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Formulario del Mercado de seguros de salud de California para el 2014 (Lista de medicamentos cubiertos)

IMPORTANTE: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS MEDICAMENTOS QUE CUBRIMOS CUANDO PARTICIPA EN UN PLAN DE SALUD CALIFICADO OFRECIDO POR KAISER PERMANENTE, E INCLUYE EL MERCADO DE SEGUROS DE SALUD (EN CALIFORNIA, ESTE MERCADO SE CONOCE COMO COVERED CALIFORNIA)

¿Qué es el formulario del Mercado de seguros de salud de California de Kaiser Permanente?

El formulario del Mercado de seguros de salud de California (California Marketplace Formulary) es una lista de los medicamentos cubiertos seleccionados por un grupo de médicos y farmacéuticos conocido como el Comité de Farmacia y Terapéutica (Pharmacy and Therapeutics Committee). Este comité se reúne con frecuencia para evaluar y seleccionar los medicamentos que son seguros y eficaces para nuestros miembros. Este formulario cumple con los requerimientos descritos bajo las leyes federales de planes de salud calificados que se ofrecen dentro de un mercado de seguros de salud (en California, este mercado se conoce como Covered California).

¿Qué medicamentos están cubiertos? Kaiser Permanente cubrirá generalmente los medicamentos genéricos y de marca que se mencionan en el Formulario del Mercado de seguros de salud de California siempre que el medicamento sea necesario desde el punto de vista médico, el medicamento recetado se surta en una farmacia de Kaiser Permanente o una farmacia afiliada y se cumplan otras reglas de cobertura.

Si le recetan un medicamento del Formulario del Mercado de seguros de salud de California, el medicamento estará cubierto bajo los términos de los beneficios de medicamentos.

¿Qué medicamentos no están cubiertos? Los medicamentos que no se mencionan en el Formulario del Mercado de seguros de salud de California no están cubiertos a menos que el médico de Kaiser Permanente determine a través de un proceso de excepciones que es un medicamento necesario desde el punto de vista médico. Si un medicamento que no se encuentra en el formulario es necesario desde el punto de vista médico, ese medicamento se cubrirá bajo las condiciones de los beneficios de medicamentos. Los medicamentos recetados que no se encuentran en el formulario pueden surtirse en farmacias de Kaiser Permanente. Sin embargo, se

Formulario del Mercado de seguros de salud de California de Kaiser Permanente para el 2014 • 1

aplicará el precio total del medicamento a menos que un médico de Kaiser Permanente haya proporcionado una excepción por ser necesario desde el punto de vista médico.

¿Existen restricciones en los medicamentos cubiertos en el formulario? Es posible que algunos de los medicamentos cubiertos posean requisitos adicionales o límites respecto a la cobertura, como límites en la cantidad. Para determinados medicamentos, Kaiser Permanente puede limitar la cantidad surtida a una cantidad determinada por día. Además, cuando no hay cantidad suficiente del medicamento a nivel nacional, es posible que limitemos la cantidad del medicamento surtido.

¿Qué es un medicamento de marca? Los medicamentos de marca generalmente los fabrica y los vende la empresa de medicamentos que realizó las investigaciones originales y desarrolló el medicamento. Cuando la patente de un medicamento de marca expira, otras empresas de medicamentos pueden fabricar y vender una versión genérica aprobada por la FDA con los mismos ingredientes activos a un precio menor.

¿Qué es un medicamento genérico? Un medicamento genérico aprobado por la FDA posee los mismos ingredientes activos que el medicamento de marca. Generalmente, los medicamentos genéricos son más económicos que los medicamentos de marca.

¿Qué medicamentos son elegibles para ser enviados desde la farmacia de pedido por correo? La mayoría de los medicamentos pueden ser enviados desde nuestra farmacia de pedido por correo. Algunos medicamentos (por ejemplo, los medicamentos que son extremadamente costosos o que requieren manipulación especial) no son elegibles para ser enviados por correo. Los medicamentos no pueden ser enviados fuera de los Estados Unidos.

Puede solicitar el surtido de medicamentos recetados por nuestro servicio de pedido por correo en línea en kp.org/refill, por teléfono o mediante la aplicación móvil. No se aplican cargos adicionales por el pedido por correo. Se aplicará el costo compartido apropiado (según el beneficio de medicamentos recetados).

Es posible que el beneficio de medicamentos recetados tenga costos compartidos menores si utiliza el servicio de farmacia de pedido por correo.

Consulte la Evidencia de cobertura (Evidence of Coverage) o el Certificado de seguro (Certificate of Insurance) para obtener información completa sobre el beneficio de medicamentos recetados. Formulario del Mercado de seguros de salud de California de Kaiser Permanente Kaiser Permanente puede agregar o eliminar medicamentos del Formulario del Mercado de seguros de salud de California durante el año. Estos cambios al Formulario se basan en información nueva o medicamentos nuevos que se encuentran disponibles.

El Formulario del Mercado de seguros de salud de California más actual comienza en la página 4. Proporciona información de cobertura de algunos de los medicamentos cubiertos por Kaiser Permanente. También puede buscar los medicamentos por orden alfabético utilizando el índice que comienza en la página 25. La primera columna de la tabla indica el nombre del medicamento. Los medicamentos de marca aparecen en mayúsculas (por ejemplo: ALBENZA) y los medicamentos genéricos aparecen en cursiva minúscula (por ejemplo: amoxicilina).


Es posible que no aparezcan todas las formas y las concentraciones de dosificación de un medicamento en particular en el Formulario. Algunos medicamentos tienen formas de dosificación múltiples. En tales casos, algunas dosificaciones pueden estar en el Formulario y otras no. Importante: Algunos de estos medicamentos pueden estar disponibles únicamente en una clínica. La segunda columna, “Nivel de medicamento”, indica el número de nivel en el que se encuentra el medicamento. Los medicamentos del Formulario del Mercado de seguros de salud de California se encuentran clasificados en uno de los dos niveles. Nivel 1: medicamentos genéricos Nivel 2: medicamentos de marca Importante: El nivel bajo el cual un medicamento genérico o de marca está clasificado puede variar en cualquier momento a lo largo del año. Además, ciertos medicamentos de marca pueden estar cubiertos con los costos compartidos que se aplican para el Nivel 1 y algunos medicamentos genéricos pueden estar cubiertos con los costos compartidos del Nivel 2. La tercera columna de la tabla indica los requerimientos o límites del medicamento: LD (Limited Distribution) = Distribución limitada. Los medicamentos de distribución limitada podrán obtenerse en determinadas farmacias especializadas. Para obtener más información sobre las farmacias especializadas, comuníquese con el Servicio a los miembros las 24 horas del día, siete días a la semana (cerrado los días festivos). 1-800-464-4000 inglés 1-800-788-0616 español 1-800-757-7585 dialectos chinos 1-800-777-1370 (TTY para las personas con problemas auditivos y del habla) MO (Mail Order) = Pedido por correo. Un medicamento que puede suministrarse por pedido por correo. Es posible que se apliquen ciertas restricciones o limitaciones.

QL (Quantity Limits) = Límites de cantidad. Para determinados medicamentos, es posible que limitemos la cantidad de medicamentos que puede recibir. Además, cuando no hay cantidad suficiente del medicamento a nivel nacional, es posible que limitemos la cantidad del medicamento surtido.


Nombre del medicamento

Nivel del

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Requerimiento s/Límites

ANTI-INFECTIVE AGENTS ANTHELMINTICS ALBENZA 2 BILTRICIDE 2 MEBENDAZOLE 2 ANTIBACTERIALS amikacin sulfate 1 amoxicillin 1, 2 amoxicillin & pot clavulanate 1, 2 ampicillin 1, 2 ampicillin & sulbactam sodium 1, 2 ampicillin sodium 1, 2 AVELOX 2 AZACTAM IN ISO-OSMOTIC DEXTROSE 2

azithromycin 1, 2 aztreonam 1, 2 bacitracin 1 BACTOCILL IN DEXTROSE 2 BICILLIN L-A 2 CAYSTON 2 cefaclor 1 cefadroxil 1 cefazolin sodium 1 CEFAZOLIN SODIUM/DEXTROSE 2

cefdinir 1 cefepime hcl 1 cefotaxime sodium 1 CEFOTETAN 2 CEFOTETAN/DEXTROSE 2 cefoxitin sodium 1 CEFOXITIN SODIUM 2 cefpodoxime proxetil 1 ceftazidime 1, 2 CEFTRIAXONE IN ISOOSMOTI C DEXTROSE 2

ceftriaxone sodium 1 CEFTRIAXONE/DEXTROSE 2 cefuroxime axetil 1 cefuroxime sodium 1, 2 CEFUROXIME/DEXTROSE 2 cephalexin 1, 2 CHLORAMPHENICOL SODIUM SU CCINATE 2


Nivel del

medi cam ento


ciprofloxacin 1, 2 ciprofloxacin hcl 1 ciprofloxacin in d5w 1 clarithromycin 1 CLEOCIN IN D5W 2 clindamycin hcl 1 clindamycin palmitate hydrochloride 1, 2

clindamycin phosphate 1, 2 CUBICIN 2 demeclocycline hcl 1 dicloxacillin sodium 1 doxycycline (monohydrate) 1, 2 doxycycline hyclate 1 ERY-TAB 2 ERYTHROCIN LACTOBIONATE 2

ERYTHROCIN STEARATE 2 erythromycin ethylsuccinate 1, 2 erythromycin-sulfisoxazole 1 FLUCONAZOLE IN NACL 2 FORTAZ 2 gentamicin in saline 1, 2 gentamicin sulfate 1 INVANZ 2 levofloxacin 1 levofloxacin in d5w 1 meropenem 1 minocycline hcl 1, 2 moxifloxacin hcl 1, 2 nafcillin sodium 1, 2 NALLPEN ISO-OSMOTIC IN DE XTROSE 2

neomycin sulfate 1 oxacillin sodium 1 penicillin g potassium 1 PENICILLIN G POTASSIUM IN ISO-OSMOTIC DEXTROSE

2

PENICILLIN G PROCAINE 2 PENICILLIN G SODIUM 2 penicillin v potassium 1 piperacillin sodiumtazobactam sodium 1

PRIMAXIN IV 2



Nivel del

medi cam ento


PRIMSOL 2 STREPTOMYCIN SULFATE 2 SULFADIAZINE 2 sulfamethoxazoletrimethoprim 1, 2

sulfasalazine 1 SUPRAX 2 SYNERCID 2 tetracycline hcl 1 tobramycin 1, 2 tobramycin sulfate 1 vancomycin hcl 1 VANCOMYCIN HCL IN DEXTROS E 2

XIFAXAN 2 ZINACEF IN ISO-OSMOTIC DEXTROSE 2

ZINACEF IN ISO-OSMOTIC DILUENT 2

ZOSYN 2 ZYVOX 2 ANTIFUNGALS ABELCET 2 AMBISOME 2 AMPHOTERICIN B 2 CANCIDAS 2 fluconazole 1 fluconazole in dextrose 1 fluconazole in nacl 1 flucytosine 1 griseofulvin microsize 1, 2 griseofulvin ultramicrosize 1 itraconazole 1, 2 ketoconazole 1 nystatin 1 nystatin (mouth-throat) 1 terbinafine hcl 1 voriconazole 1, 2 ANTIMYCOBACTERIALS CAPASTAT SULFATE 2 DAPSONE 2 ethambutol hcl 1 isoniazid 1, 2 PRIFTIN 2 pyrazinamide 1


Nivel del

medi cam ento


rifabutin 1 RIFAMATE 2 rifampin 1 SEROMYCIN 2 TRECATOR 2 ANTIPROTOZOALS ALINIA 2 atovaquone 1 atovaquone-proguanil hcl 1, 2 chloroquine phosphate 1 COARTEM 2 DARAPRIM 2 hydroxychloroquine sulfate 1 mefloquine hcl 1 metronidazole 1 metronidazole in nacl 1, 2 NEBUPENT 2 paromomycin sulfate 1 PRIMAQUINE PHOSPHATE 2 YODOXIN 2 ANTIVIRALS abacavir sulfate 1, 2 abacavir sulfate-lamivudinezidovudine 1, 2

acyclovir 1 acyclovir sodium 1, 2 adefovir dipivoxil 1, 2 APTIVUS 2 ATRIPLA 2 COMPLERA 2 CRIXIVAN 2 CYTOVENE 2 didanosine 1, 2 EDURANT 2 EMTRIVA 2 entecavir 1, 2 EPZICOM 2 famciclovir 1 FOSCARNET SODIUM 2 FUZEON 2 QL INCIVEK 2 INFERGEN 2 QL INTELENCE 2



Nivel del

medi cam ento


INVIRASE 2 ISENTRESS 2 KALETRA 2 lamivudine 1, 2 lamivudine-zidovudine 1 LEXIVA 2 nevirapine 1, 2 NORVIR 2 PEG-INTRON 2 QL PEGASYS 2 QL PREZISTA 2 RELENZA DISKHALER 2 RESCRIPTOR 2 REYATAZ 2 ribavirin (hepatitis c) 1 rimantadine hydrochloride 1 SELZENTRY 2 SOVALDI 2 QL stavudine 1 STRIBILD 2 SUSTIVA 2 SYNAGIS 2 TAMIFLU 2 TIVICAY 2 TRUVADA 2 valacyclovir hcl 1 VALCYTE 2 QL VICTRELIS 2 VIRACEPT 2 VIRAZOLE 2 VIREAD 2 VISTIDE 2 voriconazole 1 zidovudine 1, 2 URINARY ANTI-INFECTIVES methenamine hippurate 1 nitrofurantoin 1, 2 nitrofurantoin macrocrystal 1, 2 nitrofurantoin monohyd macro 1 TRAC 2 trimethoprim 1 ANTIHISTAMINE DRUGS FIRST GENERATION ANTIHISTAMINES


Nivel del

medi cam ento


chlorpheniramine & phenylephrine 1

cyproheptadine hcl 1 diphenhydramine hcl 1 promethazine hcl 1 ANTINEOPLASTIC AGENTS ANTINEOPLASTIC AGENTS ABRAXANE 2 ADCETRIS 2 AFINITOR 2 QL ALIMTA 2 ALKERAN 2 anastrozole 1 ARRANON 2 AVASTIN 2 bicalutamide 1 BICNU 2 bleomycin sulfate 1 CAMPATH 2 capecitabine 1, 2 QL CAPRELSA 2 QL carboplatin 1 CEENU 2 cisplatin 1 cladribine 1 COMETRIQ 2 QL CYCLOPHOSPHAMIDE 2 cytarabine 1, 2 dacarbazine 1, 2 DACOGEN 2 dactinomycin 1 daunorubicin hcl 1, 2 DAUNOXOME 2 DEPOCYT 2 doxorubicin hcl 1 doxorubicin hcl liposomal 1 ELSPAR 2 EMCYT 2 ERBITUX 2 ERIVEDGE 2 QL ERWINAZE 2 etoposide 1, 2 exemestane 1



