lista de medicamentos preferidos aprobada por medicaid

143
Kentucky Lista de medicamentos preferidos aprobada por Medicaid En vigencia desde el 1 de julio de 2021 Leyenda En cada categoría, los medicamentos se listan en orden alfabético por marca o nombre genérico. Medicamento de marca: letra mayúscula en negrita Medicamento genérico: letra minúscula en texto sin formato AL: restricción de límite de edad DO: programa de optimización de dosis GR: restricción de género OTC: medicamento de venta libre disponible con receta. (Los recetadores deben incluir la sigla OTC en la receta). PA: requiere autorización previa. La autorización previa es el proceso mediante el cual se obtiene la aprobación de los beneficios antes de que se puedan abastecer ciertas recetas. QL: límites de cantidad. Ciertos medicamentos recetados tienen límites de cantidad específicos, por receta o por mes. SP: farmacia de medicamentos especiales ST: requiere terapia escalonada. Es posible que necesite utilizar un medicamento antes de que los beneficios para el uso de otro medicamento puedan autorizarse.

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Page 1: Lista de medicamentos preferidos aprobada por Medicaid

Kentucky

Lista de medicamentos preferidos aprobada por Medicaid En vigencia desde el 1 de julio de 2021

Leyenda

En cada categoría, los medicamentos se listan en orden alfabético por marca o nombre genérico.

Medicamento de marca: letra mayúscula en negrita

Medicamento genérico: letra minúscula en texto sin formato

AL: restricción de límite de edad

DO: programa de optimización de dosis

GR: restricción de género

OTC: medicamento de venta libre disponible con receta. (Los recetadores deben incluir la sigla OTC en la

receta).

PA: requiere autorización previa. La autorización previa es el proceso mediante el cual se obtiene la aprobación

de los beneficios antes de que se puedan abastecer ciertas recetas.

QL: límites de cantidad. Ciertos medicamentos recetados tienen límites de cantidad específicos, por receta o por

mes.

SP: farmacia de medicamentos especiales ST: requiere terapia escalonada. Es posible que necesite utilizar un medicamento antes de que los beneficios para el uso de otro medicamento puedan autorizarse.

