................................................................96hydromorphone hcl liqd 1 mg/ml..................................2hydromorphone hcl preservative free inj 10 mg/

ml................................................................................... 2hydromorphone hcl tab 2 mg....................................... 2hydromorphone hcl tab 4 mg....................................... 2hydromorphone hcl tab 8 mg....................................... 2hydroxychloroquine sulfate tab 200 mg.................... 37HYDROXYPROGESTERONE

CAPROATE................................................................82hydroxyurea cap 500 mg............................................ 30hydroxyzine hcl syrup 10 mg/5ml.............................. 48hydroxyzine hcl tab 10 mg..........................................48hydroxyzine hcl tab 25 mg..........................................48hydroxyzine hcl tab 50 mg..........................................48Iibandronate sodium iv soln 3 mg/3ml........................93ibandronate sodium tab 150 mg................................ 93IBRANCE.......................................................................30IBRANCE.......................................................................30IBRANCE.......................................................................30ibuprofen susp 100 mg/5ml.......................................... 2ibuprofen tab 400 mg.................................................... 2ibuprofen tab 600 mg.................................................... 2ibuprofen tab 800 mg.................................................... 2ICLUSIG........................................................................ 30ICLUSIG........................................................................ 30idarubicin hcl iv inj 10 mg/10ml (1 mg/

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

ml)................................................................................30idarubicin hcl iv inj 5 mg/5ml (1 mg/ml).....................30IDHIFA............................................................................30IDHIFA............................................................................30IFEX............................................................................... 30IFOSFAMIDE................................................................ 30ifosfamide for inj 1 gm.................................................30ifosfamide iv inj 1 gm/20ml (50 mg/ml)..................... 30ifosfamide iv inj 3 gm/60ml (50 mg/ml)..................... 30ILARIS............................................................................89ILEVRO..........................................................................94imatinib mesylate tab 100 mg.................................... 31imatinib mesylate tab 400 mg.................................... 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31

IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMFINZI..........................................................................31IMFINZI..........................................................................31imipenem-cilastatin intravenous for soln 250

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

mg................................................................................11imipramine hcl tab 10 mg........................................... 20imipramine hcl tab 25 mg........................................... 20imipramine hcl tab 50 mg........................................... 20imiquimod cream 5%...................................................72IMLYGIC........................................................................ 31IMLYGIC........................................................................ 31IMOVAX RABIES (H.D.C.V.)...................................... 89IMPAVIDO..................................................................... 11INCRELEX.................................................................... 81INCRUSE ELLIPTA..................................................... 98indapamide tab 1.25 mg............................................. 61indapamide tab 2.5 mg............................................... 61INFANRIX......................................................................89INLYTA...........................................................................31INLYTA...........................................................................31INSULIN INJECTION DEVICE...................................50INSULIN SYRINGE/NEEDLE.....................................50INTELENCE.................................................................. 44INTELENCE.................................................................. 44INTELENCE.................................................................. 44INTRON A.....................................................................44INTRON A.....................................................................44INTRON A.....................................................................44INTRON A.....................................................................44INTRON A.....................................................................44INTRON A W/DILUENT..............................................44INTRON A W/DILUENT..............................................44INTRON A W/DILUENT..............................................45INVANZ.......................................................................... 11INVANZ.......................................................................... 11INVEGA......................................................................... 40INVEGA......................................................................... 40INVEGA......................................................................... 40INVEGA......................................................................... 40INVEGA SUSTENNA.................................................. 40INVEGA SUSTENNA.................................................. 40INVEGA SUSTENNA.................................................. 40INVEGA SUSTENNA.................................................. 40INVEGA SUSTENNA.................................................. 40INVEGA TRINZA..........................................................40INVEGA TRINZA..........................................................40INVEGA TRINZA..........................................................40

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INVEGA TRINZA..........................................................40INVIRASE......................................................................45INVIRASE......................................................................45INVOKAMET.................................................................50INVOKAMET.................................................................50INVOKAMET.................................................................50INVOKAMET.................................................................50INVOKAMET XR..........................................................50INVOKAMET XR..........................................................50INVOKAMET XR..........................................................50INVOKAMET XR..........................................................50INVOKANA....................................................................50INVOKANA....................................................................50IPOL INACTIVATED IPV.............................................89ipratropium bromide inhal soln 0.02%.......................98ipratropium bromide nasal soln 0.03% (21 mcg/

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

spray)..........................................................................99irbesartan-hydrochlorothiazide tab 150-12.5

mg................................................................................61irbesartan-hydrochlorothiazide tab 300-12.5

mg................................................................................61irbesartan tab 150 mg.................................................61irbesartan tab 300 mg.................................................61irbesartan tab 75 mg................................................... 61IRESSA..........................................................................31IRINOTECAN................................................................31irinotecan hcl inj 100 mg/5ml (20 mg/

ml)................................................................................31irinotecan hcl inj 40 mg/2ml (20 mg/ml).................... 31ISENTRESS..................................................................45ISENTRESS..................................................................45ISENTRESS..................................................................45ISENTRESS..................................................................45ISENTRESS HD...........................................................45ISONIAZID.................................................................... 26isoniazid tab 100 mg................................................... 26isoniazid tab 300 mg................................................... 26isosorbide dinitrate tab 10 mg....................................61isosorbide dinitrate tab 20 mg....................................61isosorbide dinitrate tab 30 mg....................................61isosorbide dinitrate tab 5 mg......................................61isosorbide mononitrate tab 10 mg............................. 61isosorbide mononitrate tab 20 mg............................. 61isosorbide mononitrate tab er 24hr 120

mg................................................................................61isosorbide mononitrate tab er 24hr 30

mg................................................................................61isosorbide mononitrate tab er 24hr 60

mg................................................................................61isotretinoin cap 10 mg.................................................72

isotretinoin cap 20 mg.................................................72isotretinoin cap 30 mg.................................................72isotretinoin cap 40 mg.................................................72isradipine cap 2.5 mg..................................................61isradipine cap 5 mg..................................................... 61ISTALOL........................................................................ 94ISTODAX.......................................................................31ISTODAX (OVERFILL)................................................31itraconazole cap 100 mg............................................ 24ivermectin tab 3 mg.....................................................37IXEMPRA KIT...............................................................31IXEMPRA KIT...............................................................31IXIARO...........................................................................89JJADENU........................................................................ 73JADENU........................................................................ 73JADENU........................................................................ 74JADENU SPRINKLE................................................... 74JADENU SPRINKLE................................................... 74JADENU SPRINKLE................................................... 74JAKAFI...........................................................................31JAKAFI...........................................................................31JAKAFI...........................................................................31JAKAFI...........................................................................31JAKAFI...........................................................................31JANUMET......................................................................50JANUMET......................................................................51JANUMET XR...............................................................51JANUMET XR...............................................................51JANUMET XR...............................................................51JANUVIA........................................................................51JANUVIA........................................................................51JANUVIA........................................................................51JARDIANCE..................................................................51JARDIANCE..................................................................51JENTADUETO.............................................................. 51JENTADUETO.............................................................. 51JENTADUETO.............................................................. 51JENTADUETO XR....................................................... 51JENTADUETO XR....................................................... 51JEVTANA.......................................................................31JULUCA.........................................................................45JUXTAPID..................................................................... 61JUXTAPID..................................................................... 61JUXTAPID..................................................................... 61JUXTAPID..................................................................... 61JUXTAPID..................................................................... 62JUXTAPID..................................................................... 62KKADCYLA......................................................................31KADCYLA......................................................................31

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KADIAN............................................................................3KADIAN............................................................................3KADIAN............................................................................3KADIAN............................................................................3KADIAN............................................................................3KADIAN............................................................................3KADIAN............................................................................3KADIAN............................................................................3KADIAN............................................................................3KALETRA...................................................................... 45KALETRA...................................................................... 45KALYDECO...................................................................99KALYDECO...................................................................99KALYDECO...................................................................99kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45%

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



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


inj................................................................................. 74KEPIVANCE..................................................................70ketoconazole cream 2%..............................................24ketoconazole shampoo 2%........................................ 24ketoconazole tab 200 mg........................................... 24ketoprofen cap 50 mg................................................... 3ketoprofen cap 75 mg................................................... 3ketorolac tromethamine ophth soln

0.4%............................................................................94ketorolac tromethamine ophth soln

0.5%............................................................................94KEYTRUDA...................................................................31KINERET....................................................................... 89KINRIX........................................................................... 89KISQALI.........................................................................31KISQALI FEMARA 200 DOSE...................................31KISQALI FEMARA 400 DOSE...................................31KISQALI FEMARA 600 DOSE...................................32KOMBIGLYZE XR........................................................51KOMBIGLYZE XR........................................................51KOMBIGLYZE XR........................................................51KORLYM........................................................................85KUVAN...........................................................................78KUVAN...........................................................................78KUVAN...........................................................................78KYNAMRO.................................................................... 62

KYPROLIS.................................................................... 32KYPROLIS.................................................................... 32Llabetalol hcl tab 100 mg..............................................62labetalol hcl tab 200 mg..............................................62labetalol hcl tab 300 mg..............................................62LACRISERT.................................................................. 94lactated ringer's solution............................................. 74lactic acid (ammonium lactate) cream

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

12%............................................................................. 72lactulose (encephalopathy) solution 10

gm/15ml......................................................................76lactulose solution 10 gm/15ml....................................76lamivudine oral soln 10 mg/ml................................... 45lamivudine tab 100 mg (hbv)......................................45lamivudine tab 150 mg................................................45lamivudine tab 300 mg................................................45lamivudine-zidovudine tab 150-300 mg.................... 45lamotrigine 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................................................................................16lansoprazole cap delayed release 15

mg................................................................................76lansoprazole cap delayed release 30

mg................................................................................76lanthanum carbonate chew tab 1000



mg................................................................................74LANTUS.........................................................................51LANTUS SOLOSTAR..................................................51LARTRUVO...................................................................32LARTRUVO...................................................................32latanoprost ophth soln 0.005%.................................. 94LATUDA.........................................................................40LATUDA.........................................................................40LATUDA.........................................................................40LATUDA.........................................................................40LATUDA.........................................................................40LAZANDA........................................................................ 3LAZANDA........................................................................ 3LAZANDA........................................................................ 3

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leflunomide tab 10 mg.................................................89leflunomide tab 20 mg.................................................89LENVIMA 10 MG DAILY DOSE.................................32LENVIMA 14 MG DAILY DOSE.................................32LENVIMA 18 MG DAILY DOSE.................................32LENVIMA 20 MG DAILY DOSE.................................32LENVIMA 24 MG DAILY DOSE.................................32LENVIMA 8 MG DAILY DOSE...................................32LETAIRIS.......................................................................99LETAIRIS.......................................................................99letrozole tab 2.5 mg.....................................................32LEUCOVORIN CALCIUM...........................................32LEUCOVORIN CALCIUM...........................................32LEUCOVORIN CALCIUM...........................................32leucovorin calcium for inj 100 mg.............................. 32leucovorin calcium for inj 200 mg.............................. 32leucovorin calcium for inj 350 mg.............................. 32leucovorin calcium for inj 50 mg................................ 32leucovorin calcium tab 25 mg.................................... 32leucovorin calcium tab 5 mg.......................................32LEUKERAN...................................................................32LEUKINE....................................................................... 54leuprolide acetate inj kit 5 mg/ml............................... 85LEVEMIR.......................................................................51LEVEMIR FLEXTOUCH..............................................51levetiracetam 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%................................ 95levocarnitine oral soln 1 gm/10ml