Nivel del

medi cam ento


FASLODEX 2 fludarabine phosphate 1 fluorouracil 1 flutamide 1 GAZYVA 2 GEMZAR 2 GLEEVEC 2 QL HALAVEN 2 HERCEPTIN 2 HEXALEN 2 hydroxyurea 1 idarubicin hcl 1, 2 ifosfamide 1 IFOSFAMIDE/MESNA 2 IMBRUVICA 2 QL INTRON-A 2 QL irinotecan hcl 1 ISTODAX 2 IXEMPRA KIT 2 JAKAFI 2 QL JEVTANA 2 KADCYLA 2 KYPROLIS 2 letrozole 1 LEUKERAN 2 leuprolide acetate 1, 2 LUPRON DEPOT 2 LUPRON DEPOT-PED 2 LYSODREN 2 MATULANE 2 megestrol acetate 1 MEKINIST 2 QL melphalan hcl 1 mercaptopurine 1 methotrexate sodium 1 mitomycin 1 mitoxantrone hcl 1 MUSTARGEN 2 MYLERAN 2 NEXAVAR 2 QL ONCASPAR 2 oxaliplatin 1 paclitaxel 1


Nivel del

medi cam ento


pentostatin 1 PERJETA 2 POMALYST 2 QL PROLEUKIN 2 REVLIMID 2 QL RITUXAN 2 SPRYCEL 2 QL STIVARGA 2 SUTENT 2 QL TABLOID 2 TAFINLAR 2 QL tamoxifen citrate 1 TARCEVA 2 QL TARGRETIN 2 TASIGNA 2 QL TAXOTERE 2 temozolomide 1 THIOTEPA 2 topotecan hcl 1, 2 TORISEL 2 TREANDA 2 tretinoin (chemotherapy) 1 TRISENOX 2 TYKERB 2 QL VELCADE 2 VIDAZA 2 VINBLASTINE SULFATE 2 vincristine sulfate 1 vinorelbine tartrate 1 VOTRIENT 2 QL VUMON 2 XALKORI 2 QL XTANDI 2 QL YERVOY 2 ZANOSAR 2 ZELBORAF 2 QL ZYTIGA 2 QL AUTONOMIC DRUGS ANTICHOLINERGIC AGENTS atropine sulfate 1, 2 ATROVENT HFA 2 BELLADONNA & OPIUM 2 chlordiazepoxide hcl-clidinium 1



Nivel del

medi cam ento


bromide dicyclomine hcl 1, 2 glycopyrrolate 1, 2 hyoscyamine sulfate 1, 2 ipratropium bromide 1 ipratropium bromide (nasal) 1 phenobarbital-hyoscyamineatropine-scopolamine 1, 2

PROPANTHELINE BROMIDE 2 SCOPOLAMINE HYDROBROMIDE 2

SPIRIVA HANDIHALER 2 AUTONOMIC DRUGS, MISCELLANEOUS nicotine 1 nicotine polacrilex 1, 2 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS bethanechol chloride 1 donepezil hydrochloride 1 ENLON 2 galantamine hydrobromide 1 GUANIDINE HCL 2 MYTELASE 2 neostigmine methylsulfate 1 PHYSOSTIGMINE SALICYLATE 2

pilocarpine hcl (oral) 1 PROSTIGMIN 2 pyridostigmine bromide 1, 2 SKELETAL MUSCLE RELAXANTS atracurium besylate 1 baclofen 1, 2 cisatracurium besylate 1 cyclobenzaprine hcl 1 dantrolene sodium 1 methocarbamol 1 pancuronium bromide 1 QUELICIN 2 rocuronium bromide 1, 2 tizanidine hcl 1 vecuronium bromide 1 SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS DIBENZYLINE 2 dihydroergotamine mesylate 1, 2


Nivel del

medi cam ento


ERGOMAR 2 guanfacine hcl 1 PHENTOLAMINE MESYLATE 2 SYMPATHOMIMETIC (ADRENERGIC) AGENTS ADVAIR DISKUS 2 albuterol sulfate 1, 2 COMBIVENT 2 dobutamine hcl 1 dobutamine in d5w 1 dopamine hcl 1, 2 dopamine in d5w 1 ephedrine sulfate (pressors) 1 EPINEPHRINE 2 epinephrine hcl 1 isoproterenol hcl 1, 2 metaproterenol sulfate 1, 2 midodrine hcl 1 norepinephrine bitartrate 1 phenylephrine hcl (pressors) 1 SEREVENT DISKUS 2 terbutaline sulfate 1 BLOOD DERIVATIVES BLOOD DERIVATIVES albumin, human 1 PLASMANATE 2 BLOOD FORMATION, COAGULATION, AND THROMBOSIS ANTIANEMIA DRUGS iron dextran 1 polysaccharide iron complex 1 PROFERRIN ES 2 PROFERRIN-FORTE 2 VENOFER 2 ANTIHEMORRHAGIC AGENTS ADVATE 2 QL ALPHANATE/VON WILLEBRAND FACTOR COMPLEX/HUMAN

2 QL

ALPHANINE SD 2 QL aminocaproic acid 1, 2 BENEFIX 2 CYKLOKAPRON 2 GELFILM OP 2 GELFOAM SPONGE 2



Nivel del

medi cam ento


HEMOFIL M 2 QL KCENTRA 2 KOGENATE FS 2 QL NOVOSEVEN RT 2 PROFILNINE SD 2 QL PROTAMINE SULFATE 2 RECOTHROM 2 THROMBIN-JMI DILUENT 2 XYNTHA 2 QL ANTITHROMBOTIC AGENTS ACD-A NOCLOT-50 2 ACTIVASE 2 AGGRENOX 2 anagrelide hcl 1 ANGIOMAX 2 argatroban 1 ARGATROBAN 2 ATRYN 2 BRILINTA 2 clopidogrel bisulfate 1 EFFIENT 2 heparin (porcine) in sodium chloride 1, 2

heparin sod (porcine) in d5w 1 heparin sodium (porcine) 1 heparin sodium (porcine) lock flush 1

INTEGRILIN 2 LOVENOX 2 QL PRADAXA 2 PROFILNINE SD 2 REFLUDAN 2 REOPRO 2 THROMBATE III W/10 ML STE RILE WATER 2

TNKASE 2 warfarin sodium 1, 2 HEMATOPOIETIC AGENTS LEUKINE 2 NEUMEGA 2 NEUPOGEN 2 QL PROCRIT 2 QL PROMACTA 2 QL HEMORRHEOLOGIC AGENTS


Nivel del

medi cam ento


pentoxifylline 1 CARDIOVASCULAR DRUGS ALPHA-ADRENERGIC BLOCKING AGENTS doxazosin mesylate 1 prazosin hcl 1 tamsulosin hcl 1 terazosin hcl 1 ANTILIPEMIC AGENTS atorvastatin calcium 1 cholestyramine 1 cholestyramine light 1 colestipol hcl 1 fenofibrate 1 gemfibrozil 1 lovastatin 1 pravastatin sodium 1 simvastatin 1 BETA-ADRENERGIC BLOCKING AGENTS atenolol 1 atenolol & chlorthalidone 1 bisoprolol & hydrochlorothiazide 1

bisoprolol fumarate 1 BREVIBLOC 2 carvedilol 1 esmolol hcl 1 labetalol hcl 1 metoprolol & hydrochlorothiazide 1

metoprolol tartrate 1 nadolol 1 propranolol hcl 1 sotalol hcl 1 sotalol hcl (afib/afl) 1 CALCIUM-CHANNEL BLOCKING AGENTS amlodipine besylate 1 diltiazem hcl 1 diltiazem hcl coated beads 1 nicardipine hcl 1 nifedipine 1 nimodipine 1 verapamil hcl 1, 2 CARDIAC DRUGS adenosine 1, 2



Nivel del

medi cam ento


amiodarone hcl 1 digoxin 1, 2 disopyramide phosphate 1, 2 flecainide acetate 1 ibutilide fumarate 1 lidocaine hcl (cardiac) 1, 2 lidocaine in d5w 1 mexiletine hcl 1 milrinone in dextrose 1 milrinone lactate 1 PROCAINAMIDE HCL 2 propafenone hcl 1 quinidine gluconate 1, 2 quinidine sulfate 1, 2 TIKOSYN 2 HYPOTENSIVE AGENTS clonidine hcl 1 hydralazine hcl 1 methyldopa 1 METHYLDOPATE HCL 2 minoxidil 1 NITROPRESS 2 PROGLYCEM 2 RESERPINE 2 RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS benazepril hcl 1 captopril 1 enalaprilat 1 lisinopril 1 lisinopril & hydrochlorothiazide 1 losartan potassium 1 losartan potassium & hydrochlorothiazide 1

spironolactone 1 spironolactone & hydrochlorothiazide 1

SCLEROSING AGENTS ETHAMOLIN 2 SOTRADECOL 2 VASODILATING AGENTS alprostadil 1 CAVERJECT 2 dipyridamole 1


Nivel del

medi cam ento


dipyridamole (diagnostic) 1 isosorbide dinitrate 1, 2 isosorbide mononitrate 1 LETAIRIS 2 LEVITRA 2 QL nitroglycerin 1, 2 nitroglycerin in d5w 1, 2 papaverine hcl 1 REMODULIN 2 sildenafil citrate (pulmonary hypertension) 1

TRACLEER 2 TYVASO 2 VENTAVIS 2 CENTRAL NERVOUS SYSTEM AGENTS ANALGESICS AND ANTIPYRETICS acetaminophen w/ codeine 1 alfentanil 1, 2 buprenorphine hcl 1, 2 buprenorphine hcl-naloxone hcl dihydrate 1

butorphanol tartrate 1 choline & mag salicylate 1 codeine sulfate 1, 2 etodolac 1 fentanyl 1 QL fentanyl citrate 1 hydrocodone-acetaminophen 1, 2 hydromorphone hcl 1, 2 ibuprofen 1 indomethacin 1, 2 indomethacin sodium 1 INFUMORPH 200 2 ketorolac tromethamine 1, 2 MECLOFENAMATE SODIUM 2 mefenamic acid 1 meloxicam 1 meperidine hcl 1 methadone hcl 1, 2 morphine sulfate 1, 2 MORPHINE SULFATE IN DEXTR OSE 5% 2

nabumetone 1 nalbuphine hcl 1



Nivel del

medi cam ento


naproxen 1 naproxen sodium 1 NEOPROFEN 2 OFIRMEV 2 OPANA 2 oxycodone hcl 1 oxycodone w/ acetaminophen 1 pentazocine w/ naloxone 1 salsalate 1 sufentanil citrate 1 sulindac 1 tramadol hcl 1 tramadol-acetaminophen 1 ULTIVA 2 ANOREXIGENIC AGENTS AND RESPIRATORY AND CEREBRAL STIMULANTS amphetaminedextroamphetamine 1, 2

caffeine citrate 1 dextroamphetamine sulfate 1 methylphenidate hcl 1, 2 VYVANSE 2 ANTICONVULSANTS BANZEL 2 carbamazepine 1, 2 CELONTIN 2 clonazepam 1 divalproex sodium 1 EQUETRO 2 ethosuximide 1 felbamate 1 fosphenytoin sodium 1 gabapentin 1 lamotrigine 1, 2 levetiracetam 1, 2 magnesium sulfate 1, 2 oxcarbazepine 1, 2 phenytoin 1 phenytoin sodium 1 phenytoin sodium extended 1, 2 primidone 1 SABRIL 2 QL topiramate 1 valproate sodium 1


Nivel del

medi cam ento


valproic acid 1 ANTIMANIC AGENTS LITHIUM 2 lithium carbonate 1, 2 ANTIMIGRAINE AGENTS CAFERGOT 2 ergoloid mesylates 2 naratriptan hcl 1 rizatriptan benzoate 1 SUMATRIPTAN 2 sumatriptan succinate 1 ANTIPARKINSONIAN AGENTS amantadine hcl 1 APOKYN 2 AZILECT 2 benztropine mesylate 1 bromocriptine mesylate 1 cabergoline 1 carbidopa-levodopa 1 CARBIDOPA/LEVODOPA/EN TACA PONE 2

entacapone 1, 2 LODOSYN 2 pramipexole dihydrochloride 1 ropinirole hydrochloride 1 selegiline hcl 1 trihexyphenidyl hcl 1 ANXIOLYTICS, SEDATIVES, AND HYPNOTICS alprazolam 1 buspirone hcl 1 BUTISOL SODIUM 2 CHLORAL HYDRATE 2 chlordiazepoxide hcl 1 clorazepate dipotassium 1 DIASTAT ACUDIAL 2 diazepam 1, 2 droperidol 1 hydroxyzine hcl 1, 2 hydroxyzine pamoate 1, 2 lorazepam 1, 2 midazolam hcl 1 NEMBUTAL SODIUM 2 oxazepam 1



Nivel del

medi cam ento


phenobarbital 1, 2 PHENOBARBITAL SODIUM 1, 2 PRECEDEX 2 temazepam 1 zolpidem tartrate 1 CENTRAL NERVOUS SYSTEM AGENTS, MISCELLANEOUS acamprosate calcium 1 flumazenil 1 NAMENDA 2 riluzole 1 selegiline hcl 1 GENERAL ANESTHETICS BREVITAL SODIUM 2 ETHRANE 2 etomidate 1 FORANE 2 ketamine hcl 1 propofol 1 SUPRANE 2 OPIATE ANTAGONISTS naloxone hcl 1, 2 naltrexone hcl 1, 2 PSYCHOTHERAPEUTIC AGENTS ABILIFY 2 amitriptyline hcl 1 AMOXAPINE 2 bupropion hcl 1 chlorpromazine hcl 1, 2 citalopram hydrobromide 1 clomipramine hcl 1 clozapine 1 desipramine hcl 1 doxepin hcl 1, 2 duloxetine hcl 1 escitalopram oxalate 1 fluoxetine hcl 1 fluphenazine decanoate 1 fluphenazine hcl 1, 2 fluvoxamine maleate 1 haloperidol 1 haloperidol decanoate 1 haloperidol lactate 1


Nivel del

medi cam ento


imipramine hcl 1 loxapine succinate 1 MAPROTILINE HCL 2 mirtazapine 1 nefazodone hcl 1, 2 nortriptyline hcl 1, 2 olanzapine 1, 2 ORAP 2 paroxetine hcl 1 perphenazine 1 PERPHENAZINE/AMITRIPTY LIN E 2

phenelzine sulfate 1 prochlorperazine 1 prochlorperazine edisylate 1 prochlorperazine maleate 1 protriptyline hcl 1 quetiapine fumarate 1 risperidone 1 sertraline hcl 1 SURMONTIL 2 thioridazine hcl 1 thiothixene 1 tranylcypromine sulfate 1 trazodone hcl 1 trifluoperazine hcl 1 venlafaxine hcl 1 ziprasidone hcl 1 CONTRACEPTIVES (FOAMS, DEVICES) CONTRACEPTIVES (FOAMS, DEVICES) levonorgestrel & eth estradiol 1 ORTHO DIAPHRAGM ALLFLEX/ 65MM 2