Page 2: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

ADYUVANTES FARMACÉUTICOS

VEHÍCULOS SEMISÓLIDOS

cvs petroleum jelly external gel OTC

petroleum jelly external gel OTC

qc petroleum jelly external gel OTC

white petroleum jelly external gel OTC

AGENTES ANORRECTALES

ANESTÉSICOS LOCALES RECTALES

LIPOCAINE 5 EXTERNAL CREAM OTC

COMBINACIONES RECTALES VARIAS

cvs hemorrhoidal rectal ointment Preparation H OTC

cvs hemorrhoidal rectal suppository Preparation H OTC

eq hemorrhoidal rectal suppository OTC

eql hemorrhoidal rectal ointment Preparation H OTC

eql hemorrhoidal rectal suppository Preparation H OTC

goodsense hemorrhoidal rectal ointment Preparation H OTC

goodsense hemorrhoidal rectal suppository Preparation H OTC

hemorrhoidal rectal ointment Preparation H OTC

hemorrhoidal rectal suppository OTC

hm hemorrhoidal rectal ointment Preparation H OTC

PREPARATION H RECTAL SUPPOSITORY

OTC

px hemorrhoidal rectal ointment OTC

px hemorrhoidal rectal suppository OTC

qc hemorrhoidal rectal ointment Preparation H OTC

qc hemorrhoidal rectal suppository Preparation H OTC

ra hemorrhoidal rectal ointment OTC

ra hemorrhoidal rectal suppository OTC

sb hemorrhoid rectal ointment OTC

sm hemorrhoidal rectal ointment Preparation H OTC

sm hemorrhoidal rectal suppository OTC

ESTEROIDES INTRARRECTALES

hydrocortisone rectal enema Cortenema

AGENTES ANSIOLÍTICOS

AGENTES ANSIOLÍTICOS VARIOS

hydroxyzine hcl oral syrup

hydroxyzine hcl oral tablet

2

Page 3: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

hydroxyzine pamoate oral capsule

AGENTES ANTIANGINOSOS

NITRATOS

isosorbide dinitrate oral tablet Isordil Titradose

isosorbide mononitrate er oral tablet extended release 24 hour

isosorbide mononitrate oral tablet

MINITRAN TRANSDERMAL PATCH 24 HOUR

NITRO-BID TRANSDERMAL OINTMENT

NITRO-DUR TRANSDERMAL PATCH 24 HOUR

nitroglycerin sublingual tablet sublingual Nitrostat

nitroglycerin transdermal patch 24 hour Nitro-Dur

AGENTES ANTIASMÁTICOS Y AGENTES BRONCODILATADORES

AGENTES ANTIINFLAMATORIOS

cromolyn sodium inhalation nebulization solution

ANTICUERPOS MONOCLONALES ANTI-IGE

XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PA

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED

PA

XANTINAS

theophylline er oral tablet extended release 12 hour

theophylline er oral tablet extended release 24 hour

theophylline oral solution

AGENTES ANTIINFECCIOSOS VARIOS

*URINARY ANTI-INFECTIVES***

methenamine hippurate oral tablet Hiprex

nitrofurantoin macrocrystal oral capsule Macrodantin

nitrofurantoin monohyd macro oral capsule Macrobid

3

Page 4: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

AGENTES ANTIINFECCIOSOS VARIOS

trimethoprim oral tablet

AGENTES LEPROSTÁTICOS

dapsone oral tablet

LINCOSAMIDAS

clindamycin hcl oral capsule Cleocin

clindamycin palmitate hcl oral solution reconstituted

Cleocin

AGENTES ANTIMIASTÉNICOS

AGENTES ANTIMIASTÉNICOS/COLINÉRGICOS

pyridostigmine bromide er oral tablet extended release

Mestinon

pyridostigmine bromide oral solution Mestinon

pyridostigmine bromide oral tablet Mestinon

AGENTES ANTIMICOBACTERIALES

AGENTES ANTIMICOBACTERIALES

ethambutol hcl oral tablet

isoniazid oral syrup

isoniazid oral tablet

PRIFTIN ORAL TABLET

pyrazinamide oral tablet

rifabutin oral capsule Mycobutin

rifampin oral capsule

AGENTES ANTIPSICÓTICOS/ANTIMANÍACOS

AGENTES ANTIMANÍACOS

lithium carbonate er oral tablet extended release

Lithobid DO; QL

lithium carbonate oral capsule DO; QL

lithium carbonate oral tablet

lithium oral solution AL

AGENTES CARDIOVASCULARES VARIOS

VASODILATADORES PERIFÉRICOS

eql niacin flush free oral capsule OTC

niacin flush free oral capsule OTC

4

Page 5: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

qc niacin oral capsule OTC

AGENTES DE INMUNIZACIÓN PASIVA Y TRATAMIENTO

SUEROS INMUNOLÓGICOS

GAMUNEX-C INJECTION SOLUTION PA; AL

OCTAGAM INTRAVENOUS SOLUTION PA; AL

VARIZIG INTRAMUSCULAR SOLUTION AL

AGENTES DE INMUNIZACIÓN PASIVA

ANTICUERPOS MONOCLONALES ANTIVIRALES

SYNAGIS INTRAMUSCULAR SOLUTION PA

AGENTES DERMATOLÓGICOS

AGENTES EMOLIENTES/QUERATOLÍTICOS

gordons urea external cream OTC; QL

gormel external cream OTC

urea 10 hydrating external cream Aqua Care OTC

urea 20 intensive hydrating external cream OTC

ureacin-20 external cream OTC

AGENTES QUEROTOLÍTICOS/ANTIMICÓTICOS