(10%).......................................................................... 74levocarnitine tab 330 mg............................................ 74levocetirizine dihydrochloride tab 5 mg.....................99LEVOFLOXACIN..........................................................11levofloxacin in d5w iv soln 250

mg/50ml......................................................................11levofloxacin in d5w iv soln 500

mg/100ml....................................................................11levofloxacin in d5w iv soln 750

mg/150ml....................................................................11levofloxacin iv soln 25 mg/ml..................................... 11levofloxacin tab 250 mg..............................................11

levofloxacin tab 500 mg..............................................11levofloxacin tab 750 mg..............................................11levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mg............................................................. 82levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg..............................................................................82levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg..............................................................................82levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg........................82levonorgestrel-ethinyl estradiol (continuous) tab

90-20 mcg..................................................................82levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7)...................................................................82levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7)...................................................................82LEVORPHANOL TARTRATE....................................... 3levothyroxine sodium tab 100 mcg............................84levothyroxine sodium tab 112 mcg............................ 84levothyroxine sodium tab 125 mcg............................84levothyroxine sodium tab 137 mcg............................84levothyroxine sodium tab 150 mcg............................84levothyroxine sodium tab 175 mcg............................84levothyroxine sodium tab 200 mcg............................84levothyroxine sodium tab 25 mcg..............................84levothyroxine sodium tab 300 mcg............................84levothyroxine sodium tab 50 mcg..............................84levothyroxine sodium tab 75 mcg..............................84levothyroxine sodium tab 88 mcg..............................84LEXIVA...........................................................................45LEXIVA...........................................................................45LIALDA...........................................................................92LIDOCAINE HCL..........................................................62lidocaine hcl gel 2%.......................................................5lidocaine hcl local inj 1%...............................................5lidocaine hcl local preservative free inj

1%..................................................................................5lidocaine hcl soln 4%.....................................................5lidocaine hcl viscous soln 2%.......................................5lidocaine oint 5%............................................................5lidocaine patch 5%.........................................................5lidocaine-prilocaine cream 2.5-2.5%........................... 5LINDANE....................................................................... 37LINEZOLID....................................................................11linezolid for susp 100 mg/5ml.................................... 11linezolid iv soln 600 mg/300ml (2 mg/

ml)................................................................................11linezolid tab 600 mg.................................................... 11LINZESS........................................................................76LINZESS........................................................................76LINZESS........................................................................76liothyronine sodium tab 25 mcg.................................84

2018

124

liothyronine sodium tab 50 mcg.................................84liothyronine sodium tab 5 mcg................................... 84lisinopril & hydrochlorothiazide tab 10-12.5

mg................................................................................62lisinopril & hydrochlorothiazide tab 20-12.5

mg................................................................................62lisinopril & hydrochlorothiazide tab 20-25

mg................................................................................62lisinopril tab 10 mg...................................................... 62lisinopril tab 2.5 mg..................................................... 62lisinopril tab 20 mg...................................................... 62lisinopril tab 30 mg...................................................... 62lisinopril tab 40 mg...................................................... 62lisinopril tab 5 mg.........................................................62LITHIUM........................................................................ 49lithium carbonate cap 150 mg....................................49lithium carbonate cap 300 mg....................................49lithium carbonate cap 600 mg....................................49lithium carbonate tab 300 mg.....................................49lithium carbonate tab er 300 mg................................49lithium carbonate tab er 450 mg................................49LONSURF..................................................................... 32LONSURF..................................................................... 32loperamide hcl cap 2 mg............................................ 76lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/

ml)................................................................................45lorazepam tab 0.5 mg................................................. 49lorazepam tab 1 mg.................................................... 49lorazepam tab 2 mg.................................................... 49losartan potassium & hydrochlorothiazide tab

100-12.5 mg.............................................................. 62losartan potassium & hydrochlorothiazide tab 100-25

mg................................................................................62losartan potassium & hydrochlorothiazide tab

50-12.5 mg.................................................................62losartan potassium tab 100 mg..................................62losartan potassium tab 25 mg....................................62losartan potassium tab 50 mg....................................62LOTEMAX..................................................................... 95LOTEMAX..................................................................... 95LOTEMAX..................................................................... 95lovastatin tab 10 mg....................................................62lovastatin tab 20 mg....................................................62lovastatin tab 40 mg....................................................62loxapine succinate cap 10 mg....................................40loxapine succinate cap 25 mg....................................40loxapine succinate cap 50 mg....................................40loxapine succinate cap 5 mg......................................40LUMIGAN...................................................................... 95LUMIZYME....................................................................78LUPRON DEPOT (1-MONTH)...................................85LUPRON DEPOT (1-MONTH)...................................85

LUPRON DEPOT (3-MONTH)...................................85LUPRON DEPOT (3-MONTH)...................................85LUPRON DEPOT (4-MONTH)...................................85LUPRON DEPOT (6-MONTH)...................................85LUPRON DEPOT-PED (1-MONTH)..........................85LUPRON DEPOT-PED (1-MONTH)..........................85LUPRON DEPOT-PED (1-MONTH)..........................85LUPRON DEPOT-PED (3-MONTH)..........................85LUPRON DEPOT-PED (3-MONTH)..........................86LYNPARZA....................................................................32LYNPARZA....................................................................32LYNPARZA....................................................................32LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYSODREN...................................................................85Mmagnesium sulfate inj 50%........................................ 74malathion lotion 0.5%..................................................37MAPROTILINE HCL.................................................... 20MAPROTILINE HCL.................................................... 20MAPROTILINE HCL.................................................... 20MARPLAN..................................................................... 20MARQIBO......................................................................32MATULANE...................................................................32MAVYRET..................................................................... 45meclizine hcl tab 12.5 mg...........................................22meclizine hcl tab 25 mg..............................................23medroxyprogesterone acetate im susp 150 mg/

ml.................................................................................82medroxyprogesterone acetate im susp prefilled syr

150 mg/ml.................................................................. 82medroxyprogesterone acetate tab 10

mg................................................................................83medroxyprogesterone acetate tab 2.5

mg................................................................................82medroxyprogesterone acetate tab 5

mg................................................................................82mefloquine hcl tab 250 mg......................................... 37megestrol acetate susp 40 mg/ml..............................83megestrol acetate tab 20 mg..................................... 83megestrol acetate tab 40 mg..................................... 83MEKINIST......................................................................32MEKINIST......................................................................32meloxicam tab 15 mg....................................................3meloxicam tab 7.5 mg...................................................3

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melphalan 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.................................................................. 90MENEST........................................................................83MENEST........................................................................83MENEST........................................................................83MENVEO....................................................................... 90mercaptopurine tab 50 mg......................................... 33meropenem iv for soln 1 gm...................................... 11meropenem iv for soln 500 mg.................................. 11mesalamine enema 4 gm........................................... 92mesalamine rectal enema 4 gm & cleanser wipe

kit................................................................................. 92mesalamine tab delayed release 1.2

gm................................................................................92mesna inj 100 mg/ml...................................................33MESNEX........................................................................33MESTINON................................................................... 25metformin hcl tab 1000 mg.........................................51metformin hcl tab 500 mg...........................................51metformin hcl tab 850 mg...........................................51metformin hcl tab er 24hr 500 mg............................. 51metformin hcl tab er 24hr 750 mg............................. 51methadone hcl tab 10 mg.............................................3methadone hcl tab 5 mg............................................... 3methazolamide tab 25 mg.......................................... 62methazolamide tab 50 mg.......................................... 62methenamine hippurate tab 1 gm..............................11methimazole tab 10 mg.............................................. 86methimazole tab 5 mg.................................................86methocarbamol tab 500 mg..................................... 101methocarbamol tab 750 mg..................................... 101METHOTREXATE SODIUM.......................................90methotrexate sodium for inj 1 gm.............................. 90methotrexate sodium inj 50 mg/2ml (25 mg/

ml)................................................................................90methotrexate sodium inj pf 1000 mg/40ml (25 mg/



ml)................................................................................90methotrexate sodium tab 2.5 mg............................... 90methoxsalen rapid cap 10 mg....................................72methscopolamine bromide tab 2.5 mg......................76methscopolamine bromide tab 5 mg......................... 76methylergonovine maleate tab 0.2 mg......................79methylphenidate hcl tab 10 mg..................................69

methylphenidate hcl tab 20 mg..................................69methylphenidate hcl tab 5 mg....................................69methylphenidate hcl tab er 20 mg............................. 69methylprednisolone sod succ for inj 1000

mg................................................................................80methylprednisolone sod succ for inj 125

mg................................................................................80methylprednisolone sod succ for inj 40

mg................................................................................80methylprednisolone tab 16 mg...................................80methylprednisolone tab 32 mg...................................80methylprednisolone tab 4 mg.....................................80methylprednisolone tab 8 mg.....................................80methylprednisolone tab therapy pack 4 mg

(21)..............................................................................80methyltestosterone cap 10 mg...................................83metoclopramide hcl inj 5 mg/ml................................. 76metoclopramide hcl soln 5 mg/5ml (10

mg/10ml).....................................................................76metoclopramide hcl tab 10 mg...................................76metoclopramide hcl tab 5 mg.....................................76metolazone tab 10 mg................................................ 62metolazone tab 2.5 mg............................................... 62metolazone tab 5 mg...................................................62metoprolol & hydrochlorothiazide tab 100-25

mg................................................................................62metoprolol & hydrochlorothiazide tab 50-25

mg................................................................................62metoprolol succinate tab er 24hr 100




mg................................................................................62metoprolol tartrate tab 100 mg...................................63metoprolol tartrate tab 25 mg.....................................62metoprolol tartrate tab 50 mg.....................................63METRO IV.....................................................................12metronidazole cap 375 mg.........................................12metronidazole cream 0.75%.......................................72metronidazole gel 0.75%............................................ 72metronidazole gel 1%..................................................72metronidazole in nacl 0.79% iv soln 500

mg/100ml....................................................................12metronidazole iv soln 5 mg/ml................................... 12metronidazole lotion 0.75%........................................ 72metronidazole tab 250 mg..........................................12metronidazole tab 500 mg..........................................12metronidazole vaginal gel 0.75%...............................12mexiletine hcl cap 150 mg..........................................63

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mexiletine hcl cap 200 mg..........................................63mexiletine hcl cap 250 mg..........................................63MIACALCIN...................................................................93midodrine hcl tab 10 mg............................................. 63midodrine hcl tab 2.5 mg............................................ 63midodrine hcl tab 5 mg............................................... 63MIGERGOT...................................................................25miglustat cap 100 mg..................................................78MIGRANAL....................................................................25minocycline hcl cap 100 mg.......................................12minocycline hcl cap 50 mg......................................... 12minocycline hcl cap 75 mg......................................... 12minocycline hcl tab 100 mg........................................12minocycline hcl tab 50 mg..........................................12minocycline hcl tab 75 mg..........................................12minoxidil tab 10 mg..................................................... 63minoxidil tab 2.5 mg.................................................... 63mirtazapine orally disintegrating tab 15

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

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

mg................................................................................20mirtazapine tab 15 mg................................................ 21mirtazapine tab 30 mg................................................ 21mirtazapine tab 45 mg................................................ 21mirtazapine tab 7.5 mg............................................... 20misoprostol tab 100 mcg............................................ 76misoprostol tab 200 mcg............................................ 76mitomycin for iv soln 20 mg....................................... 33mitomycin for iv soln 40 mg....................................... 33mitomycin for iv soln 5 mg..........................................33mitoxantrone hcl inj conc 20 mg/10ml (2 mg/

ml)................................................................................33mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/

ml)................................................................................33mitoxantrone hcl inj conc 30 mg/15ml (2 mg/

ml)................................................................................33M-M-R II........................................................................ 89modafinil tab 100 mg.................................................101modafinil tab 200 mg.................................................101moexipril hcl tab 15 mg...............................................63moexipril hcl tab 7.5 mg..............................................63moexipril-hydrochlorothiazide tab 15-12.5

mg................................................................................63moexipril-hydrochlorothiazide tab 15-25

mg................................................................................63moexipril-hydrochlorothiazide tab 7.5-12.5

mg................................................................................63mometasone furoate cream 0.1%............................. 72mometasone furoate nasal susp 50 mcg/

act................................................................................99

mometasone furoate oint 0.1%..................................72mometasone furoate solution 0.1%