WIDE-SEAL SILICONE DIAPHR AGM KIT 60 2

DEVICES DEVICES 1ML TB SYRINGE/25G X 5/8" /LUER SLIP TIP 2

3ML LUER-LOK SYRINGE 21G X 1" 2

AEROCHAMBER Z-STAT PLUS/F LOWSIGNAL 2

AEROTRACH PLUS 2 ASTHMAPACK I 2



Nivel del

medi cam ento


BD 10ML LUER-LOK SYRINGE 20G X 1-1/2" 2

BD 5ML LUER-LOK SYRINGE/2 0G X 1" 2

BD DISPOSABLE NEEDLE 23GX 1" PRECISION GLIDE 2

BD DISPOSABLE NEEDLE REGU LAR BEVEL 25GX1" 2

BD DISPOSABLE NEEDLE/30GX 1" 2

BD HYPODERMIC NEEDLE REGU LAR BEVEL 26GX5/8" 2

BD INSULIN SYRINGE MICROF INE IV/U100/0.5ML/28G X 1/2"

2

BD LANCET DEVICE 2 BD LANCET ULTRAFINE 33G 2 BD NEEDLE/16G X 1-1/2" 2 BD NEEDLE/18G 1-1/2" 2 BD NEEDLE/20G X 1" 2 BD NEEDLE/21G 1-1/2" 2 BD NEEDLE/22G X 1-1/2" 2 BD NEEDLE/27G X 1/2" 2 BD PEN NEEDLE/MINI/ULTRAF INE/31G X 3/16"

2

BD SAFETYGLIDE 27G X 5/8" 2

DISPOSABLE POWER 2 INSPIREASE REPLACEMENT MO UTHPIECE

2

INSPIREASE RESERVOIR BAGS 2

NORDIPEN 5 INJECTION DEVI CE 2

ONETOUCH NORMAL CONTROL 2

ONETOUCH ULTRA MINI 2 PEDIATRIC SMALL MASK 2 PENLET II AUTOMATIC BLOOD SAMPLER 2

syringe (disposable) 1, 2 TRUZONE PEAK FLOW METER 2

YALE NEEDLES/REGULAR BEVE L/THIN WALL/19G X 11/2"

2

DIAGNOSTIC AGENTS DIAGNOSTIC AGENTS


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ACETEST 2 ADENOSCAN 2 ALBUSTIX 2 CANDIN 2 CHEMSTRIP 9 STRIPS 2 CHIRHOSTIM 2 CLINITEST 2 CONRAY 2 CORTROSYN 2 CREON 2 CYSTOGRAFIN 2 D-XYLOSE 2 DEFINITY 2 DIASTIX 2 E-Z-CAT DRY 2 EOVIST 2 fluorescein sodium injection 1 fluorescein sodium topical 1 fluorescein w/ benoxinate 1 GADAVIST 2 GASTROGRAFIN 2 HYPAQUE SODIUM 2 indigotindisulfonate sodium 1 KETO-DIASTIX 2 LEXISCAN 2 MAGNEVIST 2 METOPIRONE 2 MULTIHANCE 2 OMNIPAQUE 2 ONETOUCH ULTRA BLUE 2 THYROGEN 2 TUBERSOL 2 ELECTROLYTIC, CALORIC, AND WATER BALANCE ACIDIFYING AGENTS AMMONIUM CHLORIDE 2 K-PHOS MF 2 ALKALINIZING AGENTS potassium citrate (alkalinizer) 2 potassium citrate-citric acid 1, 2 sodium acetate 1 sodium bicarbonate 1, 2 sodium citrate & citric acid 1 THAM 2



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TRICITRATES 2 AMMONIA DETOXICANTS BUPHENYL 2 QL lactulose 1 lactulose (encephalopathy) 1 LITHOSTAT 2 CALORIC AGENTS amino acid electrolyte infusion 1, 2 amino acid infusion 1, 2 CLINIMIX 2.75%/DEXTROSE 5 % 2

CLINIMIX 4.25%/DEXTROSE 1 0% 2



CLINIMIX 5%/DEXTROSE 15% 2

CLINIMIX E 2.75%/DEXTROSE 10% 2



CLINIMIX E 5%/DEXTROSE 15 % 2

CLINIMIX E 5%/DEXTROSE 20 % 2

dextrose 1, 2 fat emulsion 1, 2 PHENEX-1 2 DIURETICS amiloride & hydrochlorothiazide 1

bumetanide 1 CHLORTHALIDONE 2 DYRENIUM 2 EDECRIN 2 furosemide 1, 2 hydrochlorothiazide 1 indapamide 1 mannitol 1 metolazone 1 SODIUM EDECRIN 2 torsemide 1 triamterene & hydrochlorothiazide 1


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ION-REMOVING AGENTS RENVELA 2 sodium polystyrene sulfonate 1, 2 IRRIGATING SOLUTIONS acetic acid 1 DIANEAL LOW CALCIUM/1.5% DEXTROSE 2

lactated ringer's (irrigation) 1 ringer's irrigation 1 sodium chloride (gu irrigant) 1 water for irrigation, sterile 1 REPLACEMENT PREPARATIONS calcium acetate (phosphate binder) 1, 2

calcium chloride (dihydrate) 1 calcium gluconate 1 chromium chloride 1, 2 COPPER SULFATE 2 COPPER TRACE METAL 2 DEXTROSE 5% /ELECTROLYTE #48 VIAFLEX

2

dextrose in lactated ringers 1 dextrose in ringers 1 dextrose w/ sodium chloride 1, 2 hetastarch in sodium chloride 1 HEXTEND 2 HYPERLYTE-CR 1 K-PHOS 2 KCL 0.15%/D5W/LR 2 lactated ringer's 1 LMD 10% DEXTROSE 5% 2 LMD 10% SODIUM CHLORIDE 0 .9% 2

M.T.E.-5 CONCENTRATE 2 MAGNESIUM SULFATE IN D5W 2

MANGANESE TRACE METAL 2

PLASMA-LYTE A 2 potassium acetate 1 potassium bicarbonate 1 potassium chloride 1, 2 potassium chloride in dextrose 1 potassium chloride in dextrose & sodium chloride 1, 2



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potassium chloride in nacl 1, 2 potassium chloride microencapsulated crystals cr 1

potassium phosphate dibasic 1 ringer's 1 saline, bacteriostatic 1 SELENIUM 2 sodium chloride 1 sodium phosphate 1 trace minerals (cr-cu-mn-zn) 1, 2 zinc sulfate 1, 2 ZINC TRACE METAL 2 URICOSURIC AGENTS colchicine w/ probenecid 1 probenecid 1 ENZYMES ENZYMES ALDURAZYME 2 CEREDASE 2 CEREZYME 2 ELAPRASE 2 ELITEK 2 FABRAZYME 2 HYLENEX 2 KUVAN 2 MYOZYME 2 NAGLAZYME 2 PROLASTIN 2 PULMOZYME 2 VIMIZIM 2 VORAXAZE 2 VPRIV 2 EYE, EAR, NOSE, AND THROAT (EENT) PREPARATIONS ANTI-INFECTIVES BACITRACIN 2 bacitracin-polymyxin b (ophth) 1 chlorhexidine gluconate (mouth-throat) 1

ciprofloxacin hcl (ophth) 1 erythromycin (ophth) 1 gentamicin sulfate (ophth) 1 neomycin-bacitracin znpolymyxin 1

neomycin-polymyxin 1


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gramicidin ofloxacin (ophth) 1 ofloxacin (otic) 1 polymyxin b-trimethoprim 1 sulfacetamide sodium (ophth) 1 tobramycin (ophth) 1, 2 trifluridine 1 VITRASERT 2 ZYMAXID 2 ANTI-INFLAMMATORY AGENTS CIPRODEX 2 COLY-MYCIN S 2 dexamethasone sodium phosphate (ophth) 1

diclofenac sodium (ophth) 1 flunisolide (nasal) 1, 2 fluorometholone (ophth) 1, 2 flurbiprofen sodium 1 fluticasone propionate (nasal) 1 ketorolac tromethamine (ophth) 1

neomycin-polymy-dexameth 1 neomycin-polymyxin-hc (otic) 1 prednisolone acetate (ophth) 1, 2 PREDNISOLONE SODIUM PHOSP HATE 2

RESTASIS 2 RETISERT 2 sulfacetamide sodprednisolone 1, 2

TOBRADEX 2 VEXOL 2 ANTIALLERGIC AGENTS ALOCRIL 2 azelastine hcl 1 cromolyn sodium (ophth) 1 ANTIGLAUCOMA AGENTS acetazolamide 1, 2 acetazolamide sodium 1 betaxolol hcl (ophth) 1 brimonidine tartrate 1 dorzolamide hcl 1 dorzolamide hcl-timolol maleate 1

ISOPTO CARBACHOL 2



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latanoprost 1 levobunolol hcl 1, 2 LUMIGAN 2 methazolamide 1 MIOCHOL-E 2 PHOSPHOLINE IODIDE 2 pilocarpine hcl 1 timolol maleate (ophth) 1 EENT DRUGS, MISCELLANEOUS acetic acid (otic) 1 ACETIC ACID/ALUMINUM ACET ATE 2

apraclonidine hcl 1, 2 EYLEA 2 HEALON5 2 JETREA 2 LACRISERT 2 LUCENTIS 2 MACUGEN 2 ophthalmic irrigation solution intraocular 1

saline 1 VISUDYNE 2 LOCAL ANESTHETICS AKTEN 2 antipyrine-benzocaine 1 COCAINE HCL 2 lidocaine hcl (mouth-throat) 1 proparacaine hcl 1, 2 tetracaine hcl (ophth) 1 MYDRIATICS atropine sulfate (ophthalmic) 1, 2 CYCLOMYDRIL 2 cyclopentolate hcl 1, 2 ISOPTO HOMATROPINE 2 tropicamide 1 VASOCONSTRICTORS NAPHAZOLINE HCL 2 phenylephrine hcl (ophth) 1 GASTROINTESTINAL DRUGS ANTACIDS AND ADSORBENTS alum & mag hydroxsimethicone 1

aluminum hydroxide gel 1, 2


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ANTI-INFLAMMATORY AGENTS balsalazide disodium 1 mesalamine 1, 2 ANTIDIARRHEA AGENTS bismuth subsalicylate 1 diphenoxylate w/ atropine 1, 2 OPIUM TINCTURE (PAREGORIC ) 2

ANTIEMETICS dronabinol 1 EMEND 2 meclizine hcl 1 ondansetron 1 ondansetron hcl 1 TRANSDERM-SCOP 2 ANTIULCER AGENTS AND ACID SUPPRESSANTS cimetidine hcl 1 famotidine 1 FAMOTIDINE PREMIXED 2 misoprostol 1 omeprazole 1 pantoprazole sodium 1, 2 ranitidine hcl 1, 2 sucralfate 1, 2 ZANTAC 2 CATHARTICS AND LAXATIVES AMITIZA 2 CASCARA SAGRADA 2 castor oil 1 docusate sodium 1 glycerin (laxative) 1 magnesium hydroxide 1 MINERAL OIL LIGHT 2 peg 3350-kcl-sod bicarb-sod chloride-sod sulfate 1

SORBITOL 2 CHOLELITHOLYTIC AGENTS ursodiol 1 DIGESTANTS CREON 2 PROKINETIC AGENTS metoclopramide hcl 1 GOLD COMPOUNDS GOLD COMPOUNDS



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RIDAURA 2 HEAVY METAL ANTAGONISTS HEAVY METAL ANTAGONISTS BAL IN OIL 2 CHEMET 2 CUPRIMINE 2 deferoxamine mesylate 1 EXJADE 2 QL PENTETATE CALCIUM TRISODI UM 2

PENTETATE ZINC TRISODIUM 2

sodium thiosulfate 1, 2 HORMONES AND SYNTHETIC SUBSTITUTES ADRENALS A-HYDROCORT 1, 2 ARISTOSPAN INTRAARTICULA R 2

ASMANEX TWISTHALER 120 ME TERED DOSES 2

betamethasone sod phosphate & acetate 1

budesonide 1, 2 budesonide (inhalation) 1, 2 CELESTONE 2 CORTISONE ACETATE 2 dexamethasone 1, 2 dexamethasone sodium phosphate 1

FLOVENT HFA 2 fludrocortisone acetate 1 hydrocortisone 1 KENALOG-10 2 methylprednisolone 1, 2 methylprednisolone acetate 1 methylprednisolone sod succ 1, 2 prednisolone 1, 2 prednisolone sodium phosphate 1

prednisone 1, 2 QVAR 2 ANDROGENS ANDRODERM 2 ANDROID 2 ANDROXY 2 danazol 1


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oxandrolone 1 testosterone cypionate 1, 2 testosterone enanthate 1 ANTIDIABETIC AGENTS acarbose 1 glimepiride 1 glipizide 1 glipizide-metformin hcl 1 glyburide 1, 2 HUMALOG 2 HUMALOG MIX 50/50 2 HUMULIN 70/30 2 HUMULIN N 2 HUMULIN R 2 LANTUS 2 metformin hcl 1 pioglitazone hcl 1 TOLBUTAMIDE 2 ANTIHYPOGLYCEMIC AGENTS GLUCAGEN 2 GLUCAGON EMERGENCY KIT 2

CONTRACEPTIVES desogestrel & ethinyl estradiol 1 drospirenone-ethinyl estradiol 1 ELLA 2 ethynodiol diacet & eth estrad 1, 2 levonorgestrel & eth estradiol 1 levonorgestrel-eth estradiol (triphasic) 1

MIRENA 2 NECON 1/50-28 2 NECON 10/11-28 2 NEXPLANON 2 norethin acet & estrad-fe 1 norethindrone & eth estradiol 1 norethindrone (contraceptive) 1 norethindrone acet & eth estra 1 norethindrone-eth estradiol (triphasic) 1

norgestimate-ethinyl estradiol 1 norgestimate-ethinyl estradiol (triphasic) 1

norgestrel & ethinyl estradiol 1, 2 NUVARING 2



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PLAN B ONE-STEP 2 ESTROGENS AND ESTROGEN AGONISTSANTAGONISTS clomiphene citrate 1 DEPO-ESTRADIOL 2 esterified estrogens & methyltestosterone 1