callus removers external padClear Away 1-Step Wart Remover

OTC

callus removers extra thick external padClear Away 1-Step Wart Remover

OTC

CLEAR AWAY 1-STEP WART REMOVER EXTERNAL PAD

OTC

COMPOUND W EXTERNAL PAD OTC

COMPOUND W FOR KIDS EXTERNAL STRIP

OTC

COMPOUND W ONE STEP EXTERNAL PAD

OTC

COMPOUND W ONE STEP INVISIBLE EXTERNAL STRIP

OTC

corn remover one-step external strip Compound W for Kids OTC

cvs callus removers external padClear Away 1-Step Wart Remover

OTC

cvs corn removers external padClear Away 1-Step Wart Remover

OTC

5

Page 6: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

cvs plantar wart remover external padClear Away 1-Step Wart Remover

OTC

cvs wart remover external padClear Away 1-Step Wart Remover

OTC

cvs wart remover one step external strip Compound W for Kids OTC

DR SCHOLLS CALLUS REM/DURAGEL EXTERNAL PAD

OTC

DRS CHOICE CORN/CALLUS REMOVER EXTERNAL PAD

OTC

DUOFILM EXTERNAL SOLUTION OTC

eql callus remover extra thick external padClear Away 1-Step Wart Remover

OTC

gel callus removers external padClear Away 1-Step Wart Remover

OTC

gnp corn removers external padClear Away 1-Step Wart Remover

OTC

medicated callus removers external padClear Away 1-Step Wart Remover

OTC

medicated corn removers external padClear Away 1-Step Wart Remover

OTC

medicated wart removers external padClear Away 1-Step Wart Remover

OTC

podofilox external solution

ra corn removers ultra thin external padClear Away 1-Step Wart Remover

OTC

ra wart remover external padClear Away 1-Step Wart Remover

OTC

sm medicated corn removers external padClear Away 1-Step Wart Remover

OTC

ultra thin corn removers external padClear Away 1-Step Wart Remover

OTC

wart remover maximum strength external strip

Compound W for Kids OTC

wart remover medicated external padClear Away 1-Step Wart Remover

OTC

ANALGÉSICOS - TÓPICOS

blue gel external gel Mineral Ice OTC

cvs therapeutic menthol external gel Mineral Ice OTC

ice blue external gel Mineral Ice OTC

MINERAL ICE EXTERNAL GEL OTC

6

Page 7: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

ANESTÉSICOS LOCALES TÓPICOS

afterburn external gel OTC

ALOCANE EMERGENCY BURN MAX STR EXTERNAL PAD

OTC

aloe/lidocaine pain reliever external gel OTC

ANECREAM EXTERNAL CREAM OTC

ASPERCREME W/LIDOCAINE EXTERNAL CREAM

OTC

BENGAY LIDOCAINE EXTERNAL CREAM OTC

blue tube/ aloe external cream AneCream OTC

capsaicin external cream DermacinRx Penetral OTC

cooling external gel OTC

cvs aftersun aloe/lidocaine external gel OTC

cvs lidocaine maximum strength external cream

Aspercreme w/Lidocaine OTC

cvs pain relief external cream Aspercreme w/Lidocaine OTC

DERMACINRX PENETRAL EXTERNAL CREAM

OTC

eq pain relieving external cream Aspercreme w/Lidocaine OTC

gnp lidocaine pain relieving external cream Aspercreme w/Lidocaine OTC

GOLD BOND MULTI-SYMPTOM EXTERNAL CREAM

OTC

lidocaine external cream OTC

lidocaine hcl external cream Aspercreme w/Lidocaine OTC

lidocaine hcl external solution

lidocaine hcl urethral/mucosal external gel

lidocaine plus external cream Aspercreme w/Lidocaine OTC

LIDODOSE EXTERNAL GEL OTC

LIDODOSE PEDIATRIC BULK PACK EXTERNAL GEL

OTC

pain relieving + lidocaine external cream Aspercreme w/Lidocaine OTC

ra pain relief external cream Aspercreme w/Lidocaine OTC

REGENECARE HA EXTERNAL GEL OTC

REGENECARE HA EXTERNAL LIQUID OTC

sure result sr relief external cream DermacinRx Penetral OTC

xolido external cream OTC

xolido xp external cream Aspercreme w/Lidocaine OTC

7

Page 8: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

ANTIMETABOLITOS ANTINEOPLÁSICOS TÓPICOS

fluorouracil external cream Efudex PA

fluorouracil external solution PA

ANTIMICÓTICOS - COMBINACIONES TÓPICAS

g-myco nail external solution Myco Nail OTC

MYCO NAIL EXTERNAL SOLUTION OTC

ANTIMICÓTICOS RELACIONADOS CON EL IMIDAZOL TÓPICOS

alevazol external ointment OTC

antifungal external powder Desenex OTC

athletes foot external powder Desenex OTC

cvs athletes foot spray external aerosol Lotrimin AF OTC

DESENEX EXTERNAL POWDER OTC

gnp miconazorb af external powder Desenex OTC

LOTRIMIN AF EXTERNAL POWDER PA; OTC

MICRO GUARD EXTERNAL POWDER OTC

MYCOZYL AP EXTERNAL POWDER OTC

ZEASORB-AF EXTERNAL POWDER OTC

ANTIMICÓTICOS TÓPICOS

anti-fungal external liquidElon Dual Defense Anti-Fungal

OTC