(lotion).........................................................................72montelukast sodium chew tab 4 mg..........................99montelukast sodium chew tab 5 mg..........................99montelukast sodium oral granules packet 4

mg................................................................................99montelukast sodium tab 10 mg..................................99MORPHINE SULFATE.................................................. 3MORPHINE SULFATE.................................................. 3morphine sulfate cap er 24hr 100 mg......................... 3morphine sulfate cap er 24hr 10 mg........................... 3morphine sulfate cap er 24hr 20 mg........................... 3morphine sulfate cap er 24hr 30 mg........................... 3morphine sulfate cap er 24hr 50 mg........................... 3morphine sulfate cap er 24hr 60 mg........................... 3morphine sulfate cap er 24hr 80 mg........................... 3morphine sulfate inj pf 0.5 mg/ml.................................3morphine sulfate inj pf 1 mg/ml....................................3morphine sulfate oral soln 100 mg/5ml (20 mg/

ml)..................................................................................3morphine sulfate oral soln 10 mg/5ml......................... 3morphine sulfate oral soln 20 mg/5ml......................... 3morphine sulfate tab er 100 mg...................................3morphine sulfate tab er 15 mg..................................... 3morphine sulfate tab er 200 mg...................................3morphine sulfate tab er 30 mg..................................... 3morphine sulfate tab er 60 mg..................................... 3MOVIPREP................................................................... 76MOXEZA........................................................................95MOXIFLOXACIN HCL................................................. 12moxifloxacin hcl 400 mg/250ml in sodium chloride

0.8% inj.......................................................................12moxifloxacin hcl ophth soln 0.5%.............................. 95moxifloxacin hcl tab 400 mg.......................................12MOZOBIL...................................................................... 54MULTAQ........................................................................ 63mupirocin oint 2%........................................................ 72MUSTARGEN............................................................... 33MYALEPT...................................................................... 76MYCAMINE...................................................................24MYCAMINE...................................................................24mycophenolate mofetil cap 250 mg...........................90mycophenolate mofetil for oral susp 200 mg/

ml.................................................................................90mycophenolate mofetil hcl for iv soln 500

mg................................................................................90mycophenolate mofetil tab 500 mg........................... 90mycophenolate sodium tab dr 180 mg......................90mycophenolate sodium tab dr 360 mg......................90MYLOTARG.................................................................. 33

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Nnabumetone tab 500 mg...............................................4nabumetone tab 750 mg...............................................4nadolol tab 20 mg........................................................63nadolol tab 40 mg........................................................63nadolol tab 80 mg........................................................63NAFCILLIN SODIUM...................................................12NAFCILLIN SODIUM...................................................12nafcillin sodium for inj 1 gm........................................12nafcillin sodium for inj 2 gm........................................12nafcillin sodium for iv soln 10 gm.............................. 12NAGLAZYME................................................................78NALOXONE HCL........................................................... 6NALOXONE HCL........................................................... 6naloxone hcl inj 0.4 mg/ml............................................6naloxone hcl inj 4 mg/10ml...........................................6naltrexone hcl tab 50 mg.............................................. 6NAMENDA.................................................................... 18NAMENDA.................................................................... 18NAMENDA TITRATION PAK......................................18naproxen sodium tab 275 mg.......................................4naproxen sodium tab 550 mg.......................................4naproxen susp 125 mg/5ml.......................................... 4naproxen tab 250 mg.................................................... 4naproxen tab 375 mg.................................................... 4naproxen tab 500 mg.................................................... 4naproxen tab ec 375 mg...............................................4naproxen tab ec 500 mg...............................................4naratriptan hcl tab 1 mg..............................................25naratriptan hcl tab 2.5 mg...........................................25NARCAN..........................................................................6NATACYN......................................................................95nateglinide tab 120 mg............................................... 51nateglinide tab 60 mg..................................................51NATPARA...................................................................... 93NATPARA...................................................................... 93NATPARA...................................................................... 93NATPARA...................................................................... 93NEBUPENT...................................................................37NEFAZODONE HCL....................................................21NEFAZODONE HCL....................................................21NEFAZODONE HCL....................................................21nefazodone hcl tab 250 mg........................................21nefazodone hcl tab 50 mg..........................................21neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin..........................95neomycin-polymy-gramicid op sol

1.75-10000-0.025mg-unt-mg/ml............................. 95neomycin-polymyxin b gu irrigation

soln..............................................................................12

neomycin-polymyxin-dexamethasone ophth oint0.1%............................................................................95

neomycin-polymyxin-dexamethasone ophth susp0.1%............................................................................95

neomycin-polymyxin-hc otic soln 1%........................ 96neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%.................................................................. 96neomycin sulfate tab 500 mg.....................................12NERLYNX......................................................................33NEULASTA....................................................................55NEULASTA ONPRO KIT............................................ 55NEUPRO....................................................................... 38NEUPRO....................................................................... 38NEUPRO....................................................................... 38NEUPRO....................................................................... 38NEUPRO....................................................................... 38NEUPRO....................................................................... 38nevirapine tab 200 mg................................................ 45nevirapine tab er 24hr 100 mg...................................45nevirapine tab er 24hr 400 mg...................................45NEXAVAR......................................................................33NEXIUM.........................................................................76NEXIUM.........................................................................76NEXIUM.........................................................................76NEXIUM.........................................................................76NEXIUM.........................................................................76niacin tab er 1000 mg................................................. 63niacin tab er 500 mg................................................... 63niacin tab er 750 mg................................................... 63nicardipine hcl cap 20 mg...........................................63nicardipine hcl cap 30 mg...........................................63NICOTROL INHALER................................................... 6NICOTROL NS............................................................... 6nifedipine tab er 24hr 30 mg...................................... 63nifedipine tab er 24hr 60 mg...................................... 63nifedipine tab er 24hr 90 mg...................................... 63nifedipine tab er 24hr osmotic release 30

mg................................................................................63nifedipine tab er 24hr osmotic release 60

mg................................................................................63nifedipine tab er 24hr osmotic release 90

mg................................................................................63nilutamide tab 150 mg.................................................33nimodipine cap 30 mg.................................................63NINLARO.......................................................................33NINLARO.......................................................................33NINLARO.......................................................................33NIPENT..........................................................................33NISOLDIPINE ER........................................................ 63nisoldipine tab er 24hr 17 mg.................................... 63nisoldipine tab er 24hr 34 mg.................................... 63nisoldipine tab er 24hr 8.5 mg................................... 63

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NITRO-BID....................................................................63nitrofurantoin 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.......................................... 63nitroglycerin sl tab 0.4 mg.......................................... 63nitroglycerin sl tab 0.6 mg.......................................... 64nitroglycerin td patch 24hr 0.1 mg/hr.........................64nitroglycerin td patch 24hr 0.2 mg/hr.........................64nitroglycerin td patch 24hr 0.4 mg/hr.........................64nitroglycerin td patch 24hr 0.6 mg/hr.........................64nitroglycerin tl soln 0.4 mg/spray (400 mcg/

spray)..........................................................................64nizatidine cap 150 mg.................................................76nizatidine cap 300 mg.................................................76norethindrone & ethinyl estradiol-fe chew tab 0.4

mg-35 mcg.................................................................83norethindrone & ethinyl estradiol-fe chew tab 0.8

mg-25 mcg.................................................................83norethindrone & ethinyl estradiol tab 0.4 mg-35

mcg..............................................................................83norethindrone & ethinyl estradiol tab 0.5 mg-35

mcg..............................................................................83norethindrone & ethinyl estradiol tab 1 mg-35

mcg..............................................................................83norethindrone ace & ethinyl estradiol-fe tab 1.5

mg-30 mcg.................................................................83norethindrone ace & ethinyl estradiol-fe tab 1 mg-20

mcg..............................................................................83norethindrone ace & ethinyl estradiol tab 1.5 mg-30

mcg..............................................................................83norethindrone ace & ethinyl estradiol tab 1 mg-20

mcg..............................................................................83norethindrone ace-ethinyl estradiol-fe tab 1 mg-20

mcg (24).....................................................................83norethindrone acetate tab 5 mg.................................83norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35

mg-mcg.......................................................................83norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35

mg-mcg.......................................................................83norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35

mg-mcg.......................................................................83norethindrone tab 0.35 mg......................................... 83norgestimate & ethinyl estradiol tab 0.25 mg-35

mcg..............................................................................83norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg.........................83

norgestimate-eth estrad tab0.18-35/0.215-35/0.25-35 mg-mcg.........................83

norgestrel & ethinyl estradiol tab 0.3 mg-30mcg..............................................................................83

NORMOSOL-M IN D5W............................................. 74NORTHERA.................................................................. 64NORTHERA.................................................................. 64NORTHERA.................................................................. 64nortriptyline 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.........................................................................45NORVIR.........................................................................45NORVIR.........................................................................45NORVIR.........................................................................45NOXAFIL....................................................................... 24NOXAFIL....................................................................... 24NOXAFIL....................................................................... 24NUCYNTA ER.................................................................4NUCYNTA ER.................................................................4NUCYNTA ER.................................................................4NUCYNTA ER.................................................................4NUCYNTA ER.................................................................4NUEDEXTA...................................................................69NULOJIX........................................................................90NUPLAZID.....................................................................40nystatin cream 100000 unit/gm..................................24nystatin oint 100000 unit/gm...................................... 24nystatin susp 100000 unit/ml......................................24nystatin tab 500000 unit..............................................24nystatin topical powder 100000 unit/

gm................................................................................24nystatin-triamcinolone cream 100000-0.1 unit/gm-

%..................................................................................72nystatin-triamcinolone oint 100000-0.1 unit/gm-

%..................................................................................72OOCALIVA....................................................................... 78OCALIVA....................................................................... 78octreotide acetate inj 1000 mcg/ml (1 mg/

ml)................................................................................86octreotide acetate inj 100 mcg/ml (0.1 mg/




ml)................................................................................86

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ODEFSEY..................................................................... 45ODOMZO...................................................................... 33OFEV............................................................................. 99OFEV............................................................................. 99ofloxacin ophth soln 0.3%...........................................95ofloxacin otic soln 0.3%.............................................. 96ofloxacin tab 400 mg...................................................12olanzapine for im inj 10 mg........................................ 40olanzapine orally disintegrating tab 10

mg................................................................................40olanzapine orally disintegrating tab 15



mg................................................................................40olanzapine tab 10 mg..................................................41olanzapine tab 15 mg..................................................41olanzapine tab 2.5 mg.................................................41olanzapine tab 20 mg..................................................41olanzapine tab 5 mg....................................................41olanzapine tab 7.5 mg.................................................41olmesartan-amlodipine-hydrochlorothiazide tab

20-5-12.5 mg............................................................. 64olmesartan-amlodipine-hydrochlorothiazide tab

40-10-12.5 mg...........................................................64olmesartan-amlodipine-hydrochlorothiazide tab

40-10-25 mg.............................................................. 64olmesartan-amlodipine-hydrochlorothiazide tab

40-5-12.5 mg............................................................. 64olmesartan-amlodipine-hydrochlorothiazide tab

40-5-25 mg................................................................ 64olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg.................................................................64olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg.................................................................64olmesartan medoxomil-hydrochlorothiazide tab

40-25 mg....................................................................64olmesartan medoxomil tab 20 mg............................. 64olmesartan medoxomil tab 40 mg............................. 64olmesartan medoxomil tab 5 mg............................... 64olopatadine hcl nasal soln 0.6%................................ 99olopatadine hcl ophth soln 0.1%................................95olopatadine hcl ophth soln 0.2%................................95omega-3-acid ethyl esters cap 1 gm.........................64omeprazole cap delayed release 10

mg................................................................................76omeprazole cap delayed release 20

mg................................................................................76omeprazole cap delayed release 40

mg................................................................................76OMNITROPE................................................................ 81