ESTRACE 2 estradiol 1, 2 estradiol valerate 1 PREMARIN 2 raloxifene hcl 1 GONADOTROPINS BRAVELLE 2 chorionic gonadotropin 1 MENOPUR 2 SYNAREL 2 PARATHYROID FORTEO 2 QL FORTICAL 2 PITUITARY ACTHAR HP 2 desmopressin acetate 1, 2 desmopressin acetate refrigerated 1

desmopressin acetate spray 1 desmopressin acetate spray refrigerated 1

vasopressin 1 PROGESTINS DEPO-PROVERA 2 ENDOMETRIN 2 medroxyprogesterone acetate 1 medroxyprogesterone acetate (contraceptive) 1

norethindrone acetate 1 progesterone 1 progesterone micronized 1 SOMATROPIN AGONISTS-ANTAGONISTS NORDITROPIN FLEXPRO 2 QL SEROSTIM 2 QL THYROID AND ANTITHYROID AGENTS ARMOUR THYROID 2 levothyroxine sodium 1, 2 liothyronine sodium 1


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methimazole 1 propylthiouracil 1 SSKI 2 LOCAL ANESTHETICS LOCAL ANESTHETICS bupivacaine hcl 1 bupivacaine in dextrose 1 bupivacaine w/ epinephrine 1, 2 chloroprocaine hcl 1, 2 lidocaine hcl (cardiac) 1 lidocaine hcl (local anesth.) 1 lidocaine w/ epinephrine 1, 2 mepivacaine hcl 1, 2 NAROPIN 2 TETRACAINE HCL 1 MISCELLANEOUS THERAPEUTIC AGENTS MISCELLANEOUS THERAPEUTIC AGENTS ACETADOTE 2 acetylcysteine 1 ACTIMMUNE 2 alendronate sodium 1, 2 allopurinol 1 amifostine crystalline 1 ATGAM 2 AVONEX 2 QL azathioprine 1 AZATHIOPRINE SODIUM 2 BOTOX 2 BOTOX COSMETIC 2 COLCRYS 2 COPAXONE 2 QL cyclosporine modified (for microemulsion) 1, 2

CYSTADANE 2 QL CYSTAGON 2 QL dexrazoxane 1 disulfiram 1, 2 ELMIRON 2 ENBREL 2 QL ETIDRONATE DISODIUM 2 EXTAVIA 2 QL finasteride 1 FIRAZYR 2



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FLUOR-A-DAY 2 FUSILEV 2 HUMIRA 2 KALYDECO 2 QL KINERET 2 QL leflunomide 1 leucovorin calcium 1 levocarnitine (metabolic modifiers) 1

mesna 1, 2 QL methylene blue (antidote) 1 mycophenolate mofetil 1, 2 MYOBLOC 2 octreotide acetate 1, 2 ORENCIA 2 QL pamidronate disodium 1, 2 REMICADE 2 RIMSO-50 2 SANDIMMUNE 2 SENSIPAR 2 sirolimus 1, 2 sodium fluoride 1, 2 sodium fluoride (dental) 1, 2 SOLIRIS 2 SORIATANE 2 SUPARTZ 2 tacrolimus 1, 2 THALOMID 2 QL THIOLA 2 TRI-CHLOR 2 TYSABRI 2 water for injection, sterile 1 zoledronic acid 1 OXYTOCICS OXYTOCICS CERVIDIL 2 HEMABATE 2 methylergonovine maleate 1, 2 MIFEPREX 2 oxytocin 1 PHARMACEUTICAL AIDS PHARMACEUTICAL AIDS ALOE VERA 2


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ALPROSTADIL 2 ATROPINE SULFATE MONOHYDR ATE 2

BACLOFEN 2 BACTERIOSTATIC WATER FOR INJECTION/BENZYL ALCOHOL

2

BIOTIN 2 BORIC ACID 2 CANTHARIDIN 2 CARBAMAZEPINE 2 CHLOROFORM 2 CHLORPROMAZINE HCL 2 CHOLESTEROL ACETATE 2 CLINDAMYCIN HCL 2 CLOBETASOL PROPIONATE 2 CLONIDINE HCL 2 CLOTRIMAZOLE 2 COAL TAR 2 COLLODION FLEXIBLE 2 CYSTEAMINE HCL 2 DEXAMETHASONE 2 DILTIAZEM HCL 2 DIPHENYLCYCLOPROPENO NE 2

ESTRADIOL 2 GABAPENTIN 2 GLYCERIN 2 GLYCOPYRROLATE 2 HALOPERIDOL 2 HYDROCORTISONE 2 hydrophilic ointment 1 HYDROXOCOBALAMIN 2 HYDROXYPROGESTERONE CAPRO ATE 2

INDOMETHACIN 2 ISOSORBIDE 2 KETAMINE HCL 2 KETOPROFEN 2 L-ARGININE 2 L-CITRULLINE 2 L-ISOLEUCINE 2 L-PROLINE 2 L-VALINE 2 LACTIC ACID 2



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LACTOSE 2 LACTOSE MONOHYDRATE 2 LIDOCAINE HCL MONOHYDRATE 2

METHADONE HCL 2 METHYLCELLULOSE 2 METOCLOPRAMIDE HCL MONOHY DRATE 2

METRONIDAZOLE 2 MORPHINE SULFATE 2 NEOMYCIN SULFATE 2 PAPAVERINE HCL 2 PHENOBARBITAL 2 PHENTOLAMINE MESYLATE 2 PLURONIC F127 2 PODOPHYLLIN RESIN 2 POLYETHYLENE GLYCOL 400 2

POLYETHYLENE GLYCOL 8000 2

PROGESTERONE MICRONIZED 2

PROGESTERONE WETTABLE 2

PROPYLENE GLYCOL 2 QUINACRINE HCL 2 SALICYLIC ACID 2 SODIUM BENZOATE 2 SORBITOL 2 SQUARIC ACID DIBUTYLESTER 2

SULFUR PRECIPITATED 2 TESTOSTERONE 2 THYMOL 2 TRANEXAMIC ACID 2 TRIAMCINOLONE ACETONIDE 2

UREA 2 VERAPAMIL HCL 2 water for injection, sterile 1 ZINC SULFATE HEPTAHYDRATE 2

RESPIRATORY TRACT AGENTS ANTI-INFLAMMATORY AGENTS COMBIVENT RESPIMAT 2 cromolyn sodium 1 cromolyn sodium 1


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(mastocytosis) DULERA 2 montelukast sodium 1 ANTITUSSIVES benzonatate 1 guaifenesin-codeine 1 hydrocodone w/ homatropine 1 phenyleph-promethazine w/ cod 1

phenylephrine-chlorphen-dm 1 PHENYLHISTINE DH 2 promethazine w/codeine 1 promethazine-dm 1 pseudoephedrine w/ codeinegg 1

MUCOLYTIC AGENTS sodium chloride (inhalant) 1 PULMONARY SURFACTANTS CUROSURF 2 SURVANTA INTRATRACHEAL 2

RESPIRATORY AGENTS, MISCELLANEOUS OPSUMIT 2 QL XOLAIR 2 SERUMS, TOXOIDS, AND VACCINES SERUMS ANTIVENIN LATRODECTUS MAC TANS 2

CARIMUNE NANOFILTERED 2 CROFAB 2 CYTOGAM 2 DIGIFAB 2 GAMASTAN S/D 2 GAMMAGARD LIQUID 2 HYPERRAB S/D 2 HYPERTET S/D 2 MICRHOGAM ULTRAFILTERED PLUS 2

NABI-HB 2 VARIZIG 2 WILATE 2 TOXOIDS ADACEL 2 DECAVAC 2 DIPHTHERIA/TETANUS 2



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TOXOID PEDIATRIC INFANRIX 2 VACCINES ACTHIB 2 AFLURIA PF 2013-2014 2 ENGERIX-B 2 FLUARIX QUADRIVALENT 2013 -2014 2

FLUBLOK 2013-2014 2 FLUCELVAX 2013-2014 2 FLULAVAL 2013-2014 2 FLUMIST QUADRIVALENT 2 FLUVIRIN 2013-2014 2 FLUVIRIN PF 2013-2014 2 FLUZONE HIGH-DOSE PF 2013 -2014 2

GARDASIL 2 HAVRIX 2 IMOVAX RABIES (H.D.C.V.) 2 IPOL INACTIVATED IPV 2 IXIARO 2 KINRIX 2 M-M-R II W/DILUENT 10 DOS E 2

MENACTRA 2 MENOMUNE-A/C/Y/W-135 2 PEDIARIX 2 PNEUMOVAX 23/5 DOSE 2 PREVNAR 13 2 PROQUAD 2 RABAVERT 2 ROTARIX 2 ROTATEQ 2 THERACYS 2 TWINRIX 2 TYPHIM VI 2 VARIVAX 2 VIVOTIF BERNA 2 YF-VAX 2 ZOSTAVAX 2 SKIN AND MUCOUS MEMBRANE AGENTS ANTI-INFECTIVES ACID JELLY 2 bacitracin (topical) 1


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bacitracin zinc 1 benzoyl peroxideerythromycin 1, 2

clindamycin phosphate (topical) 1

clindamycin phosphate vaginal 1

clotrimazole 1 dakin's solution 1, 2 erythromycin (acne aid) 1, 2 gentamicin sulfate (topical) 1 GENTIAN VIOLET 2 iodoquinol-hc 1 ketoconazole (topical) 1 malathion 1 metronidazole (topical) 1 metronidazole vaginal 1 mupirocin 1 neomycin/polymyxin b gu 1 nystatin (topical) 1 permethrin 1, 2 PHISOHEX 2 selenium sulfide 1 silver sulfadiazine 1 SULFAMYLON 2 ANTI-INFLAMMATORY AGENTS alclometasone dipropionate 1 AMCINONIDE 2 betamethasone dipropionate augmented 1

betamethasone valerate 1 clobetasol propionate 1 clobetasol propionate emollient base 1

CORDRAN TAPE 2 CORTISPORIN 2 desonide 1 fluocinolone acetonide 1 fluocinonide 1 fluocinonide emulsified base 1 fluticasone propionate 1 halobetasol propionate 1 hydrocortisone (intrarectal) 1 hydrocortisone (rectal) 1 hydrocortisone (topical) 1



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hydrocortisone acetate (rectal) 1 hydrocortisone butyrate 1 hydrocortisone valerate 1 mometasone furoate 1 nystatin-triamcinolone 1 PRAMOSONE 2 PROCTOFOAM HC 2 triamcinolone acetonide (mouth) 1

triamcinolone acetonide (topical) 1, 2

ANTIPRURITICS AND LOCAL ANESTHETICS butamben-tetracainebenzocaine 1

hydrocortisone acetate w/ pramoxine 1, 2

lidocaine 1 lidocaine hcl 1 lidocaine-prilocaine 1, 2 PHENOL 2 PONTOCAINE 2 ASTRINGENTS aluminum chloride 1 XERAC AC 2 zinc oxide (topical) 1 CELL STIMULANTS AND PROLIFERANTS KEPIVANCE 2 RETIN-A MICRO 2 tretinoin 1, 2 DEPIGMENTING AND PIGMENTING AGENTS 8-MOP 2 OXSORALEN 2 OXSORALEN ULTRA 2 KERATOLYTIC AGENTS KERALYT 2 sulfacetamide sodium w/ sulfur 1, 2

sulfacetamide sodium-sulfur w/ sunscreens 1

KERATOPLASTIC AGENTS ELTA TAR 2 SKIN AND MUCOUS MEMBRANE AGENTS, MISCELLANEOUS acitretin 1 AQUAPHOR 2 BENZOIN COMPOUND 2


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TINCTURE calcipotriene 1 capsaicin 1 DIFFERIN 2 DRITHO-CREME HP 2 ELIDEL 2 EPIDUO 2 fluorouracil (topical) 1, 2 imiquimod 1 isotretinoin 1, 2 LEVULAN KERASTICK 2 PODOCON 25 IN BENZOIN TIN CTURE 2

podofilox 1, 2 PROTOPIC 2 SANTYL 2 sodium chloride 1 TARGRETIN 2 TAZORAC 2 VECTICAL 2 SMOOTH MUSCLE RELAXANTS GENITOURINARY SMOOTH MUSCLE RELAXANTS oxybutynin chloride 1 OXYTROL 2 trospium chloride 1 RESPIRATORY SMOOTH MUSCLE RELAXANTS aminophylline 1, 2 theophylline 1 theophylline in dextrose 1, 2 VITAMINS MULTIVITAMIN PREPARATIONS b-complex w/ c & folic acid 1 multiple vitamin 1 ped multivitamins w/fl & iron 1, 2 pediatric multiple vitamin w/ c 1 pediatric multiple vitamins w/ iron 1

pediatric multivitamins w/fl 1 pediatric vitamins acd fluoride & iron 1

pediatric vitamins acd w/ fluoride 1

VITAMIN A AQUASOL A PARENTERAL 2 VITAMIN B COMPLEX



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cyanocobalamin 1 FOLIC ACID 2 niacin 1, 2 POTABA 2 PYRIDOXINE HCL 2 thiamine hcl 1 VITAMIN C ascorbic acid 1 VITAMIN D calcitriol 1, 2 ergocalciferol 1 VITAMIN K ACTIVITY phytonadione 1, 2


Esta lista de medicamentos está sujeta a cambios a lo largo del año y no representa el beneficio de medicamentos recetados específico de su plan. Si tiene alguna pregunta específica sobre su beneficio de medicamentos recetados, comuníquese con el Servicio a los Miembros, disponible las 24 horas del día, 7 días a la semana (cerrado los días festivos) 1-800-464-4000 inglés 1-800-788-0616 español 1-800-757-7585 dialectos chinos 1-800-777-1370 (TTY para las personas con problemas auditivos y del habla)