anti-fungal external powder Odor Eaters Antifungal OTC

athletes foot (terbinafine) external cream LamISIL AT OTC

BLIS-TO-SOL EXTERNAL LIQUID OTC

cvs antifungal maximum str external liquidElon Dual Defense Anti-Fungal

OTC

cvs athletes foot external cream LamISIL AT OTC

cvs jock itch external cream LamISIL AT OTC

ELON DUAL DEFENSE ANTI-FUNGAL EXTERNAL LIQUID

OTC

eql athletes foot(terbinafine) external cream LamISIL AT OTC

FUNGICURE MAXIMUM STRENGTH EXTERNAL LIQUID

OTC

gnp terbinafine hydrochloride external cream LamISIL AT OTC

HONGO CURA ANTI-FUNGAL EXTERNAL LIQUID

OTC

8

Page 9: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

LAMISIL AT EXTERNAL CREAM OTC

LAMISIL AT JOCK ITCH EXTERNAL CREAM

OTC

medicated anti-fungal external solution Blis-To-Sol OTC

ODOR EATERS ANTIFUNGAL EXTERNAL POWDER

OTC

qc athletes foot external cream LamISIL AT OTC

ra antifungal pen external liquidElon Dual Defense Anti-Fungal

OTC

sm athletes foot external cream LamISIL AT OTC

terbinafine hcl external cream LamISIL AT OTC

tolnaftate external powder Odor Eaters Antifungal OTC

ANTIVIRALES - TÓPICOS

ABREVA EXTERNAL CREAM OTC

ASTRINGENTES

BOUDREAUXS BUTT PASTE EXTERNAL OINTMENT

OTC; QL

calamine external lotion OTC

calamine phenolated external lotion OTC

cvs diaper rash external ointment Boudreauxs Butt Paste OTC; QL

cvs zinc oxide external ointment OTC; QL

diaper rash external ointment Boudreauxs Butt Paste OTC; QL

eq diaper rash external ointment Boudreauxs Butt Paste OTC; QL

eql baby basics diaper rash external ointment

Boudreauxs Butt Paste OTC; QL

gnp calamine phenolated external lotion OTC

gnp zinc oxide external ointment OTC; QL

meijer zinc oxide external ointment OTC; QL

qc calamine external lotion OTC

qc diaper rash external ointment Boudreauxs Butt Paste OTC; QL

ra zinc oxide external ointment OTC; QL

sm calamine phenolated external lotion OTC

zinc oxide external ointment OTC; QL

COMBINACIONES ANESTÉSICAS TÓPICAS

allevess external patch OTC

lidocaine-prilocaine external cream

reliever external patch OTC

9

Page 10: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

COMBINACIONES DE ANTISEBORREICOS

sebex external shampoo OTC

COMBINACIONES DE EMOLIENTES

mineral oil-hydrophil petrolat external ointment

OTC

COMBINACIONES DE ESCABICIDAS

cvs lice killing external shampoo Rid Lice Killing Shampoo OTC

eq lice killing max st external shampoo Rid Lice Killing Shampoo OTC

eql lice killing max st external shampoo Rid Lice Killing Shampoo OTC

gnp lice treatment external shampoo Rid Lice Killing Shampoo OTC

hm lice killing max st external shampoo Rid Lice Killing Shampoo OTC

lice killing external shampoo Rid Lice Killing Shampoo OTC

lice killing maximum strength external shampoo

Rid Lice Killing Shampoo OTC

ra lice maximum strength external shampoo Rid Lice Killing Shampoo OTC

sb lice killing max st external shampoo Rid Lice Killing Shampoo OTC

sm lice killing max strength external shampoo

Rid Lice Killing Shampoo OTC

COMBINACIONES DE ESTEROIDES TÓPICOS

hydrocortisone-aloe external cream PA; OTC

kp hydrocortisone-aloe external cream OTC

COMBINACIONES DE LINIMENTOS

DOULEURIN EXTERNAL LOTION OTC

MENTHOZEN EXTERNAL CREAM OTC

qc muscle rub external cream Arthritis Hot OTC

CORTICOESTEROIDES - TÓPICOS

amcinonide external ointment PA

GYNECORT 10 EXTERNAL CREAM OTC

hydrocortisone acetate external cream Gynecort 10 OTC

LANACORT 10 EXTERNAL CREAM OTC

scalp relief maximum strength external solution

Scalpicin Maximum Strength

OTC

SCALPICIN MAXIMUM STRENGTH EXTERNAL SOLUTION

OTC

VAGISIL EXTERNAL CREAM OTC

10

Page 11: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

EMOLIENTES

a&d external ointment OTC

advanced healing/baby external ointment DermaPhor OTC

AL12 EXTERNAL LOTION OTC

AMLACTIN DAILY EXTERNAL LOTION OTC

AMLACTIN EXTERNAL LOTION OTC

ammonium lactate external cream QL

ammonium lactate external lotion AL12

baby vitamin a & d external ointment OTC

beauty lotion external lotion DermaDaily OTC

complete moisture external lotion DermaDaily OTC

cvs advanced healing external ointment DermaPhor OTC

cvs beauty 360 pure glycerin external liquid OTC

cvs beauty 360 pure vitamin e external oil OTC

cvs dry skin therapy external lotion DermaDaily OTC

cvs extra moisturizing external lotion DermaDaily OTC

cvs gentle skin cleanser external lotion DermaDaily OTC