OMNITROPE................................................................ 81OMNITROPE................................................................ 81ONCASPAR.................................................................. 33ondansetron 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......................................................................51ONGLYZA......................................................................51ONIVYDE...................................................................... 33OPDIVO.........................................................................33OPDIVO.........................................................................33OPDIVO.........................................................................33OPSUMIT...................................................................... 99ORACEA........................................................................72ORALAIR.......................................................................99ORENCIA...................................................................... 90ORENCIA...................................................................... 90ORENCIA...................................................................... 90ORENCIA...................................................................... 90ORENCIA CLICKJECT............................................... 90ORFADIN.......................................................................78ORFADIN.......................................................................78ORFADIN.......................................................................78ORFADIN.......................................................................78ORFADIN.......................................................................78ORKAMBI......................................................................99ORKAMBI......................................................................99oseltamivir phosphate cap 30 mg..............................45oseltamivir phosphate cap 45 mg..............................45oseltamivir phosphate cap 75 mg..............................45oseltamivir phosphate for susp 6 mg/

ml.................................................................................45OTEZLA.........................................................................90OTEZLA.........................................................................90oxaliplatin for iv inj 100 mg.........................................33oxaliplatin for iv inj 50 mg...........................................33oxaliplatin iv soln 100 mg/20ml..................................33oxaliplatin iv soln 50 mg/10ml....................................33oxandrolone tab 10 mg............................................... 83oxandrolone tab 2.5 mg..............................................83

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oxaprozin 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..........................79oxybutynin chloride tab 5 mg..................................... 79oxybutynin chloride tab er 24hr 10 mg......................79oxybutynin chloride tab er 24hr 15 mg......................79oxybutynin chloride tab er 24hr 5 mg........................79oxycodone-aspirin tab 4.8355-325 mg........................4oxycodone hcl tab 10 mg..............................................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...................................................................... 51OZEMPIC...................................................................... 51Ppaclitaxel iv conc 100 mg/16.7ml (6 mg/

ml)................................................................................33paclitaxel iv conc 300 mg/50ml (6 mg/

ml)................................................................................33paclitaxel iv conc 30 mg/5ml (6 mg/ml).....................33paliperidone tab er 24hr 1.5 mg.................................41paliperidone tab er 24hr 3 mg....................................41paliperidone tab er 24hr 6 mg....................................41paliperidone tab er 24hr 9 mg....................................41palonosetron hcl iv soln 0.25 mg/5ml........................23PALONOSETRON

HYDROCHLORIDE.................................................. 23PANRETIN.....................................................................33pantoprazole sodium ec tab 20 mg........................... 76pantoprazole sodium ec tab 40 mg........................... 77pantoprazole sodium for iv soln 40 mg..................... 77

paricalcitol cap 1 mcg................................................. 93paricalcitol cap 2 mcg................................................. 93paricalcitol cap 4 mcg................................................. 93paricalcitol iv soln 2 mcg/ml....................................... 93paricalcitol iv soln 5 mcg/ml....................................... 93paromomycin 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........................................................................... 26PATANOL.......................................................................95PAXIL............................................................................. 21PAZEO........................................................................... 95PEDIARIX......................................................................90PEDVAX HIB................................................................ 90peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236

gm................................................................................77peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240

gm................................................................................77peg 3350-kcl-sod bicarb-nacl for soln 420

gm................................................................................77PEGANONE..................................................................16PEGASYS..................................................................... 45PEGASYS..................................................................... 45PEGASYS PROCLICK................................................45PEGASYS PROCLICK................................................45penicillin g potassium for inj 20000000

unit...............................................................................12penicillin g potassium for inj 5000000

unit...............................................................................12PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 12PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 12PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 12PENICILLIN G SODIUM............................................. 12penicillin v potassium for soln 125

mg/5ml........................................................................ 12penicillin v potassium for soln 250

mg/5ml........................................................................ 13penicillin v potassium tab 250 mg............................. 13penicillin v potassium tab 500 mg............................. 13PENTACEL....................................................................90PENTAM 300................................................................37PENTASA...................................................................... 92PENTASA...................................................................... 92pentoxifylline tab er 400 mg....................................... 64perindopril erbumine tab 2 mg................................... 64perindopril erbumine tab 4 mg................................... 64perindopril erbumine tab 8 mg................................... 64

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PERJETA.......................................................................33permethrin cream 5%..................................................37perphenazine tab 16 mg.............................................23perphenazine tab 2 mg............................................... 23perphenazine tab 4 mg............................................... 23perphenazine tab 8 mg............................................... 23phenelzine sulfate tab 15 mg.....................................21PHENOBARBITAL....................................................... 16PHENOBARBITAL....................................................... 16PHENOBARBITAL....................................................... 16PHENOBARBITAL....................................................... 16phenobarbital elixir 20 mg/5ml...................................16PHENOBARBITAL SODIUM...................................... 16PHENOBARBITAL SODIUM...................................... 17phenobarbital tab 16.2 mg..........................................17phenobarbital tab 32.4 mg..........................................17phenobarbital tab 64.8 mg..........................................17phenobarbital tab 97.2 mg..........................................17phenoxybenzamine hcl cap 10 mg............................64phenytoin 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...................................................................74PHOSPHOLINE IODIDE.............................................95PICATO..........................................................................72PICATO..........................................................................72pilocarpine hcl ophth soln 1%.................................... 95pilocarpine hcl ophth soln 2%.................................... 95pilocarpine hcl ophth soln 4%.................................... 95pilocarpine hcl tab 5 mg..............................................70pilocarpine hcl tab 7.5 mg.......................................... 70pimozide tab 1 mg....................................................... 41pimozide tab 2 mg....................................................... 41pindolol tab 10 mg....................................................... 64pindolol tab 5 mg......................................................... 64pioglitazone hcl-glimepiride tab 30-2

mg................................................................................52pioglitazone hcl-glimepiride tab 30-4

mg................................................................................52pioglitazone hcl-metformin hcl tab 15-500

mg................................................................................52pioglitazone hcl-metformin hcl tab 15-850

mg................................................................................52pioglitazone hcl tab 15 mg..........................................52pioglitazone hcl tab 30 mg..........................................52pioglitazone hcl tab 45 mg..........................................52

piperacillin sod-tazobactam na for inj 3.375 gm(3-0.375 gm)..............................................................13

piperacillin sod-tazobactam sod for inj 2.25 gm(2-0.25 gm)................................................................ 13

piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5gm).............................................................................. 13

piroxicam cap 10 mg..................................................... 4piroxicam cap 20 mg..................................................... 4PLEGRIDY.................................................................... 69PLEGRIDY.................................................................... 69PLEGRIDY STARTER PACK..................................... 69PLEGRIDY STARTER PACK..................................... 69podofilox soln 0.5%..................................................... 72polyethylene glycol 3350 oral packet........................ 77polyethylene glycol 3350 oral powder.......................77polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1%...................................................................... 95POMALYST...................................................................33POMALYST...................................................................33POMALYST...................................................................33POMALYST...................................................................34PORTRAZZA................................................................ 34POTASSIUM CHLORIDE/DEXTROSE.....................74POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................74POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................74potassium chloride 20 meq/l (0.15%) in dextrose 5%

inj................................................................................. 74potassium chloride cap er 10 meq............................ 74potassium chloride cap er 8 meq...............................74potassium chloride inj 2 meq/ml................................ 74potassium chloride microencapsulated crys er tab 10

meq............................................................................. 74potassium chloride microencapsulated crys er tab 20

meq............................................................................. 74potassium chloride oral soln 10% (20

meq/15ml).................................................................. 74potassium chloride tab er 10 meq............................. 74potassium chloride tab er 8 meq (600

mg).............................................................................. 74potassium citrate tab er 10 meq (1080



mg).............................................................................. 74PRADAXA..................................................................... 55PRADAXA..................................................................... 55PRADAXA..................................................................... 55PRALUENT................................................................... 64PRALUENT................................................................... 64

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pramipexole dihydrochloride tab 0.125mg................................................................................38





pramipexole dihydrochloride tab 1 mg...................... 38prasugrel hcl tab 10 mg..............................................55prasugrel hcl tab 5 mg................................................ 55pravastatin sodium tab 10 mg....................................64pravastatin sodium tab 20 mg....................................64pravastatin sodium tab 40 mg....................................64pravastatin sodium tab 80 mg....................................64praziquantel tab 600 mg............................................. 37prazosin hcl cap 1 mg.................................................64prazosin hcl cap 2 mg.................................................64prazosin hcl cap 5 mg.................................................65prednicarbate cream 0.1%......................................... 72prednicarbate oint 0.1%..............................................72prednisolone acetate ophth susp 1%........................95prednisolone sod phosphate oral soln 15

mg/5ml........................................................................ 80prednisolone sod phosph oral soln 6.7 mg/5ml (5

mg/5ml base).............................................................80prednisolone syrup 15 mg/5ml...................................80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80prednisone tab 10 mg................................................. 81prednisone tab 1 mg................................................... 80prednisone tab 2.5 mg................................................ 80prednisone tab 20 mg................................................. 81prednisone tab 5 mg................................................... 81PREMARIN................................................................... 83PREMARIN................................................................... 83PREMARIN................................................................... 83PREMARIN................................................................... 83PREMARIN................................................................... 83PREMARIN................................................................... 83PREMPHASE............................................................... 83PREMPRO.................................................................... 84PREMPRO.................................................................... 84PREMPRO.................................................................... 84PREMPRO.................................................................... 84PREZCOBIX................................................................. 45

PREZISTA..................................................................... 45PREZISTA..................................................................... 46PREZISTA..................................................................... 46PREZISTA..................................................................... 46PREZISTA..................................................................... 46PRIFTIN.........................................................................26PRIMAQUINE PHOSPHATE......................................37primidone tab 250 mg................................................. 17primidone tab 50 mg................................................... 17PRISTIQ........................................................................ 21PRISTIQ........................................................................ 21PRISTIQ........................................................................ 21PROAIR HFA................................................................99PROAIR RESPICLICK................................................ 99probenecid tab 500 mg............................................... 25prochlorperazine edisylate inj 5 mg/ml......................23prochlorperazine maleate tab 10 mg.........................23prochlorperazine maleate tab 5 mg...........................23prochlorperazine suppos 25 mg................................ 23PROCRIT...................................................................... 55PROCRIT...................................................................... 55PROCRIT...................................................................... 55PROCRIT...................................................................... 55PROCRIT...................................................................... 55PROCRIT...................................................................... 55PROGLYCEM............................................................... 52PROGRAF.....................................................................90PROLASTIN-C..............................................................78PROLASTIN-C..............................................................78PROLENSA...................................................................95PROLEUKIN................................................................. 34PROLIA..........................................................................93PROMACTA.................................................................. 55PROMACTA.................................................................. 55PROMACTA.................................................................. 55PROMACTA.................................................................. 55promethazine 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........................ 65propafenone hcl cap er 12hr 325 mg........................ 65propafenone hcl cap er 12hr 425 mg........................ 65propafenone hcl tab 150 mg...................................... 65propafenone hcl tab 225 mg...................................... 65propafenone hcl tab 300 mg...................................... 65propranolol hcl cap er 24hr 120 mg.......................... 65propranolol hcl cap er 24hr 160 mg.......................... 65propranolol hcl cap er 24hr 60 mg.............................65propranolol hcl cap er 24hr 80 mg.............................65