ÍNDICE

1

1ML TB SYRINGE/25G X 5/8 .................................. 12

3

3ML LUER-LOK SYRINGE 21G X 1........................ 12

8

8-MOP ...................................................................... 21

A abacavir sulfate .......................................................... 5 abacavir sulfate-lamivudine-zidovudine ..................... 5 ABELCET ................................................................... 5 ABILIFY .................................................................... 11 ABRAXANE ................................................................ 6 acamprosate calcium................................................ 11 acarbose ................................................................... 16 ACD-A NOCLOT-50 ................................................... 8 ACETADOTE............................................................ 17 acetaminophen w/ codeine....................................... 10 acetazolamide........................................................... 15 acetazolamide sodium.............................................. 15 ACETEST ................................................................. 12 acetic acid................................................................. 13 acetic acid (otic)........................................................ 15 ACETIC ACID/ALUMINUM ACET ATE.................... 15 acetylcysteine ........................................................... 17 ACID JELLY.............................................................. 20 acitretin ..................................................................... 21 ACTHAR HP............................................................. 17 ACTHIB..................................................................... 20 ACTIMMUNE............................................................ 17 ACTIVASE.................................................................. 8 acyclovir...................................................................... 5 acyclovir sodium ......................................................... 5 ADACEL ................................................................... 20 ADCETRIS.................................................................. 6 adefovir dipivoxil ......................................................... 5 ADENOSCAN........................................................... 13 adenosine ................................................................... 9 ADVAIR DISKUS........................................................ 8 ADVATE ..................................................................... 8 AEROCHAMBER Z-STAT PLUS/F LOWSIGNAL ... 12 AEROTRACH PLUS................................................. 12 AFINITOR ................................................................... 6 AFLURIA PF 2013-2014........................................... 20 AGGRENOX............................................................... 8 A-HYDROCORT....................................................... 16 AKTEN...................................................................... 15 ALBENZA ................................................................... 4 albumin, human .......................................................... 8 ALBUSTIX ................................................................ 13 albuterol sulfate .......................................................... 8 alclometasone dipropionate ..................................... 20 ALDURAZYME ......................................................... 14

alendronate sodium .................................................. 17 alfentanil ................................................................... 10 ALIMTA....................................................................... 6 ALINIA ........................................................................ 5 ALKERAN................................................................... 6 allopurinol ................................................................. 17 ALOCRIL .................................................................. 15 ALOE VERA ............................................................. 18 ALPHANATE/VON WILLEBRAND FACTOR

COMPLEX/HUMAN ................................................ 8 ALPHANINE SD ......................................................... 8 alprazolam ................................................................ 11 alprostadil ................................................................. 10 ALPROSTADIL......................................................... 18 alum & mag hydrox-simethicone .............................. 15 aluminum chloride .................................................... 21 aluminum hydroxide gel............................................ 15 amantadine hcl ......................................................... 11 AMBISOME ................................................................ 5 AMCINONIDE........................................................... 20 amifostine crystalline ................................................ 17 amikacin sulfate .......................................................... 4 amiloride & hydrochlorothiazide ............................... 13 amino acid electrolyte infusion ................................. 13 amino acid infusion................................................... 13 aminocaproic acid....................................................... 8 aminophylline............................................................ 21 amiodarone hcl ........................................................... 9 AMITIZA.................................................................... 16 amitriptyline hcl ......................................................... 11 amlodipine besylate.................................................... 9 AMMONIUM CHLORIDE.......................................... 13 AMOXAPINE ............................................................ 11 amoxicillin ................................................................... 4 amoxicillin & pot clavulanate ...................................... 4 amphetamine-dextroamphetamine........................... 10 AMPHOTERICIN B..................................................... 5 ampicillin ..................................................................... 4 ampicillin & sulbactam sodium ................................... 4 ampicillin sodium ........................................................ 4 anagrelide hcl ............................................................. 8 anastrozole ................................................................. 6 ANDRODERM .......................................................... 16 ANDROID ................................................................. 16 ANDROXY................................................................ 16 ANGIOMAX ................................................................ 8 antipyrine-benzocaine .............................................. 15 ANTIVENIN LATRODECTUS MAC TANS............... 19 APOKYN................................................................... 11 apraclonidine hcl....................................................... 15 APTIVUS .................................................................... 5 AQUAPHOR ............................................................. 21 AQUASOL A PARENTERAL.................................... 22 argatroban .................................................................. 8 ARGATROBAN .......................................................... 8 ARISTOSPAN INTRA-ARTICULA R........................ 16 ARMOUR THYROID ................................................ 17 ARRANON.................................................................. 6


ascorbic acid............................................................. 22 ASMANEX TWISTHALER 120 ME TERED DOSES16 ASTHMAPACK I....................................................... 12 atenolol ....................................................................... 9 atenolol & chlorthalidone ............................................ 9 ATGAM..................................................................... 18 atorvastatin calcium.................................................... 9 atovaquone ................................................................. 5 atovaquone-proguanil hcl ........................................... 5 atracurium besylate .................................................... 8 ATRIPLA..................................................................... 5 atropine sulfate ........................................................... 7 atropine sulfate (ophthalmic) .................................... 15 ATROPINE SULFATE MONOHYDR ATE ............... 18 ATROVENT HFA........................................................ 7 ATRYN........................................................................ 8 AVASTIN .................................................................... 6 AVELOX ..................................................................... 4 AVONEX................................................................... 18 AZACTAM IN ISO-OSMOTIC DEXTROSE ............... 4 azathioprine .............................................................. 18 AZATHIOPRINE SODIUM ....................................... 18 azelastine hcl ............................................................ 15 AZILECT ................................................................... 11 azithromycin................................................................ 4 aztreonam................................................................... 4

B bacitracin .................................................................... 4 BACITRACIN............................................................ 14 bacitracin (topical) .................................................... 20 bacitracin zinc ........................................................... 20 bacitracin-polymyxin b (ophth) ................................. 14 baclofen ...................................................................... 8 BACLOFEN .............................................................. 18 BACTERIOSTATIC WATER FOR

INJECTION/BENZYL ALCOHOL.......................... 18 BACTOCILL IN DEXTROSE...................................... 4 BAL IN OIL................................................................ 16 balsalazide disodium ................................................ 15 BANZEL.................................................................... 10 b-complex w/ c & folic acid ....................................... 21 BD 10ML LUER-LOK SYRINGE 20G X 1-1/2 ......... 12 BD 5ML LUER-LOK SYRINGE/2 0G X 1................. 12 BD DISPOSABLE NEEDLE 23GX 1........................ 12 BD DISPOSABLE NEEDLE REGU LAR BEVEL

25GX1 ................................................................... 12 BD DISPOSABLE NEEDLE/30GX 1........................ 12 BD HYPODERMIC NEEDLE REGU LAR BEVEL

26GX5/8 ................................................................ 12 BD INSULIN SYRINGE MICROF INE IV/U

100/0.5ML/28G X 1/2............................................ 12 BD LANCET DEVICE............................................... 12 BD LANCET ULTRAFINE 33G ................................ 12 BD NEEDLE/16G X 1-1/2......................................... 12 BD NEEDLE/18G 1-1/2 ............................................ 12 BD NEEDLE/20G X 1............................................... 12 BD NEEDLE/21G 1-1/2 ............................................ 12 BD NEEDLE/22G X 1-1/2......................................... 12 BD NEEDLE/27G X 1/2............................................ 12

BD PEN NEEDLE/MINI/ULTRAF INE/31G X 3/16 .. 12 BD SAFETYGLIDE 27G X 5/8 ................................. 12 BELLADONNA & OPIUM ........................................... 7 benazepril hcl.............................................................. 9 BENEFIX .................................................................... 8 BENZOIN COMPOUND TINCTURE........................ 21 benzonatate .............................................................. 19 benzoyl peroxide-erythromycin ................................ 20 benztropine mesylate ............................................... 11 betamethasone dipropionate augmented................. 20 betamethasone sod phosphate & acetate................ 16 betamethasone valerate ........................................... 20 betaxolol hcl (ophth) ................................................. 15 bethanechol chloride .................................................. 7 bicalutamide................................................................ 6 BICILLIN L-A............................................................... 4 BICNU......................................................................... 6 BILTRICIDE................................................................ 4 BIOTIN...................................................................... 18 bismuth subsalicylate ............................................... 15 bisoprolol & hydrochlorothiazide ................................ 9 bisoprolol fumarate ..................................................... 9 bleomycin sulfate........................................................ 6 BORIC ACID............................................................. 18 BOTOX ..................................................................... 18 BOTOX COSMETIC ................................................. 18 BRAVELLE ............................................................... 17 BREVIBLOC ............................................................... 9 BREVITAL SODIUM................................................. 11 BRILINTA.................................................................... 8 brimonidine tartrate................................................... 15 bromocriptine mesylate ............................................ 11 budesonide ............................................................... 16 budesonide (inhalation) ............................................ 16 bumetanide ............................................................... 13 BUPHENYL .............................................................. 13 bupivacaine hcl ......................................................... 17 bupivacaine in dextrose............................................ 17 bupivacaine w/ epinephrine...................................... 17 buprenorphine hcl..................................................... 10 buprenorphine hcl-naloxone hcl dihydrate ............... 10 bupropion hcl ............................................................ 11 buspirone hcl ............................................................ 11 butamben-tetracaine-benzocaine............................. 21 BUTISOL SODIUM................................................... 11 butorphanol tartrate .................................................. 10

C cabergoline ............................................................... 11 CAFERGOT.............................................................. 11 caffeine citrate .......................................................... 10 calcipotriene.............................................................. 21 calcitriol ..................................................................... 22 calcium acetate (phosphate binder) ......................... 14 calcium chloride (dihydrate) ..................................... 14 calcium gluconate..................................................... 14 CAMPATH .................................................................. 6 CANCIDAS ................................................................. 5 CANDIN .................................................................... 13 CANTHARIDIN ......................................................... 18


CAPASTAT SULFATE ............................................... 5 capecitabine................................................................ 6 CAPRELSA................................................................. 6 capsaicin................................................................... 21 captopril ...................................................................... 9 carbamazepine ......................................................... 10 CARBAMAZEPINE................................................... 18 CARBIDOPA/LEVODOPA/ENTACA PONE ............ 11 carbidopa-levodopa .................................................. 11 carboplatin .................................................................. 6 CARIMUNE NANOFILTERED ................................. 19 carvedilol..................................................................... 9 CASCARA SAGRADA.............................................. 16 castor oil ................................................................... 16 CAVERJECT ............................................................ 10 CAYSTON .................................................................. 4 CEENU ....................................................................... 6 cefaclor ....................................................................... 4 cefadroxil .................................................................... 4 cefazolin sodium......................................................... 4 CEFAZOLIN SODIUM/DEXTROSE........................... 4 cefdinir ........................................................................ 4 cefepime hcl................................................................ 4 cefotaxime sodium...................................................... 4 CEFOTETAN.............................................................. 4 CEFOTETAN/DEXTROSE......................................... 4 cefoxitin sodium.......................................................... 4 CEFOXITIN SODIUM................................................. 4 cefpodoxime proxetil................................................... 4 ceftazidime.................................................................. 4 CEFTRIAXONE IN ISO-OSMOTI C DEXTROSE...... 4 ceftriaxone sodium ..................................................... 4 CEFTRIAXONE/DEXTROSE..................................... 4 cefuroxime axetil......................................................... 4 cefuroxime sodium ..................................................... 4 CEFUROXIME/DEXTROSE....................................... 4 CELESTONE............................................................ 16 CELONTIN................................................................ 10 cephalexin................................................................... 4 CEREDASE.............................................................. 14 CEREZYME.............................................................. 14 CERVIDIL ................................................................. 18 CHEMET................................................................... 16 CHEMSTRIP 9 STRIPS ........................................... 13 CHIRHOSTIM........................................................... 13 CHLORAL HYDRATE .............................................. 11 CHLORAMPHENICOL SODIUM SU CCINATE ........ 4 chlordiazepoxide hcl ................................................. 11 chlordiazepoxide hcl-clidinium bromide ..................... 7 chlorhexidine gluconate (mouth-throat).................... 14 CHLOROFORM........................................................ 18 chloroprocaine hcl .................................................... 17 chloroquine phosphate ............................................... 5 chlorpheniramine & phenylephrine............................. 6 chlorpromazine hcl ................................................... 11 CHLORPROMAZINE HCL ....................................... 18 CHLORTHALIDONE ................................................ 13 CHOLESTEROL ACETATE ..................................... 18 cholestyramine............................................................ 9 cholestyramine light.................................................... 9

choline & mag salicylate ........................................... 10 chorionic gonadotropin ............................................. 17 chromium chloride .................................................... 14 cimetidine hcl ............................................................ 16 CIPRODEX............................................................... 15 ciprofloxacin................................................................ 4 ciprofloxacin hcl .......................................................... 4 ciprofloxacin hcl (ophth)............................................ 14 ciprofloxacin in d5w .................................................... 4 cisatracurium besylate................................................ 8 cisplatin....................................................................... 6 citalopram hydrobromide .......................................... 11 cladribine .................................................................... 6 clarithromycin.............................................................. 4 CLEOCIN IN D5W ...................................................... 4 clindamycin hcl ........................................................... 4 CLINDAMYCIN HCL................................................. 18 clindamycin palmitate hydrochloride .......................... 4 clindamycin phosphate ............................................... 4 clindamycin phosphate (topical) ............................... 20 clindamycin phosphate vaginal ................................ 20 CLINIMIX 2.75%/DEXTROSE 5 % .......................... 13 CLINIMIX 4.25%/DEXTROSE 1 0% ........................ 13 CLINIMIX 4.25%/DEXTROSE 2 0% ........................ 13 CLINIMIX 4.25%/DEXTROSE 2 5% ........................ 13 CLINIMIX 5%/DEXTROSE 15%............................... 13 CLINIMIX E 2.75%/DEXTROSE 10% ...................... 13 CLINIMIX E 2.75%/DEXTROSE 5% ........................ 13 CLINIMIX E 4.25%/DEXTROSE 25% ...................... 13 CLINIMIX E 5%/DEXTROSE 15 % .......................... 13 CLINIMIX E 5%/DEXTROSE 20 % .......................... 13 CLINITEST ............................................................... 13 clobetasol propionate ............................................... 20 CLOBETASOL PROPIONATE................................. 18 clobetasol propionate emollient base....................... 20 clomiphene citrate .................................................... 17 clomipramine hcl....................................................... 11 clonazepam .............................................................. 10 clonidine hcl ................................................................ 9 CLONIDINE HCL...................................................... 18 clopidogrel bisulfate.................................................... 8 clorazepate dipotassium........................................... 11 clotrimazole............................................................... 20 CLOTRIMAZOLE...................................................... 18 clozapine................................................................... 11 COAL TAR................................................................ 18 COARTEM.................................................................. 5 COCAINE HCL ......................................................... 15 codeine sulfate ......................................................... 10 colchicine w/ probenecid .......................................... 14 COLCRYS ................................................................ 18 colestipol hcl ............................................................... 9 COLLODION FLEXIBLE........................................... 18 COLY-MYCIN S........................................................ 15 COMBIVENT ............................................................ 19 COMBIVENT RESPIMAT......................................... 19 COMETRIQ ................................................................ 6 COMPLERA................................................................ 5 CONRAY .................................................................. 13 COPAXONE ............................................................. 18