cvs hydrating skin treatment external lotion AL12 OTC

cvs moisturizing external lotion DermaDaily OTC

cvs skin treatment external lotion AL12 OTC

cvs special care external lotion DermaDaily OTC

cvs vitamin a&d external ointment OTC

cvs vitamin e external oil OTC

cvs vitamin e moisturizing external creamPalmers Natural Vitamin E

OTC

cvs vitamin e moisturizing external oil OTC

DERMADAILY EXTERNAL LOTION OTC

DERMAPHOR EXTERNAL OINTMENT OTC

DERMAVANTAGE EXTERNAL LOTION OTC

DML EXTERNAL LOTION OTC

dry skin treatment adv therapy external ointment

DermaPhor OTC

dry skin treatment external ointment DermaPhor OTC

e-cream complex external cream OTC

e-oil external oil OTC

e-ointment external ointment DermaPhor OTC

eq vitamins a & d external ointment OTC

11

Page 12: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

eql absolute moisture dry skin external lotion DermaDaily OTC

eql advanced healing external ointment DermaPhor OTC

eql advanced recovery external lotion DermaDaily OTC

eql advanced skin therapy external lotion DermaDaily OTC

eql aloe after sun external lotion DermaDaily OTC

eql vitamin e ultra strength external oil OTC

FLANDERS BUTTOCKS EXTERNAL OINTMENT

OTC

glycerin external liquid OTC

gnp vitamin a & d external ointment OTC

gordomatic external lotion DermaDaily OTC

GORDONS-VITE A EXTERNAL CREAM OTC

gordons-vite e external creamPalmers Natural Vitamin E

OTC

hm glycerin external liquid OTC

HYDROLATUM EXTERNAL OINTMENT OTC

lubricating lotion external lotion DermaDaily OTC

LUBRISILK EXTERNAL LOTION OTC

MINERIN EXTERNAL LOTION OTC

moisture external lotion DermaDaily OTC

moisture recovery external lotion DermaDaily OTC

moisturizing lotion external lotion DermaDaily OTC

moisturizing sensitive skin external lotion DermaDaily OTC

natural oatmeal bath treatment external packet

Aveeno Baby Bath Treatment

OTC

PALMERS NATURAL VITAMIN E EXTERNAL CREAM

OTC

qc glycerin external liquid OTC

ra glycerin external liquid OTC

ra renewal soothing bath external packetAveeno Baby Bath Treatment

OTC

refreshing aloe external lotion DermaDaily OTC

SARATOGA EXTERNAL OINTMENT OTC

sm dry skin therapy external lotion DermaDaily OTC

sm glycerin external liquid OTC

sm oatmeal bath external packetAveeno Baby Bath Treatment

OTC

thera-derm external lotion DermaDaily OTC

12

Page 13: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

vitamin a & d external ointment OTC

vitamin a&d external ointment OTC

vitamin e beauty external oil OTC

vitamin e external creamPalmers Natural Vitamin E

OTC

vitamin e external oil OTC

vitamin e skin external cream OTC

vitamin e skin external oil OTC

vitamin e-vit a & d external cream OTC

vitamins a & d external ointment OTC

IMIDAZOQUINOLINAMINAS INMUNOMODULADORAS TÓPICAS

imiquimod external cream Aldara PA; QL

LIMPIADORES PARA LA PIEL

alcohol wipes external OTC

cvs isopropyl alcohol wipes external OTC

ra isopropyl alcohol wipes external OTC

LUBRICANTES

AQUA LUBE EXTERNAL GEL OTC

PRODUCTOS ANTISEBORREICOS

anti-dandruff external shampoo Selsun Blue Daily OTC

selenium sulfide external lotion

selenium sulfide external shampoo

SELSUN BLUE DAILY EXTERNAL LOTION

OTC

SELSUN BLUE MEDICATED EXTERNAL LOTION

OTC

PRODUCTOS DE BAÑO

ALPHASOFT EXTERNAL OIL OTC

CAMEO OIL EXTERNAL OIL OTC

cvs beauty 360 shower bath oil external oil AlphaSoft OTC

KERI MOISTURE RICH EXTERNAL OIL OTC

MAPO BATH EXTERNAL OIL OTC

PRODUCTOS DE QUEMA

silver sulfadiazine external cream SSD

SSD EXTERNAL CREAM

THERMAZENE EXTERNAL CREAM

13

Page 14: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

PRODUCTOS PARA EL ACNÉ

acne maximum strength external cream Clean & Clear Continuous OTC

acne medication 10 external gelClean & Clear Persa-Gel Max St

OTC

acne medication 10 external lotion OTC

acne medication 2.5 external gel OTC

acne medication 5 external gel

acne medication 5 external lotion OTC

acne treatment external bar OTC

acne treatment external gelClean & Clear Persa-Gel Max St

OTC

acne-clear external gelClean & Clear Persa-Gel Max St

OTC

advanced acne wash external liquid extended release

OTC

BENZEFOAM EXTERNAL FOAM

benzoyl peroxide cleanser external liquid PA; OTC

benzoyl peroxide external gel 10 %Clean & Clear Persa-Gel Max St

PA

benzoyl peroxide external gel 2.5 %, 5 % PA; OTC