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propranolol hcl inj 1 mg/ml......................................... 65propranolol hcl tab 10 mg...........................................65propranolol hcl tab 20 mg...........................................65propranolol hcl tab 40 mg...........................................65propranolol hcl tab 60 mg...........................................65propranolol hcl tab 80 mg...........................................65propylthiouracil tab 50 mg.......................................... 86PROQUAD.................................................................... 90protriptyline hcl tab 10 mg.......................................... 21protriptyline hcl tab 5 mg............................................ 21PULMOZYME............................................................... 99PURIXAN.......................................................................34PYLERA.........................................................................77pyrazinamide tab 500 mg........................................... 26pyridostigmine bromide tab 60 mg............................ 25pyridostigmine bromide tab er 180 mg......................25QQUADRACEL................................................................90quetiapine fumarate tab 100 mg................................41quetiapine fumarate tab 200 mg................................41quetiapine fumarate tab 25 mg..................................41quetiapine fumarate tab 300 mg................................41quetiapine fumarate tab 400 mg................................41quetiapine fumarate tab 50 mg..................................41quetiapine fumarate tab er 24hr 150

mg................................................................................41quetiapine fumarate tab er 24hr 200



mg................................................................................41quetiapine fumarate tab er 24hr 50 mg.....................41quinapril hcl tab 10 mg............................................... 65quinapril hcl tab 20 mg............................................... 65quinapril hcl tab 40 mg............................................... 65quinapril hcl tab 5 mg..................................................65quinapril-hydrochlorothiazide tab 10-12.5

mg................................................................................65quinapril-hydrochlorothiazide tab 20-12.5

mg................................................................................65quinapril-hydrochlorothiazide tab 20-25

mg................................................................................65quinidine gluconate tab er 324 mg............................ 65QUINIDINE SULFATE................................................. 65QUINIDINE SULFATE................................................. 65QVAR............................................................................. 99QVAR REDIHALER..................................................... 99QVAR REDIHALER..................................................... 99RRABAVERT................................................................... 91

rabeprazole sodium ec tab 20 mg............................. 77raloxifene hcl tab 60 mg............................................. 84ramipril cap 1.25 mg....................................................65ramipril cap 10 mg.......................................................65ramipril cap 2.5 mg......................................................65ramipril cap 5 mg.........................................................65RANEXA........................................................................65RANEXA........................................................................65ranitidine hcl cap 150 mg........................................... 77ranitidine hcl cap 300 mg........................................... 77ranitidine hcl syrup 15 mg/ml (75

mg/5ml).......................................................................77ranitidine hcl tab 150 mg............................................ 77ranitidine hcl tab 300 mg............................................ 77RAPAFLO...................................................................... 79RAPAFLO...................................................................... 79RAPAMUNE.................................................................. 91rasagiline mesylate tab 0.5 mg.................................. 38rasagiline mesylate tab 1 mg..................................... 38REBETOL......................................................................46REBIF.............................................................................69REBIF.............................................................................69REBIF REBIDOSE.......................................................69REBIF REBIDOSE.......................................................69REBIF REBIDOSE TITRATION................................. 69REBIF TITRATION PACK...........................................69RECOMBIVAX HB....................................................... 91RECOMBIVAX HB....................................................... 91RECOMBIVAX HB....................................................... 91REGRANEX.................................................................. 72RELENZA DISKHALER.............................................. 46RELISTOR.....................................................................77RELISTOR.....................................................................77RELISTOR.....................................................................77REMICADE................................................................... 91REMODULIN................................................................ 99REMODULIN................................................................ 99REMODULIN................................................................ 99REMODULIN................................................................ 99RENFLEXIS.................................................................. 91RENVELA......................................................................74repaglinide tab 0.5 mg................................................ 52repaglinide tab 1 mg....................................................52repaglinide tab 2 mg....................................................52REPATHA...................................................................... 65REPATHA PUSHTRONEX SYSTEM........................65REPATHA SURECLICK.............................................. 65RESCRIPTOR.............................................................. 46RESCRIPTOR.............................................................. 46RESTASIS.....................................................................95RESTASIS MULTIDOSE.............................................95RETROVIR IV INFUSION...........................................46

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REVLIMID......................................................................34REVLIMID......................................................................34REVLIMID......................................................................34REVLIMID......................................................................34REVLIMID......................................................................34REVLIMID......................................................................34REXULTI........................................................................41REXULTI........................................................................41REXULTI........................................................................41REXULTI........................................................................41REXULTI........................................................................41REXULTI........................................................................41REYATAZ.......................................................................46REYATAZ.......................................................................46REYATAZ.......................................................................46REYATAZ.......................................................................46RIBASPHERE...............................................................46RIBASPHERE...............................................................46RIBASPHERE RIBAPAK.............................................46RIBASPHERE RIBAPAK.............................................46ribavirin cap 200 mg....................................................46ribavirin for inhal soln 6 gm........................................ 99ribavirin tab 200 mg.....................................................46RIDAURA...................................................................... 91rifabutin cap 150 mg....................................................26rifampin cap 150 mg....................................................26rifampin cap 300 mg....................................................26rifampin for inj 600 mg................................................ 26riluzole tab 50 mg........................................................ 69rimantadine hydrochloride tab 100 mg......................46risedronate sodium tab 150 mg................................. 93risedronate sodium tab 30 mg................................... 93risedronate sodium tab 35 mg................................... 93risedronate sodium tab 5 mg..................................... 93risedronate sodium tab delayed release 35

mg................................................................................93RISPERDAL CONSTA................................................ 41RISPERDAL CONSTA................................................ 41RISPERDAL CONSTA................................................ 41RISPERDAL CONSTA................................................ 41risperidone orally disintegrating tab 0.25

mg................................................................................41risperidone orally disintegrating tab 0.5

mg................................................................................41risperidone orally disintegrating tab 1




mg................................................................................42

risperidone soln 1 mg/ml............................................ 42risperidone tab 0.25 mg..............................................42risperidone tab 0.5 mg................................................ 42risperidone tab 1 mg................................................... 42risperidone tab 2 mg................................................... 42risperidone tab 3 mg................................................... 42risperidone tab 4 mg................................................... 42ritonavir tab 100 mg.................................................... 46RITUXAN.......................................................................34RITUXAN.......................................................................34RITUXAN HYCELA......................................................34RITUXAN HYCELA......................................................34rivastigmine 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...................................................................... 18rivastigmine td patch 24hr 4.6 mg/24hr.....................18rivastigmine td patch 24hr 9.5 mg/24hr.....................18rizatriptan 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.........................38ropinirole hydrochloride tab 0.5 mg...........................38ropinirole hydrochloride tab 1 mg.............................. 38ropinirole hydrochloride tab 2 mg.............................. 38ropinirole hydrochloride tab 3 mg.............................. 38ropinirole hydrochloride tab 4 mg.............................. 38ropinirole hydrochloride tab 5 mg.............................. 38rosuvastatin calcium tab 10 mg................................. 66rosuvastatin calcium tab 20 mg................................. 66rosuvastatin calcium tab 40 mg................................. 66rosuvastatin calcium tab 5 mg................................... 66ROTARIX.......................................................................91ROTATEQ......................................................................91RUBRACA.....................................................................34RUBRACA.....................................................................34RUBRACA.....................................................................34RYDAPT........................................................................ 34SSABRIL.......................................................................... 17SABRIL.......................................................................... 17SAMSCA........................................................................75SAMSCA........................................................................75SANDIMMUNE............................................................. 91SANTYL.........................................................................72SAPHRIS.......................................................................42

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SAPHRIS.......................................................................42SAPHRIS.......................................................................42selegiline hcl cap 5 mg............................................... 38selegiline hcl tab 5 mg................................................ 38selenium sulfide lotion 2.5%.......................................72SELZENTRY.................................................................46SELZENTRY.................................................................46SELZENTRY.................................................................46SELZENTRY.................................................................46SELZENTRY.................................................................46SENSIPAR.....................................................................93SENSIPAR.....................................................................93SENSIPAR.....................................................................93SEREVENT DISKUS...................................................99sertraline 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......................... 75sevelamer carbonate packet 2.4 gm......................... 75sevelamer carbonate tab 800 mg..............................75SHINGRIX..................................................................... 91SIGNIFOR..................................................................... 86SIGNIFOR..................................................................... 86SIGNIFOR..................................................................... 86SIGNIFOR LAR............................................................86SIGNIFOR LAR............................................................86SIGNIFOR LAR............................................................86sildenafil citrate tab 20 mg..........................................99SILENOR.....................................................................101SILENOR.....................................................................101silver sulfadiazine cream 1%......................................72SIMBRINZA...................................................................95SIMULECT.................................................................... 91SIMULECT.................................................................... 91simvastatin tab 10 mg.................................................66simvastatin tab 20 mg.................................................66simvastatin tab 40 mg.................................................66simvastatin tab 5 mg................................................... 66simvastatin tab 80 mg.................................................66sirolimus tab 0.5 mg.................................................... 91sirolimus tab 1 mg....................................................... 91sirolimus tab 2 mg....................................................... 91SIRTURO.......................................................................26SIVEXTRO.................................................................... 13SIVEXTRO.................................................................... 13sodium chloride inj 0.45%...........................................75sodium chloride irrigation soln 0.9%......................... 75sodium chloride iv soln 0.9%..................................... 75sodium phenylbutyrate oral powder 3 gm/

teaspoonful.................................................................78

sodium phenylbutyrate tab 500 mg........................... 78sodium polystyrene sulfonate oral susp 15

gm/60ml......................................................................75sodium polystyrene sulfonate powder.......................75sodium polystyrene sulfonate rectal susp 30

gm/120ml....................................................................75SOLTAMOX...................................................................34SOMATULINE DEPOT................................................86SOMATULINE DEPOT................................................86SOMATULINE DEPOT................................................86SOMAVERT.................................................................. 86SOMAVERT.................................................................. 86SOMAVERT.................................................................. 86SOMAVERT.................................................................. 86SOMAVERT.................................................................. 86SOOLANTRA................................................................72sotalol hcl (afib/afl) tab 120 mg..................................66sotalol hcl (afib/afl) tab 160 mg..................................66sotalol hcl (afib/afl) tab 80 mg....................................66sotalol hcl tab 120 mg.................................................66sotalol hcl tab 160 mg.................................................66sotalol hcl tab 240 mg.................................................66sotalol hcl tab 80 mg...................................................66SOVALDI....................................................................... 46SPIRIVA HANDIHALER.............................................. 99SPIRIVA RESPIMAT................................................. 100SPIRIVA RESPIMAT................................................. 100spironolactone & hydrochlorothiazide tab 25-25

mg................................................................................66spironolactone tab 100 mg.........................................66spironolactone tab 25 mg........................................... 66spironolactone tab 50 mg........................................... 66SPRITAM.......................................................................17SPRITAM.......................................................................17SPRITAM.......................................................................17SPRITAM.......................................................................17SPRYCEL......................................................................34SPRYCEL......................................................................34SPRYCEL......................................................................34SPRYCEL......................................................................34SPRYCEL......................................................................34SPRYCEL......................................................................34STAMARIL.....................................................................91stavudine cap 15 mg...................................................46stavudine cap 20 mg...................................................46stavudine cap 30 mg...................................................46stavudine cap 40 mg...................................................46STELARA...................................................................... 91STELARA...................................................................... 91STELARA...................................................................... 91STELARA...................................................................... 91STIMATE....................................................................... 81

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STIOLTO RESPIMAT................................................ 100STIVARGA.....................................................................34STRENSIQ....................................................................78STRENSIQ....................................................................78STRENSIQ....................................................................78STRENSIQ....................................................................78STREPTOMYCIN SULFATE...................................... 13STRIBILD...................................................................... 46SUBLOCADE.................................................................. 6SUBLOCADE.................................................................. 6SUBOXONE....................................................................6SUBOXONE....................................................................6SUBOXONE....................................................................6SUBOXONE....................................................................6sucralfate tab 1 gm......................................................77sulfacetamide sodium lotion 10%.............................. 13sulfacetamide sodium ophth soln 10%..................... 95sulfacetamide sodium-prednisolone ophth soln