COPPER SULFATE ................................................. 14 COPPER TRACE METAL ........................................ 14 CORDRAN TAPE ..................................................... 20 CORTISONE ACETATE........................................... 16 CORTISPORIN......................................................... 20 CORTROSYN........................................................... 13 CREON..................................................................... 13 CRIXIVAN................................................................... 5 CROFAB................................................................... 19 cromolyn sodium ...................................................... 19 cromolyn sodium (mastocytosis) .............................. 19 cromolyn sodium (ophth) .......................................... 15 CUBICIN ..................................................................... 4 CUPRIMINE.............................................................. 16 CUROSURF ............................................................. 19 cyanocobalamin........................................................ 22 cyclobenzaprine hcl .................................................... 8 CYCLOMYDRIL........................................................ 15 cyclopentolate hcl ..................................................... 15 CYCLOPHOSPHAMIDE............................................. 6 cyclosporine modified (for microemulsion)............... 18 CYKLOKAPRON ........................................................ 8 cyproheptadine hcl ..................................................... 6 CYSTADANE............................................................ 18 CYSTAGON.............................................................. 18 CYSTEAMINE HCL .................................................. 18 CYSTOGRAFIN........................................................ 13 cytarabine ................................................................... 6 CYTOGAM................................................................ 19 CYTOVENE................................................................ 5

D dacarbazine ................................................................ 6 DACOGEN.................................................................. 6 dactinomycin............................................................... 6 danazol ..................................................................... 16 dantrolene sodium ...................................................... 8 DAPSONE .................................................................. 5 DARAPRIM................................................................. 5 daunorubicin hcl ......................................................... 6 DAUNOXOME ............................................................ 6 DECAVAC ................................................................ 20 deferoxamine mesylate ............................................ 16 DEFINITY ................................................................. 13 demeclocycline hcl ..................................................... 4 DEPOCYT .................................................................. 6 DEPO-ESTRADIOL.................................................. 17 DEPO-PROVERA..................................................... 17 desipramine hcl ........................................................ 11 desmopressin acetate .............................................. 17 desmopressin acetate refrigerated........................... 17 desmopressin acetate spray .................................... 17 desmopressin acetate spray refrigerated................. 17 desogestrel & ethinyl estradiol ................................. 17 desonide ................................................................... 20 dexamethasone ........................................................ 16 DEXAMETHASONE................................................. 18 dexamethasone sodium phosphate ......................... 16 dexamethasone sodium phosphate (ophth)............. 15 dexrazoxane ............................................................. 18

dextroamphetamine sulfate ...................................... 10 dextrose .................................................................... 13 DEXTROSE 5% /ELECTROLYTE #48 VIAFLEX ... 14 dextrose in lactated ringers ...................................... 14 dextrose in ringers .................................................... 14 dextrose w/ sodium chloride..................................... 14 DIANEAL LOW CALCIUM/1.5% DEXTROSE ......... 14 DIASTAT ACUDIAL.................................................. 11 DIASTIX.................................................................... 13 diazepam .................................................................. 11 DIBENZYLINE ............................................................ 8 diclofenac sodium (ophth) ........................................ 15 dicloxacillin sodium..................................................... 4 dicyclomine hcl ........................................................... 7 didanosine .................................................................. 5 DIFFERIN ................................................................. 21 DIGIFAB ................................................................... 19 digoxin ........................................................................ 9 dihydroergotamine mesylate ...................................... 8 diltiazem hcl ................................................................ 9 DILTIAZEM HCL....................................................... 18 diltiazem hcl coated beads ......................................... 9 diphenhydramine hcl .................................................. 6 diphenoxylate w/ atropine......................................... 15 DIPHENYLCYCLOPROPENONE............................ 18 DIPHTHERIA/TETANUS TOXOID PEDIATRIC ...... 20 dipyridamole ............................................................. 10 dipyridamole (diagnostic) ......................................... 10 disopyramide phosphate ............................................ 9 DISPOSABLE POWER ............................................ 12 disulfiram .................................................................. 18 divalproex sodium..................................................... 10 dobutamine hcl ........................................................... 8 dobutamine in d5w ..................................................... 8 docusate sodium ...................................................... 16 donepezil hydrochloride.............................................. 7 dopamine hcl .............................................................. 8 dopamine in d5w ........................................................ 8 dorzolamide hcl ........................................................ 15 dorzolamide hcl-timolol maleate............................... 15 doxazosin mesylate .................................................... 9 doxepin hcl................................................................ 11 doxorubicin hcl............................................................ 6 doxorubicin hcl liposomal ........................................... 6 doxycycline (monohydrate) ........................................ 4 doxycycline hyclate..................................................... 4 DRITHO-CREME HP................................................ 21 dronabinol ................................................................. 15 droperidol.................................................................. 11 drospirenone-ethinyl estradiol .................................. 17 DULERA ................................................................... 19 duloxetine hcl............................................................ 11 D-XYLOSE................................................................ 13 DYRENIUM............................................................... 13

E EDECRIN.................................................................. 13 EDURANT .................................................................. 5 EFFIENT..................................................................... 8 ELAPRASE............................................................... 14


ELIDEL ..................................................................... 21 ELITEK ..................................................................... 14 ELLA ......................................................................... 17 ELMIRON ................................................................. 18 ELSPAR...................................................................... 6 ELTA TAR................................................................. 21 EMCYT ....................................................................... 6 EMEND..................................................................... 15 EMTRIVA.................................................................... 5 enalaprilat ................................................................. 10 ENBREL ................................................................... 18 ENDOMETRIN.......................................................... 17 ENGERIX-B.............................................................. 20 ENLON ....................................................................... 7 entacapone ............................................................... 11 entecavir ..................................................................... 5 EOVIST..................................................................... 13 ephedrine sulfate (pressors)....................................... 8 EPIDUO.................................................................... 21 EPINEPHRINE ........................................................... 8 epinephrine hcl ........................................................... 8 EPZICOM ................................................................... 5 EQUETRO................................................................ 10 ERBITUX .................................................................... 6 ergocalciferol ............................................................ 22 ergoloid mesylates.................................................... 11 ERGOMAR ................................................................. 8 ERIVEDGE ................................................................. 6 ERWINAZE................................................................. 6 ERY-TAB .................................................................... 4 ERYTHROCIN LACTOBIONATE............................... 4 ERYTHROCIN STEARATE........................................ 4 erythromycin (acne aid) ............................................ 20 erythromycin (ophth)................................................. 14 erythromycin ethylsuccinate ....................................... 4 erythromycin-sulfisoxazole ......................................... 4 escitalopram oxalate................................................. 11 esmolol hcl.................................................................. 9 esterified estrogens & methyltestosterone ............... 17 ESTRACE................................................................. 17 estradiol .................................................................... 17 ESTRADIOL ............................................................. 18 estradiol valerate ...................................................... 17 ethambutol hcl ............................................................ 5 ETHAMOLIN............................................................. 10 ethosuximide............................................................. 10 ETHRANE................................................................. 11 ethynodiol diacet & eth estrad .................................. 17 ETIDRONATE DISODIUM ....................................... 18 etodolac .................................................................... 10 etomidate .................................................................. 11 etoposide .................................................................... 6 exemestane ................................................................ 6 EXJADE.................................................................... 16 EXTAVIA................................................................... 18 EYLEA ...................................................................... 15 E-Z-CAT DRY........................................................... 13

F FABRAZYME............................................................ 14

famciclovir................................................................... 5 famotidine ................................................................. 16 FAMOTIDINE PREMIXED ....................................... 16 FASLODEX................................................................. 6 fat emulsion .............................................................. 13 felbamate .................................................................. 10 fenofibrate................................................................... 9 fentanyl ..................................................................... 10 fentanyl citrate .......................................................... 10 finasteride ................................................................. 18 FIRAZYR .................................................................. 18 flecainide acetate........................................................ 9 FLOVENT HFA......................................................... 16 FLUARIX QUADRIVALENT 2013 -2014.................. 20 FLUBLOK 2013-2014............................................... 20 FLUCELVAX 2013-2014 .......................................... 20 fluconazole.................................................................. 5 fluconazole in dextrose............................................... 5 fluconazole in nacl ...................................................... 5 FLUCONAZOLE IN NACL.......................................... 4 flucytosine................................................................... 5 fludarabine phosphate ................................................ 6 fludrocortisone acetate ............................................. 16 FLULAVAL 2013-2014 ............................................. 20 flumazenil.................................................................. 11 FLUMIST QUADRIVALENT ..................................... 20 flunisolide (nasal)...................................................... 15 fluocinolone acetonide.............................................. 20 fluocinonide............................................................... 20 fluocinonide emulsified base .................................... 21 FLUOR-A-DAY ......................................................... 18 fluorescein sodium injection ..................................... 13 fluorescein sodium topical ........................................ 13 fluorescein w/ benoxinate ......................................... 13 fluorometholone (ophth) ........................................... 15 fluorouracil .................................................................. 6 fluorouracil (topical) .................................................. 21 fluoxetine hcl............................................................. 11 fluphenazine decanoate ........................................... 11 fluphenazine hcl........................................................ 12 flurbiprofen sodium ................................................... 15 flutamide ..................................................................... 6 fluticasone propionate .............................................. 21 fluticasone propionate (nasal) .................................. 15 FLUVIRIN 2013-2014............................................... 20 FLUVIRIN PF 2013-2014 ......................................... 20 fluvoxamine maleate................................................. 12 FLUZONE HIGH-DOSE PF 2013 -2014 .................. 20 FOLIC ACID.............................................................. 22 FORANE................................................................... 11 FORTAZ ..................................................................... 4 FORTEO................................................................... 17 FORTICAL................................................................ 17 FOSCARNET SODIUM.............................................. 5 fosphenytoin sodium................................................. 10 furosemide ................................................................ 13 FUSILEV................................................................... 18 FUZEON ..................................................................... 5


G

gabapentin ................................................................ 10 GABAPENTIN........................................................... 18 GADAVIST................................................................ 13 galantamine hydrobromide ......................................... 8 GAMASTAN S/D ...................................................... 19 GAMMAGARD LIQUID............................................. 19 GARDASIL................................................................ 20 GASTROGRAFIN..................................................... 13 GAZYVA ..................................................................... 6 GELFILM OP .............................................................. 8 GELFOAM SPONGE.................................................. 8 gemfibrozil .................................................................. 9 GEMZAR .................................................................... 6 gentamicin in saline .................................................... 4 gentamicin sulfate....................................................... 4 gentamicin sulfate (ophth) ........................................ 14 gentamicin sulfate (topical)....................................... 20 GENTIAN VIOLET.................................................... 20 GLEEVEC................................................................... 6 glimepiride ................................................................ 16 glipizide..................................................................... 16 glipizide-metformin hcl.............................................. 16 GLUCAGEN.............................................................. 17 GLUCAGON EMERGENCY KIT.............................. 17 glyburide ................................................................... 16 GLYCERIN ............................................................... 18 glycerin (laxative)...................................................... 16 glycopyrrolate ............................................................. 7 GLYCOPYRROLATE ............................................... 18 griseofulvin microsize ................................................. 5 griseofulvin ultramicrosize .......................................... 5 guaifenesin-codeine ................................................. 19 guanfacine hcl............................................................. 8 GUANIDINE HCL ....................................................... 8

H HALAVEN ................................................................... 6 halobetasol propionate ............................................. 21 haloperidol ................................................................ 12 HALOPERIDOL ........................................................ 18 haloperidol decanoate .............................................. 12 haloperidol lactate .................................................... 12 HAVRIX .................................................................... 20 HEALON5................................................................. 15 HEMABATE.............................................................. 18 HEMOFIL M................................................................ 8 heparin (porcine) in sodium chloride .......................... 8 heparin sod (porcine) in d5w ...................................... 8 heparin sodium (porcine)............................................ 9 heparin sodium (porcine) lock flush ........................... 9 HERCEPTIN............................................................... 6 hetastarch in sodium chloride................................... 14 HEXALEN................................................................... 6 HEXTEND................................................................. 14 HUMALOG................................................................ 16 HUMALOG MIX 50/50.............................................. 16 HUMIRA.................................................................... 18 HUMULIN 70/30 ....................................................... 16

HUMULIN N.............................................................. 16 HUMULIN R.............................................................. 16 hydralazine hcl............................................................ 9 hydrochlorothiazide .................................................. 13 hydrocodone w/ homatropine ................................... 19 hydrocodone-acetaminophen................................... 10 hydrocortisone .......................................................... 16 HYDROCORTISONE ............................................... 19 hydrocortisone (intrarectal)....................................... 21 hydrocortisone (rectal).............................................. 21 hydrocortisone (topical) ............................................ 21 hydrocortisone acetate (rectal)................................. 21 hydrocortisone acetate w/ pramoxine ...................... 21 hydrocortisone butyrate ............................................ 21 hydrocortisone valerate ............................................ 21 hydromorphone hcl................................................... 10 hydrophilic ointment.................................................. 19 HYDROXOCOBALAMIN .......................................... 19 hydroxychloroquine sulfate......................................... 5 HYDROXYPROGESTERONE CAPRO ATE ........... 19 hydroxyurea ................................................................ 6 hydroxyzine hcl ......................................................... 11 hydroxyzine pamoate ............................................... 11 HYLENEX................................................................. 14 hyoscyamine sulfate ................................................... 7 HYPAQUE SODIUM................................................. 13 HYPERLYTE-CR...................................................... 14 HYPERRAB S/D....................................................... 20 HYPERTET S/D ....................................................... 20

I ibuprofen................................................................... 10 ibutilide fumarate ........................................................ 9 idarubicin hcl............................................................... 6 ifosfamide ................................................................... 6 IFOSFAMIDE/MESNA................................................ 6 IMBRUVICA................................................................ 7 imipramine hcl........................................................... 12 imiquimod ................................................................. 21 IMOVAX RABIES (H.D.C.V.).................................... 20 INCIVEK ..................................................................... 5 indapamide ............................................................... 13 indigotindisulfonate sodium ...................................... 13 indomethacin ............................................................ 10 INDOMETHACIN...................................................... 19 indomethacin sodium................................................ 10 INFANRIX................................................................. 20 INFERGEN ................................................................. 5 INFUMORPH 200..................................................... 10 INSPIREASE REPLACEMENT MO UTHPIECE ..... 12 INSPIREASE RESERVOIR BAGS .......................... 12 INTEGRILIN................................................................ 9 INTELENCE................................................................ 5 INTRON-A .................................................................. 7 INVANZ....................................................................... 4 INVIRASE ................................................................... 5 iodoquinol-hc ............................................................ 20 IPOL INACTIVATED IPV.......................................... 20 ipratropium bromide.................................................... 7 ipratropium bromide (nasal) ....................................... 7


irinotecan hcl............................................................... 7 iron dextran................................................................. 8 ISENTRESS ............................................................... 5 isoniazid...................................................................... 5 isoproterenol hcl ......................................................... 8 ISOPTO CARBACHOL............................................. 15 ISOPTO HOMATROPINE ........................................ 15 ISOSORBIDE ........................................................... 19 isosorbide dinitrate ................................................... 10 isosorbide mononitrate ............................................. 10 isotretinoin ................................................................ 21 ISTODAX.................................................................... 7 itraconazole ................................................................ 5 IXEMPRA KIT............................................................. 7 IXIARO...................................................................... 20