benzoyl peroxide wash external liquid Benzac AC Wash PA; OTC

bp gel external gel PA; OTC

bp wash external liquid Benzac AC Wash OTC

bpo external gel PA

bpo foaming cloths externalBenzePrO Foaming Cloths

PA

CERAVE ACNE FOAMING CREAM EXTERNAL LIQUID

OTC

CLEAN & CLEAR CONTINUOUS EXTERNAL CREAM

OTC

CLEAN & CLEAR PERSA-GEL MAX ST EXTERNAL GEL

PA; OTC

CLEARASIL DAILY CLEAR ACNE EXTERNAL CREAM

OTC

CLEARSKIN EXTERNAL CREAM OTC

cvs acne cleansing external bar OTC

cvs acne control cleanser external cream Clean & Clear Continuous OTC

cvs acne external cream Clean & Clear Continuous OTC

cvs acne treatment external gelClean & Clear Persa-Gel Max St

OTC

14

Page 15: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

cvs advanced 3-in-1 cleanser external liquid Benzac AC Wash OTC

cvs creamy acne face wash external liquidCeraVe Acne Foaming Cream

OTC

effaclar duo external solution OTC

PANOXYL CREAMY WASH EXTERNAL LIQUID

PA; OTC

ra daylogic acne foaming wash external foam

OTC

PRODUCTOS PARA EL TRATAMIENTO DE CICATRICES

cvs scar external gel Celacyn OTC

scar gel external gel Celacyn OTC

PRODUCTOS PARA LA DERMATITIS DEL PAÑAL

A+D PREVENT EXTERNAL OINTMENT OTC

BALMEX MULTI-PURPOSE EXTERNAL OINTMENT

OTC

cvs all-purpose skin protect external ointment

A+D Prevent OTC

cvs pediatric ointment external ointment A+D Prevent OTC

DESITIN MULTI-PURPOSE HEALING EXTERNAL OINTMENT

OTC

MEDI-PASTE EXTERNAL OINTMENT OTC

PALADIN EXTERNAL OINTMENT OTC

PINXAV EXTERNAL OINTMENT OTC

PROTECTORES PARA LA PIEL

AMEDA TRIPLE ZERO LANOLIN EXTERNAL CREAM

OTC

AMERICERIN EXTERNAL CREAM OTC; QL

AMERISTORE EXTERNAL LOTION OTC

DERMACERIN EXTERNAL CREAM OTC; QL

eql hydrating beauty external lotion Ameristore OTC

HPA LANOLIN EXTERNAL CREAM OTC

LANSINOH LANOLIN EXTERNAL CREAM OTC

LANSINOH LANOLIN MINIS NIPPLE EXTERNAL CREAM

OTC

LANSINOH LANOLIN NIPPLE EXTERNAL CREAM

OTC

MEDELA TENDER CARE LANOLIN EXTERNAL CREAM

OTC

15

Page 16: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

medi-soothe external lotion Ameristore OTC

MINERIN CREME EXTERNAL CREAM OTC; QL

SUPERSOFT EXTERNAL LOTION OTC

THERATEIN EXTERNAL LOTION OTC

AGENTES ENDÓCRINOS Y METABÓLICOS VARIOS

AGENTES DE SOMATOSTATINA

octreotide acetate injection solution SandoSTATIN PA

AGONISTAS DE LOS RECEPTORES DE LA DOPAMINA

cabergoline oral tablet QL

REFORZADOR DE LA CARNITINA - AGENTES

levocarnitine oral tablet Carnitor

TRASTORNOS EN EL CICLO DE LA UREA - AGENTES

sodium phenylbutyrate oral powder Buphenyl PA; QL

sodium phenylbutyrate oral tablet Buphenyl PA; QL

TRATAMIENTO DEL HIPERPARATIROIDISMO - ANÁLOGOS DE VITAMINA D

calcitriol oral capsule Rocaltrol PA

calcitriol oral solution Rocaltrol PA

VASOPRESINA

DDAVP RHINAL TUBE NASAL SOLUTION

desmopressin ace spray refrig nasal solution

desmopressin acetate oral tablet DDAVP QL

desmopressin acetate spray nasal solution

AGENTES GASTROINTESTINALES VARIOS

ANTIFLATULENTOS

cvs gas relief drops ex st oral liquid Gas-X Infant Drops OTC

cvs gas relief extra strength oral capsule Gas-X Extra Strength OTC

cvs gas relief extra strength oral tablet chewable

Phazyme OTC

cvs gas relief infants oral suspensionLittle Remedies for Tummys

OTC

cvs gas relief oral tablet chewable OTC

16

Page 17: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

cvs gas relief ultra strength oral capsule Gas-X Ultra Strength OTC

cvs infants gas relief oral suspensionLittle Remedies for Tummys

OTC

drxchoice gas relief oral tablet chewable OTC

eq gas relief extra strength oral tablet chewable

Phazyme OTC

eq gas relief oral capsule Gas-X Extra Strength OTC

eq infants gas relief oral suspensionLittle Remedies for Tummys

OTC

eql gas gone oral tablet chewable Phazyme OTC

eql gas relief oral capsule Gas-X Extra Strength OTC

eql gas relief ultra strength oral capsule Gas-X Ultra Strength OTC

eql infants gas relief oral suspensionLittle Remedies for Tummys

OTC

gas relief drops infants oral suspensionLittle Remedies for Tummys

OTC

gas relief extra strength oral capsule Gas-X Extra Strength OTC

gas relief extra strength oral tablet chewable Phazyme OTC

gas relief infants oral liquid Gas-X Infant Drops OTC

gas relief infants oral suspensionLittle Remedies for Tummys

OTC

gas relief oral liquid Gas-X Infant Drops OTC

gas relief oral suspensionLittle Remedies for Tummys

OTC