10-0.23(0.25)%..........................................................95SULFADIAZINE............................................................ 13sulfamethoxazole-trimethoprim iv soln 400-80

mg/5ml........................................................................ 13sulfamethoxazole-trimethoprim susp 200-40

mg/5ml........................................................................ 13sulfamethoxazole-trimethoprim tab 400-80

mg................................................................................13sulfamethoxazole-trimethoprim tab 800-160

mg................................................................................13sulfasalazine tab 500 mg............................................92sulfasalazine tab delayed release 500

mg................................................................................92sulindac tab 150 mg...................................................... 4sulindac tab 200 mg...................................................... 4sumatriptan nasal spray 20 mg/act........................... 25sumatriptan nasal spray 5 mg/act..............................25sumatriptan succinate inj 6 mg/0.5ml........................25sumatriptan succinate solution auto-injector 4

mg/0.5ml.....................................................................25sumatriptan succinate solution auto-injector 6

mg/0.5ml.....................................................................25sumatriptan succinate solution cartridge 4

mg/0.5ml.....................................................................25sumatriptan succinate solution cartridge 6

mg/0.5ml.....................................................................25sumatriptan succinate tab 100 mg............................ 25sumatriptan succinate tab 25 mg...............................25sumatriptan succinate tab 50 mg...............................25SUPRAX........................................................................13SUPRAX........................................................................13SUPRAX........................................................................13SUPREP BOWEL PREP KIT.....................................77SUSTIVA........................................................................46

SUSTIVA........................................................................46SUSTIVA........................................................................46SUTENT........................................................................ 34SUTENT........................................................................ 34SUTENT........................................................................ 34SUTENT........................................................................ 34SYLATRON................................................................... 46SYLATRON................................................................... 47SYLATRON................................................................... 47SYLVANT.......................................................................91SYLVANT.......................................................................91SYMBICORT...............................................................100SYMBICORT...............................................................100SYMDEKO.................................................................. 100SYMFI............................................................................ 47SYMFI LO..................................................................... 47SYMLINPEN 120......................................................... 52SYMLINPEN 60............................................................52SYNAGIS.......................................................................91SYNAGIS.......................................................................91SYNAREL......................................................................86SYNERCID....................................................................13SYNJARDY................................................................... 52SYNJARDY................................................................... 52SYNJARDY................................................................... 52SYNJARDY................................................................... 52SYNJARDY XR............................................................ 52SYNJARDY XR............................................................ 52SYNJARDY XR............................................................ 52SYNJARDY XR............................................................ 52SYNRIBO...................................................................... 34SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................85SYNTHROID.................................................................85SYNTHROID.................................................................85SYNTHROID.................................................................85SYNTHROID.................................................................85SYNTHROID.................................................................85SYNTHROID.................................................................85SYPRINE.......................................................................75TTABLOID........................................................................34tacrolimus cap 0.5 mg.................................................91tacrolimus cap 1 mg....................................................91tacrolimus cap 5 mg....................................................91tacrolimus oint 0.03%..................................................72tacrolimus oint 0.1%.................................................... 72TAFINLAR..................................................................... 34

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TAFINLAR..................................................................... 34TAGRISSO.................................................................... 34TAGRISSO.................................................................... 34TAMIFLU........................................................................47tamoxifen citrate tab 10 mg........................................35tamoxifen citrate tab 20 mg........................................35tamsulosin hcl cap 0.4 mg..........................................79TARCEVA...................................................................... 35TARCEVA...................................................................... 35TARCEVA...................................................................... 35TARGRETIN..................................................................35TASIGNA....................................................................... 35TASIGNA....................................................................... 35TASIGNA....................................................................... 35tazarotene cream 0.1%...............................................72TAZORAC......................................................................72TAZORAC......................................................................72TAZORAC......................................................................72TECENTRIQ................................................................. 35TECFIDERA..................................................................69TECFIDERA..................................................................69TECFIDERA STARTER PACK...................................69TECHNIVIE................................................................... 47TEFLARO......................................................................13TEFLARO......................................................................13TEKTURNA...................................................................66TEKTURNA...................................................................66TEKTURNA HCT......................................................... 66TEKTURNA HCT......................................................... 66TEKTURNA HCT......................................................... 66TEKTURNA HCT......................................................... 66telmisartan-hydrochlorothiazide tab 40-12.5

mg................................................................................66telmisartan-hydrochlorothiazide tab 80-12.5

mg................................................................................66telmisartan-hydrochlorothiazide tab 80-25

mg................................................................................66telmisartan tab 20 mg................................................. 66telmisartan tab 40 mg................................................. 66telmisartan tab 80 mg................................................. 66temazepam cap 15 mg............................................. 101temazepam cap 30 mg............................................. 101TEMODAR.................................................................... 35TENCON..........................................................................4TENIVAC....................................................................... 91tenofovir disoproxil fumarate tab 300

mg................................................................................47terazosin hcl cap 10 mg..............................................66terazosin hcl cap 1 mg................................................66terazosin hcl cap 2 mg................................................66terazosin hcl cap 5 mg................................................66terbinafine hcl tab 250 mg..........................................24

terbutaline sulfate tab 2.5 mg.................................. 100terbutaline sulfate tab 5 mg......................................100terconazole vaginal cream 0.4%................................24terconazole vaginal cream 0.8%................................24terconazole vaginal suppos 80 mg............................24testosterone cypionate im inj in oil 100 mg/

ml.................................................................................84testosterone cypionate im inj in oil 200 mg/

ml.................................................................................84testosterone enanthate im inj in oil 200 mg/

ml.................................................................................84testosterone td gel 12.5 mg/act (1%)........................ 84testosterone td gel 25 mg/2.5gm (1%)......................84testosterone td gel 50 mg/5gm (1%).........................84testosterone td soln 30 mg/act...................................84TETANUS/DIPHTHERIA TOXOIDS

ADSORBED...............................................................91tetrabenazine tab 12.5 mg..........................................69tetrabenazine tab 25 mg.............................................70tetracycline hcl cap 250 mg........................................13tetracycline hcl cap 500 mg........................................13THALOMID....................................................................35THALOMID....................................................................35THALOMID....................................................................35THALOMID....................................................................35theophylline tab er 12hr 100 mg..............................100theophylline tab er 12hr 200 mg..............................100theophylline tab er 12hr 300 mg..............................100theophylline tab er 12hr 450 mg..............................100theophylline tab er 24hr 400 mg..............................100theophylline tab er 24hr 600 mg..............................100thioridazine hcl tab 100 mg........................................ 42thioridazine hcl tab 10 mg.......................................... 42thioridazine hcl tab 25 mg.......................................... 42thioridazine hcl tab 50 mg.......................................... 42thiotepa for inj 15 mg.................................................. 35thiothixene cap 10 mg.................................................42thiothixene cap 1 mg...................................................42thiothixene cap 2 mg...................................................42thiothixene cap 5 mg...................................................42THYMOGLOBULIN......................................................91tiagabine hcl tab 12 mg.............................................. 17tiagabine hcl tab 16 mg.............................................. 17tiagabine hcl tab 2 mg.................................................17tiagabine hcl tab 4 mg.................................................17tigecycline for iv soln 50 mg.......................................13TIMOLOL MALEATE................................................... 66TIMOLOL MALEATE................................................... 66TIMOLOL MALEATE................................................... 67timolol maleate ophth gel forming soln

0.25%..........................................................................95

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timolol maleate ophth gel forming soln0.5%............................................................................95

timolol maleate ophth soln 0.25%..............................95timolol maleate ophth soln 0.5%................................95timolol maleate ophth soln 0.5% (once-

daily)............................................................................95TIVICAY......................................................................... 47TIVICAY......................................................................... 47TIVICAY......................................................................... 47tizanidine hcl cap 2 mg............................................... 43tizanidine hcl cap 4 mg............................................... 43tizanidine hcl cap 6 mg............................................... 43tizanidine hcl tab 2 mg................................................43tizanidine hcl tab 4 mg................................................43TOBRADEX...................................................................95tobramycin-dexamethasone ophth susp

0.3-0.1%..................................................................... 96tobramycin nebu soln 300 mg/5ml.......................... 100tobramycin ophth soln 0.3%.......................................95TOBRAMYCIN SULFATE........................................... 13tobramycin sulfate for inj 1.2 gm................................13tobramycin sulfate inj 1.2 gm/30ml (40 mg/

ml)................................................................................13tobramycin sulfate inj 10 mg/ml................................. 13tobramycin sulfate inj 80 mg/2ml (40 mg/

ml)................................................................................13tolcapone tab 100 mg................................................. 38TOLMETIN SODIUM..................................................... 5tolterodine tartrate cap er 24hr 2 mg.........................79tolterodine tartrate cap er 24hr 4 mg.........................79tolterodine tartrate tab 1 mg.......................................79tolterodine tartrate tab 2 mg.......................................79topiramate sprinkle cap 15 mg...................................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........................................... 35topotecan hcl inj 4 mg/4ml (for

infusion)...................................................................... 35TORISEL....................................................................... 35torsemide tab 100 mg................................................. 67torsemide tab 10 mg................................................... 67torsemide tab 20 mg................................................... 67torsemide tab 5 mg......................................................67TOUJEO MAX SOLOSTAR........................................52TOUJEO SOLOSTAR..................................................52TOVIAZ.......................................................................... 79TOVIAZ.......................................................................... 79TRACLEER.................................................................100TRACLEER.................................................................100

TRACLEER.................................................................100TRADJENTA................................................................. 52tramadol-acetaminophen tab 37.5-325

mg..................................................................................5tramadol hcl tab 50 mg................................................. 5tramadol hcl tab er 24hr 100 mg..................................5tramadol hcl tab er 24hr 200 mg..................................5tramadol hcl tab er 24hr 300 mg..................................5trandolapril tab 1 mg................................................... 67trandolapril tab 2 mg................................................... 67trandolapril tab 4 mg................................................... 67tranexamic acid iv soln 1000 mg/10ml (100 mg/

ml)................................................................................55tranexamic acid tab 650 mg.......................................55tranylcypromine sulfate tab 10 mg............................ 21TRAVATAN Z................................................................ 96trazodone hcl tab 100 mg...........................................21trazodone hcl tab 150 mg...........................................21trazodone hcl tab 300 mg...........................................21trazodone hcl tab 50 mg.............................................21TREANDA..................................................................... 35TREANDA..................................................................... 35TRECATOR...................................................................26TRELEGY ELLIPTA...................................................100TRELSTAR....................................................................86TRELSTAR....................................................................86TRELSTAR MIXJECT..................................................86TRELSTAR MIXJECT..................................................86TRELSTAR MIXJECT..................................................86TRESIBA FLEXTOUCH.............................................. 52TRESIBA FLEXTOUCH.............................................. 52tretinoin cap 10 mg......................................................35tretinoin cream 0.025%............................................... 72tretinoin cream 0.05%................................................. 72tretinoin cream 0.1%................................................... 72tretinoin gel 0.01%.......................................................73tretinoin gel 0.025%.....................................................73triamcinolone acetonide cream

0.025%........................................................................73triamcinolone acetonide cream 0.1%........................73triamcinolone acetonide cream 0.5%........................73triamcinolone acetonide dental paste

0.1%............................................................................70triamcinolone acetonide lotion 0.025%..................... 73triamcinolone acetonide lotion 0.1%..........................73triamcinolone acetonide nasal aerosol suspension

55 mcg/act............................................................... 100triamcinolone acetonide oint 0.025%........................ 73triamcinolone acetonide oint 0.1%.............................73triamcinolone acetonide oint 0.5%.............................73triamterene & hydrochlorothiazide cap 37.5-25

mg................................................................................67