J JAKAFI........................................................................ 7 JETREA .................................................................... 15 JEVTANA.................................................................... 7

K KADCYLA................................................................... 7 KALETRA ................................................................... 5 KALYDECO .............................................................. 18 KCENTRA................................................................... 8 KCL 0.15%/D5W/LR................................................. 14 KENALOG-10 ........................................................... 16 KEPIVANCE ............................................................. 21 KERALYT ................................................................. 21 ketamine hcl.............................................................. 11 KETAMINE HCL ....................................................... 19 ketoconazole............................................................... 5 ketoconazole (topical)............................................... 20 KETO-DIASTIX......................................................... 13 KETOPROFEN......................................................... 19 ketorolac tromethamine ............................................ 10 ketorolac tromethamine (ophth) ............................... 15 KINERET .................................................................. 18 KINRIX...................................................................... 20 KOGENATE FS .......................................................... 8 K-PHOS .................................................................... 14 K-PHOS MF.............................................................. 13 KUVAN ..................................................................... 14 KYPROLIS.................................................................. 7

L labetalol hcl................................................................. 9 LACRISERT.............................................................. 15 lactated ringer's ........................................................ 14 lactated ringer's (irrigation) ....................................... 14 LACTIC ACID ........................................................... 19 LACTOSE ................................................................. 19 LACTOSE MONOHYDRATE ................................... 19 lactulose.................................................................... 13 lactulose (encephalopathy) ...................................... 13 lamivudine................................................................... 5 lamivudine-zidovudine ................................................ 5 lamotrigine ................................................................ 11

LANTUS.................................................................... 16 L-ARGININE ............................................................. 19 latanoprost ................................................................ 15 L-CITRULLINE.......................................................... 19 leflunomide ............................................................... 18 LETAIRIS.................................................................. 10 letrozole ...................................................................... 7 leucovorin calcium .................................................... 18 LEUKERAN ................................................................ 7 LEUKINE .................................................................... 9 leuprolide acetate ....................................................... 7 levetiracetam ............................................................ 11 LEVITRA................................................................... 10 levobunolol hcl .......................................................... 15 levocarnitine (metabolic modifiers)........................... 18 levofloxacin ................................................................. 4 levofloxacin in d5w ..................................................... 4 levonorgestrel & eth estradiol................................... 12 levonorgestrel-eth estradiol (triphasic) ..................... 17 levothyroxine sodium................................................ 17 LEVULAN KERASTICK............................................ 21 LEXISCAN................................................................ 13 LEXIVA ....................................................................... 5 lidocaine.................................................................... 21 lidocaine hcl .............................................................. 21 lidocaine hcl (cardiac)................................................. 9 lidocaine hcl (local anesth.) ...................................... 17 lidocaine hcl (mouth-throat) ...................................... 15 LIDOCAINE HCL MONOHYDRATE ........................ 19 lidocaine in d5w .......................................................... 9 lidocaine w/ epinephrine ........................................... 17 lidocaine-prilocaine................................................... 21 liothyronine sodium................................................... 17 lisinopril ..................................................................... 10 lisinopril & hydrochlorothiazide................................. 10 L-ISOLEUCINE......................................................... 19 LITHIUM ................................................................... 11 lithium carbonate ...................................................... 11 LITHOSTAT .............................................................. 13 LMD 10% DEXTROSE 5%....................................... 14 LMD 10% SODIUM CHLORIDE 0 .9% .................... 14 LODOSYN ................................................................ 11 lorazepam ................................................................. 11 losartan potassium ................................................... 10 losartan potassium & hydrochlorothiazide ............... 10 lovastatin..................................................................... 9 LOVENOX .................................................................. 9 loxapine succinate .................................................... 12 L-PROLINE............................................................... 19 LUCENTIS................................................................ 15 LUMIGAN ................................................................. 15 LUPRON DEPOT ....................................................... 7 LUPRON DEPOT-PED............................................... 7 L-VALINE.................................................................. 19 LYSODREN................................................................ 7

M M.T.E.-5 CONCENTRATE ....................................... 14 MACUGEN ............................................................... 15 magnesium hydroxide .............................................. 16


magnesium sulfate ................................................... 11 MAGNESIUM SULFATE IN D5W ............................ 14 MAGNEVIST............................................................. 13 malathion .................................................................. 20 MANGANESE TRACE METAL ................................ 14 mannitol .................................................................... 13 MAPROTILINE HCL................................................. 12 MATULANE ................................................................ 7 MEBENDAZOLE ........................................................ 4 meclizine hcl ............................................................. 15 MECLOFENAMATE SODIUM.................................. 10 medroxyprogesterone acetate.................................. 17 medroxyprogesterone acetate (contraceptive) ........ 17 mefenamic acid ........................................................ 10 mefloquine hcl............................................................. 5 megestrol acetate ....................................................... 7 MEKINIST................................................................... 7 meloxicam................................................................. 10 melphalan hcl.............................................................. 7 MENACTRA.............................................................. 20 MENOMUNE-A/C/Y/W-135...................................... 20 MENOPUR ............................................................... 17 meperidine hcl .......................................................... 10 mepivacaine hcl ........................................................ 17 mercaptopurine........................................................... 7 meropenem................................................................. 4 mesalamine .............................................................. 15 mesna ....................................................................... 18 metaproterenol sulfate................................................ 8 metformin hcl ............................................................ 16 methadone hcl .......................................................... 10 METHADONE HCL .................................................. 19 methazolamide ......................................................... 15 methenamine hippurate.............................................. 6 methimazole ............................................................. 17 methocarbamol ........................................................... 8 methotrexate sodium .................................................. 7 METHYLCELLULOSE.............................................. 19 methyldopa ................................................................. 9 METHYLDOPATE HCL.............................................. 9 methylene blue (antidote) ......................................... 18 methylergonovine maleate ....................................... 18 methylphenidate hcl.................................................. 10 methylprednisolone .................................................. 16 methylprednisolone acetate ..................................... 16 methylprednisolone sod succ ................................... 16 metoclopramide hcl .................................................. 16 METOCLOPRAMIDE HCL MONOHY DRATE ........ 19 metolazone ............................................................... 13 METOPIRONE.......................................................... 13 metoprolol & hydrochlorothiazide ............................... 9 metoprolol tartrate ...................................................... 9 metronidazole ............................................................. 5 METRONIDAZOLE................................................... 19 metronidazole (topical) ............................................. 20 metronidazole in nacl.................................................. 5 metronidazole vaginal............................................... 20 mexiletine hcl .............................................................. 9 MICRHOGAM ULTRA-FILTERED PLUS................. 20 midazolam hcl........................................................... 11

midodrine hcl .............................................................. 8 MIFEPREX ............................................................... 18 milrinone in dextrose .................................................. 9 milrinone lactate ......................................................... 9 MINERAL OIL LIGHT ............................................... 16 minocycline hcl ........................................................... 4 minoxidil ...................................................................... 9 MIOCHOL-E ............................................................. 15 MIRENA.................................................................... 17 mirtazapine ............................................................... 12 misoprostol ............................................................... 16 mitomycin.................................................................... 7 mitoxantrone hcl ......................................................... 7 M-M-R II W/DILUENT 10 DOS E ............................. 20 mometasone furoate................................................. 21 montelukast sodium.................................................. 19 morphine sulfate ....................................................... 10 MORPHINE SULFATE............................................. 19 MORPHINE SULFATE IN DEXTR OSE 5%............ 10 moxifloxacin hcl .......................................................... 4 MULTIHANCE .......................................................... 13 multiple vitamin ......................................................... 21 mupirocin .................................................................. 20 MUSTARGEN............................................................. 7 mycophenolate mofetil.............................................. 18 MYLERAN .................................................................. 7 MYOBLOC................................................................ 18 MYOZYME................................................................ 14 MYTELASE................................................................. 8

N NABI-HB ................................................................... 20 nabumetone.............................................................. 10 nadolol ........................................................................ 9 nafcillin sodium ........................................................... 4 NAGLAZYME............................................................ 14 nalbuphine hcl........................................................... 10 NALLPEN ISO-OSMOTIC IN DE XTROSE ............... 4 naloxone hcl.............................................................. 11 naltrexone hcl ........................................................... 11 NAMENDA................................................................ 11 NAPHAZOLINE HCL................................................ 15 naproxen................................................................... 10 naproxen sodium ...................................................... 10 naratriptan hcl ........................................................... 11 NAROPIN ................................................................. 17 NEBUPENT ................................................................ 5 NECON 1/50-28 ....................................................... 17 NECON 10/11-28 ..................................................... 17 nefazodone hcl ......................................................... 12 NEMBUTAL SODIUM............................................... 11 neomycin sulfate......................................................... 4 NEOMYCIN SULFATE............................................. 19 neomycin/polymyxin b gu ......................................... 20 neomycin-bacitracin zn-polymyxin ........................... 14 neomycin-polymy-dexameth .................................... 15 neomycin-polymyxin-gramicidin ............................... 14 neomycin-polymyxin-hc (otic)................................... 15 NEOPROFEN........................................................... 10 neostigmine methylsulfate.......................................... 8


NEUMEGA.................................................................. 9 NEUPOGEN ............................................................... 9 nevirapine ................................................................... 5 NEXAVAR................................................................... 7 NEXPLANON............................................................ 17 niacin ........................................................................ 22 nicardipine hcl............................................................. 9 nicotine ....................................................................... 7 nicotine polacrilex ....................................................... 7 nifedipine .................................................................... 9 nimodipine .................................................................. 9 nitrofurantoin............................................................... 6 nitrofurantoin macrocrystal ......................................... 6 nitrofurantoin monohyd macro.................................... 6 nitroglycerin .............................................................. 10 nitroglycerin in d5w................................................... 10 NITROPRESS ............................................................ 9 NORDIPEN 5 INJECTION DEVI CE........................ 12 NORDITROPIN FLEXPRO ...................................... 17 norepinephrine bitartrate ............................................ 8 norethin acet & estrad-fe .......................................... 17 norethindrone & eth estradiol ................................... 17 norethindrone (contraceptive) .................................. 17 norethindrone acet & eth estra ................................. 17 norethindrone acetate............................................... 17 norethindrone-eth estradiol (triphasic) ..................... 17 norgestimate-ethinyl estradiol .................................. 17 norgestimate-ethinyl estradiol (triphasic) ................. 17 norgestrel & ethinyl estradiol .................................... 17 nortriptyline hcl.......................................................... 12 NORVIR...................................................................... 5 NOVOSEVEN RT ....................................................... 8 NUVARING............................................................... 17 nystatin ....................................................................... 5 nystatin (mouth-throat) ............................................... 5 nystatin (topical) ....................................................... 20 nystatin-triamcinolone............................................... 21

O octreotide acetate ..................................................... 18 OFIRMEV ................................................................. 10 ofloxacin (ophth) ....................................................... 14 ofloxacin (otic)........................................................... 14 olanzapine ................................................................ 12 omeprazole ............................................................... 16 OMNIPAQUE............................................................ 13 ONCASPAR................................................................ 7 ondansetron.............................................................. 15 ondansetron hcl ........................................................ 15 ONETOUCH NORMAL CONTROL.......................... 12 ONETOUCH ULTRA BLUE...................................... 13 ONETOUCH ULTRA MINI ....................................... 12 OPANA ..................................................................... 10 ophthalmic irrigation solution - intraocular................ 15 OPIUM TINCTURE (PAREGORIC ) ........................ 15 OPSUMIT ................................................................. 19 ORAP........................................................................ 12 ORENCIA ................................................................. 18 ORTHO DIAPHRAGM ALL-FLEX/ 65MM................ 12 oxacillin sodium .......................................................... 4

oxaliplatin.................................................................... 7 oxandrolone .............................................................. 16 oxazepam ................................................................. 11 oxcarbazepine .......................................................... 11 OXSORALEN ........................................................... 21 OXSORALEN ULTRA .............................................. 21 oxybutynin chloride................................................... 21 oxycodone hcl........................................................... 10 oxycodone w/ acetaminophen.................................. 10 oxytocin..................................................................... 18 OXYTROL................................................................. 21

P paclitaxel..................................................................... 7 pamidronate disodium .............................................. 18 pancuronium bromide................................................. 8 pantoprazole sodium ................................................ 16 papaverine hcl .......................................................... 10 PAPAVERINE HCL .................................................. 19 paromomycin sulfate .................................................. 5 paroxetine hcl ........................................................... 12 ped multivitamins w/fl & iron..................................... 21 PEDIARIX................................................................. 20 pediatric multiple vitamin w/ c................................... 21 pediatric multiple vitamins w/ iron............................. 21 pediatric multivitamins w/fl........................................ 21 PEDIATRIC SMALL MASK ...................................... 12 pediatric vitamins acd fluoride & iron ....................... 21 pediatric vitamins acd w/ fluoride ............................. 21 peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ... 16 PEGASYS................................................................... 6 PEG-INTRON ............................................................. 5 penicillin g potassium ................................................. 4 PENICILLIN G POTASSIUM IN ISO-OSMOTIC

DEXTROSE............................................................. 4 PENICILLIN G PROCAINE ........................................ 4 PENICILLIN G SODIUM............................................. 4 penicillin v potassium.................................................. 4 PENLET II AUTOMATIC BLOOD SAMPLER .......... 12 pentazocine w/ naloxone .......................................... 10 PENTETATE CALCIUM TRISODI UM..................... 16 PENTETATE ZINC TRISODIUM.............................. 16 pentostatin .................................................................. 7 pentoxifylline ............................................................... 9 PERJETA.................................................................... 7 permethrin................................................................. 20 perphenazine ............................................................ 12 PERPHENAZINE/AMITRIPTYLIN E ........................ 12 phenelzine sulfate..................................................... 12 PHENEX-1................................................................ 13 phenobarbital ............................................................ 11 PHENOBARBITAL ................................................... 19 PHENOBARBITAL SODIUM.................................... 11 phenobarbital-hyoscyamine-atropine-scopolamine ... 7 PHENOL ................................................................... 21 PHENTOLAMINE MESYLATE................................... 8 phenyleph-promethazine w/ cod .............................. 19 phenylephrine hcl (ophth) ......................................... 15 phenylephrine hcl (pressors) ...................................... 8 phenylephrine-chlorphen-dm.................................... 19