gas relief oral tablet chewable OTC

gas relief ultra strength oral capsule Gas-X Ultra Strength OTC

GAS-X EXTRA STRENGTH ORAL CAPSULE

OTC

GAS-X INFANT DROPS ORAL LIQUID OTC

GAS-X ULTRA STRENGTH ORAL CAPSULE

OTC

gnp anti-gas oral capsule Gas-X Ultra Strength OTC

gnp gas relief extra strength oral capsule Gas-X Extra Strength OTC

gnp gas relief extra strength oral tablet chewable

Phazyme OTC

gnp gas relief oral tablet chewable OTC

gnp infant gas relief oral suspensionLittle Remedies for Tummys

OTC

goodsense gas relief oral tablet chewable Phazyme OTC

hm gas relief extra strength oral capsule Gas-X Extra Strength OTC

17

Page 18: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

hm gas relief infants drops oral suspensionLittle Remedies for Tummys

OTC

hm gas relief oral tablet chewable OTC

infants gas relief oral suspensionLittle Remedies for Tummys

OTC

infants simethicone oral suspensionLittle Remedies for Tummys

OTC

LITTLE REMEDIES FOR TUMMYS ORAL SUSPENSION

OTC

mi-acid gas relief oral tablet chewable OTC

MOMMY'S BLISS GAS RELIEF DROPS ORAL SUSPENSION

OTC

PEDIACARE INFANTS GAS RELIEF ORAL SUSPENSION

OTC

PHAZYME ORAL TABLET CHEWABLE OTC

px gas relief extra strength oral capsule Gas-X Extra Strength OTC

px gas relief infants oral suspensionLittle Remedies for Tummys

OTC

px gas relief ultra strength oral capsule Gas-X Ultra Strength OTC

qc anti-gas oral capsule Gas-X Ultra Strength OTC

qc gas relief extra strength oral capsule Gas-X Extra Strength OTC

qc gas relief extra strength oral tablet chewable

Phazyme OTC

qc gas relief oral tablet chewable OTC

ra gas relief extra strength oral tablet chewable

Phazyme OTC

ra gas relief oral capsule Gas-X Extra Strength OTC

ra gas relief oral tablet chewable OTC

ra gas relief ultra strength oral capsule Gas-X Ultra Strength OTC

sb anti-gas oral capsule Gas-X Ultra Strength OTC

sb gas relief oral suspensionLittle Remedies for Tummys

OTC

sb gas relief oral tablet chewable Phazyme OTC

simeped oral suspensionLittle Remedies for Tummys

OTC

simethicone drops infants oral liquid Gas-X Infant Drops OTC

simethicone extra strength oral capsule Gas-X Extra Strength OTC

simethicone oral capsule Gas-X Extra Strength OTC

simethicone oral suspensionLittle Remedies for Tummys

OTC

18

Page 19: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

simethicone oral tablet chewable OTC

simethicone ultra strength oral capsule Gas-X Ultra Strength OTC

sm gas relief antiflatuent oral capsule Gas-X Ultra Strength OTC

sm gas relief extra strength oral capsule Gas-X Extra Strength OTC

sm gas relief infants drops oral suspensionLittle Remedies for Tummys

OTC

sm gas relief infants oral suspensionLittle Remedies for Tummys

OTC

sm gas relief oral tablet chewable OTC

AGENTES GENITOURINARIOS VARIOS

ANALGÉSICOS URINARIOS

azo tabs oral tablet AZO Urinary Pain Relief OTC

AZO URINARY PAIN RELIEF ORAL TABLET

OTC

cvs urinary pain relief max st oral tablet OTC

cvs urinary pain relief oral tablet AZO Urinary Pain Relief OTC

eq urinary pain relief max st oral tablet OTC

eq urinary pain relief oral tablet AZO Urinary Pain Relief OTC

gnp urinary pain relief oral tablet AZO Urinary Pain Relief OTC

PHENAZO ORAL TABLET OTC

phenazopyridine hcl oral tablet AZO Urinary Pain Relief OTC

qc azo oral tablet AZO Urinary Pain Relief OTC

qc urinary pain relief max st oral tablet OTC

qc urinary pain relief oral tablet AZO Urinary Pain Relief OTC

ra urinary pain relief oral tablet AZO Urinary Pain Relief OTC

sb urinary pain relief max st oral tablet OTC

sb urinary pain relief oral tablet AZO Urinary Pain Relief OTC

sm urinary pain relief max st oral tablet OTC

sm urinary pain relief oral tablet AZO Urinary Pain Relief OTC

urinary pain relief max st oral tablet OTC

urinary pain relief oral tablet AZO Urinary Pain Relief OTC

CITRATOS

pot & sod cit-cit ac oral solution

potassium citrate er oral tablet extended release

Urocit-K 5

19

Page 20: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

IRRIGANTES GENITOURINARIOS

ARGYLE STERILE SALINE IRRIGATION SOLUTION

CURITY STERILE SALINE IRRIGATION SOLUTION

sodium chloride irrigation solution Argyle Sterile Saline

AGENTES HEMATOLÓGICOS VARIOS

AGENTES DE QUINAZOLINA

anagrelide hcl oral capsule Agrylin

AGENTES HEMORREOLÓGICOS

pentoxifylline er oral tablet extended release