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triamterene & hydrochlorothiazide tab 37.5-25mg................................................................................67

triamterene & hydrochlorothiazide tab 75-50mg................................................................................67

TRIBENZOR................................................................. 67TRIBENZOR................................................................. 67TRIBENZOR................................................................. 67TRIBENZOR................................................................. 67TRIBENZOR................................................................. 67trientine hcl cap 250 mg............................................. 75trifluoperazine hcl tab 10 mg......................................42trifluoperazine hcl tab 1 mg........................................42trifluoperazine hcl tab 2 mg........................................42trifluoperazine hcl tab 5 mg........................................42trifluridine ophth soln 1%............................................ 96trimethoprim tab 100 mg.............................................13trimipramine maleate cap 100 mg............................. 21trimipramine maleate cap 25 mg............................... 21trimipramine maleate cap 50 mg............................... 21TRINTELLIX..................................................................21TRINTELLIX..................................................................21TRINTELLIX..................................................................22TRISENOX....................................................................35TRIUMEQ......................................................................47TROGARZO..................................................................47trospium chloride cap er 24hr 60 mg.........................79trospium chloride tab 20 mg.......................................80TRULICITY....................................................................52TRULICITY....................................................................52TRUMENBA.................................................................. 92TRUVADA......................................................................47TRUVADA......................................................................47TRUVADA......................................................................47TRUVADA......................................................................47TWINRIX........................................................................92TYBOST........................................................................ 47TYGACIL....................................................................... 13TYKERB........................................................................ 35TYPHIM VI.................................................................... 92TYSABRI....................................................................... 70UULORIC......................................................................... 25ULORIC......................................................................... 25UNITUXIN......................................................................35UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100

UPTRAVI..................................................................... 100ursodiol cap 300 mg....................................................77ursodiol tab 250 mg.....................................................77ursodiol tab 500 mg.....................................................77Vvalacyclovir hcl tab 1 gm............................................ 47valacyclovir hcl tab 500 mg........................................47VALCHLOR................................................................... 35valganciclovir hcl for soln 50 mg/ml.......................... 47valganciclovir hcl tab 450 mg.....................................47valproate sodium inj 100 mg/ml.................................17valproate sodium oral soln 250 mg/5ml.................... 17valproic acid cap 250 mg............................................17valsartan-hydrochlorothiazide tab 160-12.5

mg................................................................................67valsartan-hydrochlorothiazide tab 160-25

mg................................................................................67valsartan-hydrochlorothiazide tab 320-12.5

mg................................................................................67valsartan-hydrochlorothiazide tab 320-25

mg................................................................................67valsartan-hydrochlorothiazide tab 80-12.5

mg................................................................................67valsartan tab 160 mg...................................................67valsartan tab 320 mg...................................................67valsartan tab 40 mg.....................................................67valsartan tab 80 mg.....................................................67vancomycin hcl cap 125 mg.......................................13vancomycin hcl cap 250 mg.......................................13vancomycin hcl for inj 1000 mg................................. 13vancomycin hcl for inj 100 gm................................... 13vancomycin hcl for inj 10 gm......................................14vancomycin hcl for inj 5000 mg................................. 14vancomycin hcl for inj 500 mg................................... 13vancomycin hcl for inj 750 mg................................... 13VANCOMYCIN HCL IN DEXTROSE.........................14VANCOMYCIN HCL IN DEXTROSE.........................14VANCOMYCIN HCL IN DEXTROSE.........................14VAQTA........................................................................... 92VAQTA........................................................................... 92VARIVAX........................................................................92VASCEPA...................................................................... 67VASCEPA...................................................................... 67VECTIBIX...................................................................... 35VECTIBIX...................................................................... 35VELCADE......................................................................35VENCLEXTA.................................................................35VENCLEXTA.................................................................35VENCLEXTA.................................................................35VENCLEXTA STARTING PACK................................ 35venlafaxine hcl cap er 24hr 150 mg.......................... 22

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venlafaxine 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................................................................... 100VENTAVIS................................................................... 100VENTOLIN HFA......................................................... 100verapamil hcl cap er 24hr 100 mg.............................67verapamil hcl cap er 24hr 120 mg.............................67verapamil hcl cap er 24hr 180 mg.............................67verapamil hcl cap er 24hr 200 mg.............................67verapamil hcl cap er 24hr 240 mg.............................67verapamil hcl cap er 24hr 300 mg.............................67verapamil hcl cap er 24hr 360 mg.............................67verapamil hcl tab 120 mg........................................... 68verapamil hcl tab 40 mg............................................. 68verapamil hcl tab 80 mg............................................. 68verapamil hcl tab er 120 mg.......................................68verapamil hcl tab er 180 mg.......................................68verapamil hcl tab er 240 mg.......................................68VERSACLOZ................................................................ 42VERZENIO....................................................................35VERZENIO....................................................................35VERZENIO....................................................................35VERZENIO....................................................................35VICTOZA....................................................................... 52VIDEX............................................................................ 47VIDEX............................................................................ 47VIDEX EC..................................................................... 47VIEKIRA PAK................................................................47VIEKIRA XR..................................................................47vigabatrin powd pack 500 mg.................................... 17VIGAMOX......................................................................96VIIBRYD.........................................................................22VIIBRYD.........................................................................22VIIBRYD.........................................................................22VIIBRYD STARTER PACK......................................... 22VIMOVO...........................................................................5VIMOVO...........................................................................5VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 18VINBLASTINE SULFATE............................................36

vincristine sulfate iv soln 1 mg/ml..............................36vinorelbine tartrate inj 10 mg/ml.................................36vinorelbine tartrate inj 50 mg/5ml (10 mg/

ml)................................................................................36VIOKACE.......................................................................78VIOKACE.......................................................................78VIRACEPT.................................................................... 47VIRACEPT.................................................................... 47VIRAMUNE................................................................... 47VIREAD..........................................................................47VIREAD..........................................................................47VIREAD..........................................................................47VIREAD..........................................................................47VIREAD..........................................................................48VIVITROL........................................................................ 6voriconazole for inj 200 mg........................................ 25voriconazole for susp 40 mg/ml.................................25voriconazole tab 200 mg............................................ 25voriconazole tab 50 mg...............................................25VOSEVI..........................................................................48VOTRIENT.................................................................... 36VPRIV............................................................................ 78VRAYLAR...................................................................... 42VRAYLAR...................................................................... 42VRAYLAR...................................................................... 42VRAYLAR...................................................................... 42VYXEOS........................................................................36Wwarfarin sodium tab 10 mg.........................................55warfarin sodium tab 1 mg...........................................55warfarin sodium tab 2.5 mg........................................55warfarin sodium tab 2 mg...........................................55warfarin sodium tab 3 mg...........................................55warfarin sodium tab 4 mg...........................................55warfarin sodium tab 5 mg...........................................55warfarin sodium tab 6 mg...........................................55warfarin sodium tab 7.5 mg........................................55water for irrigation, sterile irrigation

soln..............................................................................75WELCHOL.....................................................................68WELCHOL.....................................................................68XXALKORI....................................................................... 36XALKORI....................................................................... 36XARELTO...................................................................... 55XARELTO...................................................................... 55XARELTO...................................................................... 55XARELTO STARTER PACK.......................................55XATMEP........................................................................ 92XGEVA...........................................................................93XIFAXAN........................................................................77

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XOLAIR..........................................................................92XOPENEX HFA..........................................................101XTANDI.......................................................................... 36XYREM........................................................................101YYERVOY........................................................................36YERVOY........................................................................36YF-VAX.......................................................................... 92YONDELIS.................................................................... 36Zzafirlukast tab 10 mg.................................................101zafirlukast tab 20 mg.................................................101zaleplon cap 10 mg...................................................101zaleplon cap 5 mg..................................................... 101ZALTRAP.......................................................................36ZALTRAP.......................................................................36ZANOSAR..................................................................... 36ZAVESCA...................................................................... 78ZEJULA..........................................................................36ZELBORAF................................................................... 36ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZEPATIER..................................................................... 48ZERIT.............................................................................48ZIAGEN..........................................................................48zidovudine cap 100 mg...............................................48zidovudine syrup 10 mg/ml.........................................48zidovudine tab 300 mg................................................48ZINACEF....................................................................... 14ziprasidone hcl cap 20 mg..........................................42ziprasidone hcl cap 40 mg..........................................42ziprasidone hcl cap 60 mg..........................................42ziprasidone hcl cap 80 mg..........................................42ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5zoledronic acid inj conc for iv infusion 4

mg/5ml........................................................................ 93zoledronic acid iv soln 5 mg/100ml........................... 93ZOLINZA........................................................................36zolpidem tartrate tab 10 mg..................................... 101zolpidem tartrate tab 5 mg....................................... 101ZOMETA........................................................................ 94

zonisamide cap 100 mg..............................................18zonisamide cap 25 mg................................................18zonisamide cap 50 mg................................................18ZONTIVITY....................................................................55ZORTRESS...................................................................92ZORTRESS...................................................................92ZORTRESS...................................................................92ZOSTAVAX....................................................................92ZOSYN...........................................................................14ZOSYN...........................................................................14ZOSYN...........................................................................14ZYDELIG....................................................................... 36ZYDELIG....................................................................... 36ZYKADIA....................................................................... 36ZYPREXA RELPREVV............................................... 42ZYPREXA RELPREVV............................................... 42ZYPREXA RELPREVV............................................... 42ZYTIGA..........................................................................36ZYTIGA..........................................................................36

Nondiscrimination and Language Assistance

I

English: If you, or someone you’re helping, has questions about Blue Cross & Blue Shield of Rhode Island, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1-800-267-0439.

Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Blue Cross & Blue Shield of Rhode Island, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-800-267-0439.

Portuguese: Se você, ou alguém a quem você está ajudando, tem perguntas sobre o Blue Cross & Blue Shield of Rhode Island, você tem o direito de obter ajuda e informação em seu idioma e sem custos. Para falar com um intérprete, ligue para 1-800-267-0439.

Chinese: Blue Cross & Blue Shield of Rhode Island .

1-800-267-0439.

French Creole: Si oumenm oswa yon moun w ap ede gen kesyon konsènan Blue Cross & Blue Shield of Rhode Island, se dwa w pou resevwa asistans ak enfòmasyon nan lang ou pale a, san ou pa gen pou peye pou sa. Pou pale avèk yon entèprèt, rele nan 1-800-267-0439.

Cambodian-Mon-Khmer: Blue Cross & Blue Shield of Rhode Island

1-800-267-0439.

French: Si vous, ou quelqu’un que vous êtes en train d’aider, a des questions à propos de Blue Cross & Blue Shield of Rhode Island, vous avez le droit d’obtenir de l’aide et l’information dans votre langue à aucun coût. Pour parler à un interprète, appelez 1-800-267-0439.

Italian: Se tu o qualcuno che stai aiutando avete domande su Blue Cross & Blue Shield of Rhode Island, hai il diritto di ottenere aiuto e informazioni nella tua lingua gratuitamente. Per parlare con un interprete, puoi chiamare 1-800-267-0439.

Blue Cross & Blue Shield of Rhode Island (BCBSRI) complies with applicable Federal civil rights laws and does not discriminate or treat people differently on the basis of race, color, national origin, age, disability, or sex. BCBSRI provides free aids and services to people with disabilities and to people whose primary language is not English when such services are necessary to communicate effectively with us.If you need these services, contact us at 1-800-267-0439 TTY: 711.If you believe that BCBSRI has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Director of Grievance and Appeals Department, Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence RI 02903, or by calling 1-800-267-0439 TTY: 711. You can file a grievance in person, by phone or by mail, fax at (401) 459-5668 or electronically through our member portal at bcbsri.com/Medicare. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

English:

Spanish:

Portuguese:

Chinese:

French Creole:

Cambodian-Mon-Khmer:

French:

Italian:

09/16 BMED-96729 .1370

Laotian: Blue Cross & Blue

Shield of Rhode Island,

. 1-800-267-0439.