PHENYLHISTINE DH............................................... 19 phenytoin .................................................................. 11 phenytoin sodium ..................................................... 11 phenytoin sodium extended ..................................... 11 PHISOHEX ............................................................... 20 PHOSPHOLINE IODIDE .......................................... 15 PHYSOSTIGMINE SALICYLATE............................... 8 phytonadione ............................................................ 22 pilocarpine hcl........................................................... 15 pilocarpine hcl (oral) ................................................... 8 pioglitazone hcl ......................................................... 16 piperacillin sodium-tazobactam sodium ..................... 4 PLAN B ONE-STEP ................................................. 17 PLASMA-LYTE A ..................................................... 14 PLASMANATE............................................................ 8 PLURONIC F127...................................................... 19 PNEUMOVAX 23/5 DOSE ....................................... 20 PODOCON 25 IN BENZOIN TIN CTURE................ 21 podofilox ................................................................... 21 PODOPHYLLIN RESIN............................................ 19 POLYETHYLENE GLYCOL 400 .............................. 19 POLYETHYLENE GLYCOL 8000 ............................ 19 polymyxin b-trimethoprim ......................................... 14 polysaccharide iron complex ...................................... 8 POMALYST ................................................................ 7 PONTOCAINE.......................................................... 21 POTABA ................................................................... 22 potassium acetate .................................................... 14 potassium bicarbonate ............................................. 14 potassium chloride.................................................... 14 potassium chloride in dextrose................................. 14 potassium chloride in dextrose & sodium chloride... 14 potassium chloride in nacl ........................................ 14 potassium chloride microencapsulated crystals cr... 14 potassium citrate (alkalinizer) ................................... 13 potassium citrate-citric acid ...................................... 13 potassium phosphate dibasic ................................... 14 PRADAXA................................................................... 9 pramipexole dihydrochloride .................................... 11 PRAMOSONE .......................................................... 21 pravastatin sodium ..................................................... 9 prazosin hcl................................................................. 9 PRECEDEX.............................................................. 11 prednisolone ............................................................. 16 prednisolone acetate (ophth).................................... 15 PREDNISOLONE SODIUM PHOSP HATE............. 15 prednisolone sodium phosphate .............................. 16 prednisone ................................................................ 16 PREMARIN............................................................... 17 PREVNAR 13 ........................................................... 20 PREZISTA .................................................................. 6 PRIFTIN...................................................................... 5 PRIMAQUINE PHOSPHATE ..................................... 5 PRIMAXIN IV.............................................................. 4 primidone .................................................................. 11 PRIMSOL.................................................................... 4 probenecid ................................................................ 14 PROCAINAMIDE HCL................................................ 9 prochlorperazine ....................................................... 12 prochlorperazine edisylate ....................................... 12

prochlorperazine maleate ......................................... 12 PROCRIT.................................................................... 9 PROCTOFOAM HC.................................................. 21 PROFERRIN ES......................................................... 8 PROFERRIN-FORTE ................................................. 8 PROFILNINE SD ........................................................ 8 progesterone............................................................. 17 progesterone micronized .......................................... 17 PROGESTERONE MICRONIZED ........................... 19 PROGESTERONE WETTABLE............................... 19 PROGLYCEM............................................................. 9 PROLASTIN ............................................................. 14 PROLEUKIN............................................................... 7 PROMACTA ............................................................... 9 promethazine hcl ........................................................ 6 promethazine w/codeine .......................................... 19 promethazine-dm...................................................... 19 propafenone hcl.......................................................... 9 PROPANTHELINE BROMIDE ................................... 7 proparacaine hcl ....................................................... 15 propofol ..................................................................... 11 propranolol hcl ............................................................ 9 PROPYLENE GLYCOL............................................ 19 propylthiouracil ......................................................... 17 PROQUAD................................................................ 20 PROSTIGMIN............................................................. 8 PROTAMINE SULFATE............................................. 8 PROTOPIC ............................................................... 21 protriptyline hcl.......................................................... 12 pseudoephedrine w/ codeine-gg .............................. 19 PULMOZYME........................................................... 14 pyrazinamide .............................................................. 5 pyridostigmine bromide .............................................. 8 PYRIDOXINE HCL ................................................... 22

Q QUELICIN................................................................... 8 quetiapine fumarate.................................................. 12 QUINACRINE HCL................................................... 19 quinidine gluconate..................................................... 9 quinidine sulfate.......................................................... 9 QVAR........................................................................ 16

R RABAVERT .............................................................. 20 raloxifene hcl............................................................. 17 ranitidine hcl.............................................................. 16 RECOTHROM ............................................................ 8 REFLUDAN ................................................................ 9 RELENZA DISKHALER.............................................. 6 REMICADE............................................................... 18 REMODULIN ............................................................ 10 RENVELA................................................................. 13 REOPRO .................................................................... 9 RESCRIPTOR ............................................................ 6 RESERPINE............................................................... 9 RESTASIS................................................................ 15 RETIN-A MICRO ...................................................... 21 RETISERT................................................................ 15


REVLIMID................................................................... 7 REYATAZ ................................................................... 6 ribavirin (hepatitis c) ................................................... 6 RIDAURA.................................................................. 16 rifabutin ....................................................................... 5 RIFAMATE.................................................................. 5 rifampin ....................................................................... 5 riluzole ...................................................................... 11 rimantadine hydrochloride .......................................... 6 RIMSO-50................................................................. 18 risperidone ................................................................ 12 RITUXAN .................................................................... 7 rizatriptan benzoate .................................................. 11 rocuronium bromide.................................................... 8 ropinirole hydrochloride ............................................ 11 ROTARIX.................................................................. 20 ROTATEQ ................................................................ 20

S SABRIL ..................................................................... 11 SALICYLIC ACID...................................................... 19 saline ........................................................................ 15 saline, bacteriostatic ................................................. 14 salsalate.................................................................... 10 SANDIMMUNE ......................................................... 18 SANTYL.................................................................... 21 SCOPOLAMINE HYDROBROMIDE .......................... 7 selegiline hcl ............................................................. 11 SELENIUM ............................................................... 14 selenium sulfide ........................................................ 20 SELZENTRY............................................................... 6 SENSIPAR................................................................ 18 SEREVENT DISKUS.................................................. 8 SEROMYCIN.............................................................. 5 SEROSTIM............................................................... 17 sertraline hcl ............................................................. 12 sildenafil citrate (pulmonary hypertension)............... 10 silver sulfadiazine ..................................................... 20 simvastatin.................................................................. 9 sirolimus.................................................................... 18 sodium acetate ......................................................... 13 SODIUM BENZOATE............................................... 19 sodium bicarbonate .................................................. 13 sodium chloride ........................................................ 14 sodium chloride (gu irrigant) ..................................... 14 sodium chloride (inhalant) ........................................ 19 sodium citrate & citric acid........................................ 13 SODIUM EDECRIN.................................................. 13 sodium fluoride ......................................................... 18 sodium fluoride (dental) ............................................ 18 sodium phosphate .................................................... 14 sodium polystyrene sulfonate................................... 13 sodium thiosulfate..................................................... 16 SOLIRIS.................................................................... 18 SORBITOL................................................................ 16 SORIATANE............................................................. 18 sotalol hcl.................................................................... 9 sotalol hcl (afib/afl)...................................................... 9 SOTRADECOL......................................................... 10 SOVALDI .................................................................... 6

SPIRIVA HANDIHALER ............................................. 7 spironolactone .......................................................... 10 spironolactone & hydrochlorothiazide ...................... 10 SPRYCEL................................................................... 7 SQUARIC ACID DIBUTYLESTER ........................... 19 SSKI.......................................................................... 17 stavudine .................................................................... 6 STIVARGA.................................................................. 7 STREPTOMYCIN SULFATE...................................... 4 STRIBILD.................................................................... 6 sucralfate .................................................................. 16 sufentanil citrate ....................................................... 10 sulfacetamide sodium (ophth) .................................. 14 sulfacetamide sodium w/ sulfur ................................ 21 sulfacetamide sodium-sulfur w/ sunscreens ............ 21 sulfacetamide sod-prednisolone............................... 15 SULFADIAZINE.......................................................... 4 sulfamethoxazole-trimethoprim .................................. 4 SULFAMYLON ......................................................... 20 sulfasalazine ............................................................... 5 SULFUR PRECIPITATED........................................ 19 sulindac..................................................................... 10 SUMATRIPTAN........................................................ 11 sumatriptan succinate............................................... 11 SUPARTZ ................................................................. 18 SUPRANE ................................................................ 11 SUPRAX ..................................................................... 5 SURMONTIL............................................................. 12 SURVANTA INTRATRACHEAL............................... 19 SUSTIVA .................................................................... 6 SUTENT ..................................................................... 7 SYNAGIS.................................................................... 6 SYNAREL................................................................. 17 SYNERCID ................................................................. 5 syringe (disposable) ................................................. 12

T TABLOID .................................................................... 7 tacrolimus ................................................................. 18 TAFINLAR .................................................................. 7 TAMIFLU .................................................................... 6 tamoxifen citrate ......................................................... 7 tamsulosin hcl ............................................................. 9 TARCEVA................................................................... 7 TARGRETIN............................................................... 7 TASIGNA.................................................................... 7 TAXOTERE ................................................................ 7 TAZORAC................................................................. 21 temazepam ............................................................... 11 temozolomide ............................................................. 7 terazosin hcl................................................................ 9 terbinafine hcl ............................................................. 5 terbutaline sulfate ....................................................... 8 TESTOSTERONE .................................................... 19 testosterone cypionate ............................................. 16 testosterone enanthate............................................. 16 TETRACAINE HCL................................................... 17 tetracaine hcl (ophth)................................................ 15 tetracycline hcl ............................................................ 5 THALOMID ............................................................... 18


THAM........................................................................ 13 theophylline............................................................... 21 theophylline in dextrose............................................ 21 THERACYS .............................................................. 20 thiamine hcl............................................................... 22 THIOLA..................................................................... 18 thioridazine hcl.......................................................... 12 THIOTEPA.................................................................. 7 thiothixene ................................................................ 12 THROMBATE III W/10 ML STE RILE WATER .......... 9 THROMBIN-JMI DILUENT......................................... 8 THYMOL................................................................... 19 THYROGEN ............................................................. 13 TIKOSYN .................................................................... 9 timolol maleate (ophth) ............................................. 15 TIVICAY...................................................................... 6 tizanidine hcl ............................................................... 8 TNKASE ..................................................................... 9 TOBRADEX.............................................................. 15 tobramycin .................................................................. 5 tobramycin (ophth).................................................... 14 tobramycin sulfate ...................................................... 5 TOLBUTAMIDE ........................................................ 16 topiramate................................................................. 11 topotecan hcl .............................................................. 7 TORISEL .................................................................... 7 torsemide .................................................................. 13 TRAC .......................................................................... 6 trace minerals (cr-cu-mn-zn) .................................... 14 TRACLEER............................................................... 10 tramadol hcl .............................................................. 10 tramadol-acetaminophen.......................................... 10 TRANEXAMIC ACID ................................................ 19 TRANSDERM-SCOP ............................................... 15 tranylcypromine sulfate............................................. 12 trazodone hcl ............................................................ 12 TREANDA................................................................... 7 TRECATOR................................................................ 5 tretinoin ..................................................................... 21 tretinoin (chemotherapy)............................................. 7 TRIAMCINOLONE ACETONIDE ............................. 19 triamcinolone acetonide (mouth) .............................. 21 triamcinolone acetonide (topical).............................. 21 triamterene & hydrochlorothiazide ........................... 13 TRI-CHLOR .............................................................. 18 TRICITRATES .......................................................... 13 trifluoperazine hcl ..................................................... 12 trifluridine .................................................................. 14 trihexyphenidyl hcl .................................................... 11 trimethoprim................................................................ 6 TRISENOX ................................................................. 7 tropicamide ............................................................... 15 trospium chloride ...................................................... 21 TRUVADA................................................................... 6 TRUZONE PEAK FLOW METER ............................ 12 TUBERSOL .............................................................. 13 TWINRIX................................................................... 20 TYKERB ..................................................................... 7 TYPHIM VI................................................................ 20 TYSABRI .................................................................. 18

TYVASO ................................................................... 10

U

ULTIVA ..................................................................... 10 UREA........................................................................ 19 ursodiol ..................................................................... 16

V

valacyclovir hcl............................................................ 6 VALCYTE ................................................................... 6 valproate sodium ...................................................... 11 valproic acid.............................................................. 11 vancomycin hcl ........................................................... 5 VANCOMYCIN HCL IN DEXTROS E ........................ 5 VARIVAX .................................................................. 20 VARIZIG ................................................................... 20 vasopressin............................................................... 17 VECTICAL ................................................................ 21 vecuronium bromide ................................................... 8 VELCADE................................................................... 7 venlafaxine hcl .......................................................... 12 VENOFER .................................................................. 8 VENTAVIS................................................................ 10 verapamil hcl............................................................... 9 VERAPAMIL HCL..................................................... 19 VEXOL...................................................................... 15 VICTRELIS ................................................................. 6 VIDAZA....................................................................... 7 VIMIZIM .................................................................... 14 VINBLASTINE SULFATE........................................... 7 vincristine sulfate ........................................................ 7 vinorelbine tartrate...................................................... 7 VIRACEPT.................................................................. 6 VIRAZOLE.................................................................. 6 VIREAD ...................................................................... 6 VISTIDE...................................................................... 6 VISUDYNE ............................................................... 15 VITRASERT.............................................................. 14 VIVOTIF BERNA ...................................................... 20 VORAXAZE .............................................................. 14 voriconazole................................................................ 5 VOTRIENT.................................................................. 7 VPRIV ....................................................................... 14 VUMON ...................................................................... 7 VYVANSE................................................................. 10

W warfarin sodium .......................................................... 9 water for injection, sterile.......................................... 18 water for irrigation, sterile ......................................... 14 WIDE-SEAL SILICONE DIAPHR AGM KIT 60 ........ 12 WILATE .................................................................... 20

X

XALKORI .................................................................... 7 XERAC AC ............................................................... 21 XIFAXAN .................................................................... 5 XOLAIR..................................................................... 19


XTANDI....................................................................... 7 XYNTHA ..................................................................... 8

Y YALE NEEDLES/REGULAR BEVE L/THIN

WALL/19G X 1-1/2 ................................................ 12 YERVOY..................................................................... 7 YF-VAX..................................................................... 20 YODOXIN ................................................................... 5

Z ZANOSAR .................................................................. 7 ZANTAC ................................................................... 16 ZELBORAF................................................................. 7 zidovudine................................................................... 6

ZINACEF IN ISO-OSMOTIC DEXTROSE ................. 5 ZINACEF IN ISO-OSMOTIC DILUENT...................... 5 zinc oxide (topical).................................................... 21 zinc sulfate................................................................ 14 ZINC SULFATE HEPTAHYDRATE ......................... 19 ZINC TRACE METAL............................................... 14 ziprasidone hcl.......................................................... 12 zoledronic acid.......................................................... 18 zolpidem tartrate ....................................................... 11 ZOSTAVAX............................................................... 20 ZOSYN ....................................................................... 5 ZYMAXID.................................................................. 14 ZYTIGA....................................................................... 7 ZYVOX........................................................................ 5


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