Arabic:

Appendix B: Sample Translated Taglines - Languages Are Listed in Alphabetical Order

Language Translated Taglines 1. Albanian General Tagline:

Nëse ju, ose dikush që po ndihmoni, ka pyetje për [insert SBM program name], keni të drejtë të merrni ndihmë dhe informacion falas në gjuhën tuaj. Për të folur me një përkthyes, telefononi numrin [insert number here].

Tagline for Notices: Ky njoftim përmban informacion të rëndësishëm. Ky njoftim përmban informacion të rëndësishëm për aplikimin ose mbulimin tuaj nëpërmjet [insert SBM program name]. Kontrolloni për data të rëndësishme në këtë njoftim. Mund t'ju duhet të ndërmerrni veprim brenda afatave të caktuara për të mbajtur mbulimin tuaj shëndetësor ose për ndihmën me koston. Keni të drejtë ta merrni këtë informacion dhe ndihmë falas në gjuhën tuaj. Telefononi numrin [insert number here].

2. Amharic General Tagline: እርስዎ፣ ወይም እርስዎ የሚያግዙት ግለሰብ፣ ስለ [insert SBM program name] ጥያቄ ካላችሁ፣ ያለ ምንም ክፍያ በቋንቋዎ እርዳታና መረጃ የማግኘት መብት አላችሁ። ከአስተርጓሚ ጋር ለመነጋገር፣ [insert number here] ይደውሉ።

Tagline for Notices: ይህ ማስታወቂያ አስፈላጊ መረጃ ይዟል። ይህ ማስታወቂያ ስለ ማመልከቻዎ ወይም የ[insert SBM program name] ሽፋን አስፈላጊ መረጃ አለው። በዚሀ ማስታወቂያ ውስጥ ቁልፍ ቀኖችን ፈልጉ። የጤናን ሽፋንዎን ለመጠበቅና በአከፋፈል እርዳታ ለማግኘት በተውሰኑ የጊዜ ገደቦች እርምጃ መውሰድ ይገባዎት ይሆናል። ይህን መረጃ እንዲያገኙ እና ያለምንም ክፍያ በቋንቋዎ እርዳታ እንዲያገኙ መብት አለዎት። [insert number here] ይደውሉ።

3. Arabic General Tagline: (، فلديك الحق في الحصول على المساعدة والمعلومات insert SBM program nameإن كان لديك أو لدى شخص تساعده أسئلة بخصوص )

(. insert number hereالضرورية بلغتك من دون اية تكلفة. للتحدث مع مترجم اتصل بـ )

Tagline for Notices: insert SBM programيحوي هذا االشعار معلومات مهمة بخصوص طلبك للحصول على التغطية من خالل ) يحوي هذا االشعار معلومات هامة.

name here ابحث عن التواريخ الهامة في هذا االشعار. قد تحتاج التخاذ اجراء في تواريخ معينة للحفاظ على تغطيتك الصحية او للمساعدة في دفع .) (.insert number hereلمعلومات والمساعدة بلغتك من دون أي تكلفة. اتصل بـ )التكاليف. لك الحق في الحصور على ا

4. Armenian General Tagline: Եթե Դուք կամ Ձեր կողմից օգնություն ստացող անձը հարցեր ունի [insert SBM program name] մասին, Դուք իրավունք ունեք անվճար օգնություն և տեղեկություններ ստանալու Ձեր նախընտրած լեզվով։ Թարգմանչի հետ խոսելու համար զանգահարե՛ք [insert number here]։

Blue Cross & Blue Shield of Rhode Island


































.1-800-267-0439












Russian:

Rhode Island Language Assistance Taglines:

English If you, or someone you’re helping, has questions about Blue Cross & Blue Shield of Rhode Island, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1‐800‐267‐0439.

1. Spanish Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Blue Cross & Blue Shield of Rhode Island, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1‐800‐267‐0439.

2. Portuguese Se você, ou alguém a quem você está ajudando, tem perguntas sobre o Blue Cross & Blue Shield of Rhode Island, você tem o direito de obter ajuda e informação em seu idioma e sem custos. Para falar com um intérprete, ligue para 1‐800‐267‐0439.

3. Chinese 如果您，或是您正在協助的對象，有關於[插入SBM項目的名稱 Blue Cross & Blue Shield of Rhode Island 方面的問題，您有權利免費以您的母語得到幫助和訊息。洽詢一位翻譯員，請撥電話在

此插入數字1‐800‐267‐0439。 4. French

Creole Si oumenm oswa yon moun w ap ede gen kesyon konsènan Blue Cross & Blue Shield of Rhode Island, se dwa w pou resevwa asistans ak enfòmasyon nan lang ou pale a, san ou pa gen pou peye pou sa. Pou pale avèk yon entèprèt, rele nan 1‐800‐267‐0439.

5. Cambodian‐Mon‐Khmer

របសិនបេរីអនក ឬនរណាមននក់ែដលអនកកំពុងែដជួយ មននសំណួរអ្◌ពីំ Blue Cross & Blue Shield of Rhode Island េប, អនកមននសិេ◌ធិេ◌េ◌◌ួលជំនួយនិងព័ែ◌◌ម៌នន េបៅកនុងភាសា ររស់អនក េបាយមិនអស់ប្◌ាក់ ។ ែបេ◌ើមបីនិយាយជាមួយអនករកដរប សូម 1‐800‐267‐0439 ។

6. French Si vous, ou quelqu'un que vous êtes en train d’aider, a des questions à propos de Blue Cross & Blue Shield of Rhode Island, vous avez le droit d'obtenir de l'aide et l'information dans votre langue à aucun coût. Pour parler à un interprète, appelez 1‐800‐267‐0439.

7. Italian Se tu o qualcuno che stai aiutando avete domande su Blue Cross & Blue Shield of Rhode Island, hai il diritto di ottenere aiuto e informazioni nella tua lingua gratuitamente. Per parlare con un interprete, puoi chiamare 1‐800‐267‐0439.

8. Laotian ຖ້າທ່ານ, ຫ ◌ຼ ◌ື ຄົນທ ◌່ ທ່ານກໍາລັງຊ່ວຍເຫ ◌ຼ ◌ື ອ, ມ ຄໍ າຖາມກ່ຽວກັບ Blue Cross & Blue Shield of Rhode Island, ທ່ານມ ສິ ດທ ◌່ ຈະໄດ້ຮັບການຊ່ວຍເຫ ◌ຼ ◌ື ອແລະຂໍ ້ ມູນຂ່າວສານທ ◌່ ເປັນພາສາຂອງທ່ານບໍ່ ມ ຄ່າໃຊ້ຈ່າຍ. ການໂອ້ລົມກັບນາຍພາສາ, ໃຫ້ໂທຫາ 1‐800‐267‐0439.

9. Arabic ��د�� ، Blue Cross & Blue Shield of Rhode Island ��و� أ�� د� �� د� أو ��د�� ن إنو��م��وم�� م��د� �� و� ��

.0439‐267‐800‐1 ب �� م�� مع ��د� .�� دون من �� و��10. Russian Если у вас или лица, которому вы помогаете, имеются вопросы по поводу Blue Cross & Blue

Shield of Rhode Island, то вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону 1‐800‐267‐0439.

11. Vietnamese Nếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Blue Cross & Blue Shield of Rhode Island, quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi 1‐800‐267‐0439.

12. Kru I bale we, tole mut u ye hola, a gwee mbarga inyu [insert SBM program name], U gwee Kunde I kosna mahola ni biniiguene I hop wong nni nsaa wogui wo. I Nyu ipot ni mut a nla koblene we hop, sebel [insert number here].

13. Ibo Ọ bụrụ gị, ma o bụ onye I na eyere‐aka, nwere ajụjụ gbasara Blue Cross & Blue Shield of Rhode Island, I nwere ohere iwenta nye maka na ọmụma na asụsụ gị na akwu gị ụgwọ. I chọrọ I kwụrụ onye‐ntapịa okwu, kpọ 1‐800‐267‐0439.

14. Yoruba Bí ìwọ, tàbí ẹnikẹni tí o n ranlọwọ, bá ní ibeere nípa Blue Cross & Blue Shield of Rhode Island, o ní ẹtọlati rí iranwọ àti ìfitónilétí gbà ní èdè rẹ láìsanwó. Láti bá ongbufọ kan sọrọ, pè sórí 1‐800‐267‐0439

15. Polish Jeśli Ty lub osoba, której pomagasz ,macie pytania odnośnie (insert SBM program), masz prawo do uzyskania bezpłatnej informacji i pomocy we własnym języku .Aby porozmawiać z tłumaczem, zadzwoń pod numer 1‐800‐267‐0439

16. Korean 만약 귀하 또는 귀하가 돕고 있는 어떤 사람이Blue Cross & Blue Shield of Rhode Island 에 관해서

질문이 있다면 귀하는 그러한 도움과 정보를 귀하의 언어로 비용 부담없이 얻을 수 있는

권리가 있습니다. 그렇게 통역사와 얘기하기 위해서는 1‐800‐267‐0439 로 전화하십시오. 17. Tagalog Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Blue Cross & Blue Shield of

Rhode Island, may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa 1‐800‐267‐0439.






此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French



















Vietnamese: Blue Cross & Blue Shield of Rhode Island,

1-800-267-0439.

Kru: I bale we, tole mut u ye hola, a gwee mbarga inyu Blue Cross & Blue Shield of Rhode Island, U gwee Kunde I kosna mahola ni biniiguene I hop wong nni nsaa wogui wo. I Nyu ipot ni mut a nla koblene we hop, sebel 1-800-267-0439.

Ibo:






此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French



















Yoruba: Blue Cross & Blue Shield of Rhode Island,

1-800-267-0439.

Polish: Blue Cross & Blue Shield of Rhode Island, .

1-800-267-0439.

Korean:






此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French
























此插入數字1‐800‐267‐0439。 4. French



















Tagalog: Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Blue Cross & Blue Shield of Rhode Island, may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa 1-800-267-0439.

This notice is being provided to you in compliance with federal law.

Laotian:

Arabic:

Russian:

Vietnamese:

Kru:

Ibo:

Yoruba:

Polish:

Korean:

Tagalog:

This notice is being provided to you in compliance with federal law.

Este formulario fue actualizado el . El formulario puede modificarse en cualquier momento. Se le notificará cuando sea necesario. Para obtener información actualizada o si tiene otras preguntas, comuníquese con el Equipo de asistencia de Medicare al (401) 277-2958 o al 1-800-267-0439 (los usuarios de TTY deben llamar al 711), los siete días de la semana desde el 1 de octubre hasta el 14 de febrero, de 8:00 a. m. a 8:00 p. m. Desde el 15 de febrero al 30 de setiembre, puede llamar de lunes a viernes, de 8:00 a. m a 8:00 p. m. Los sábados y domingos, llame de 8:00 a. m. hasta el mediodía. Fuera de estos horarios, puede usar nuestro sistema automatizado de respuesta, o visitar www.bcbsri.com/Medicare.

El formulario puede modificarse en cualquier momento. Se le notificará cuando sea necesario. Blue Cross & Blue Shield of Rhode Island es un plan de una HMO que tiene contrato con Medicare. La inscripción en Blue Cross & Blue Shield of Rhode Island depende de

la renovación del contrato. Licenciatario independiente de Blue Cross and Blue Shield Association.

500 Exchange Street • Providence, RI 02903-2699 • bcbsri.com/Medicare

agosto 1, 2018

BMED-19870608/16

Formulario 2018 - es.bcbsri.com · columna de la lista. ¿Qué son los medicamentos genéricos?...

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Transcript of Formulario 2018 - es.bcbsri.com · columna de la lista. ¿Qué son los medicamentos genéricos?...