ANTAGONISTAS DE LOS RECEPTORES B2 DE LA BRADICININA

icatibant acetate subcutaneous solution Firazyr PA; QL

INHIBIDORES DE C1

BERINERT INTRAVENOUS KIT PA; QL

HAEGARDA SUBCUTANEOUS SOLUTION RECONSTITUTED

PA; QL

RUCONEST INTRAVENOUS SOLUTION RECONSTITUTED

PA; QL

INHIBIDORES DE CALICREÍNA PLASMÁTICA - ANTICUERPOS MONOCLONALES

TAKHZYRO SUBCUTANEOUS SOLUTION PA; QL

INHIBIDORES DE CALICREÍNA PLASMÁTICA

KALBITOR SUBCUTANEOUS SOLUTION PA; QL

AGENTES HEMATOPOYÉTICOS

ÁCIDO FÓLICO/FOLATO

cvs folic acid oral tablet OTC

folate oral tablet OTC

folic acid injection solution

folic acid oral tablet 1 mg

folic acid oral tablet 400 mcg, 800 mcg OTC

gnp folic acid oral tablet OTC

hm folic acid oral tablet OTC

kp folic acid oral tablet OTC

20

Page 21: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

px folic acid oral tablet OTC

qc folic acid oral tablet OTC

ra folic acid oral tablet OTC

sm folic acid oral tablet OTC

yl folic acid oral tablet OTC

AGENTES CITOTÓXICOS

DROXIA ORAL CAPSULE

COBALAMINAS

B-12 DOTS ORAL TABLET DISPERSIBLE OTC

B-12 MICROLOZENGE SUBLINGUAL TABLET SUBLINGUAL

OTC

b-12 oral tablet OTC

b-12 oral tablet extended release OTC

b-12 sublingual tablet sublingual B-12 Microlozenge OTC

b-12 tr oral tablet extended release OTC

b-12-sl sublingual tablet sublingual OTC

cvs b-12 oral liquid OTC

cvs b-12 oral tablet OTC

cvs b12 quick dissolve oral lozenge OTC

cvs b-12 sublingual tablet sublingual OTC

cvs vitamin b12 oral tablet OTC

cvs vitamin b-12 oral tablet OTC

cvs vitamin b12 oral tablet extended release OTC

cvs vitamin b-12 oral tablet extended release OTC

cvs vitamin b-12 sublingual tablet sublingual OTC

cyanocobalamin injection solution

cyanocobalamin sublingual tablet sublingual OTC

eql b-12 oral tablet OTC

eql vitamin b-12 oral tablet OTC

eql vitamin b-12 tr oral tablet extended release

OTC

gnp b-12 sublingual tablet sublingual OTC

gnp vitamin b-12 oral tablet OTC

gnp vitamin b-12 oral tablet extended release

OTC

hm vitamin b12 oral tablet OTC

hm vitamin b-12 oral tablet OTC

21

Page 22: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

hm vitamin b-12 tr oral tablet extended release

OTC

hydroxocobalamin acetate intramuscular solution

kp vitamin b-12 oral tablet OTC

qc vitamin b12 oral tablet OTC

qc vitamin b12 oral tablet extended release OTC

qc vitamin b12 sublingual tablet sublingual OTC

ra vitamin b-12 oral tablet OTC

ra vitamin b12 oral tablet extended release OTC

ra vitamin b-12 tr oral tablet extended release

OTC

sm vitamin b-12 oral tablet OTC

sm vitamin b12 tr oral tablet extended release

OTC

sv vitamin b-12 er oral tablet extended release

OTC

vitamin b 12 oral tablet OTC

vitamin b-12 er oral tablet extended release OTC

vitamin b-12 oral liquid OTC

vitamin b-12 oral lozenge OTC

vitamin b12 oral tablet OTC

vitamin b-12 oral tablet OTC

vitamin b12 oral tablet extended release OTC

vitamin b12 sublingual liquid OTC

vitamin b-12 sublingual liquid OTC

vitamin b-12 sublingual tablet sublingual B-12 Microlozenge OTC

vitamin b12 tr oral tablet extended release OTC

COMBINACIONES DE ÁCIDO FÓLICO/FOLATO

fa-vitamin b-6-vitamin b-12 oral tablet

FOLTABS 800 ORAL TABLET OTC

MILLGUARD ORAL TABLET OTC

COMBINACIONES DE HIERRO

ABATRON AF ORAL TABLET OTC

fe c tab oral tablet Icar-C OTC

fe c tab plus oral tablet Icar-C Plus OTC; QL

gentle iron oral capsule OTC

22

Page 23: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

HEMAX ORAL TABLET OTC

iron 100 plus oral tablet Icar-C Plus OTC; QL

iron 100/c oral tablet Icar-C OTC

iron complex oral capsule Chromagen OTC

HIERRO

BPROTECTED PEDIA IRON ORAL SOLUTION

OTC

cvs iron oral tablet FeroSul OTC; QL

cvs slow release iron oral tablet extended release

OTC

easy iron oral capsule OTC

eq slow-release iron oral tablet extended release

OTC

eql carbonyl iron oral tablet Feosol Natural Release OTC

eql iron supplement therapy oral tablet FeroSul OTC; QL

eql slow release iron oral tablet extended release

OTC

fe tabs oral tablet delayed release OTC

FERATE ORAL TABLET OTC; QL

FERGON ORAL TABLET OTC; QL

FEROSUL ORAL TABLET OTC; QL

ferretts oral tablet OTC

FERREX 150 ORAL CAPSULE OTC

ferric x-150 oral capsule Ferrex 150 OTC

FERROCITE ORAL TABLET OTC

ferrotabs oral tablet Ferate OTC; QL

ferrous fumarate oral tablet Ferrocite OTC

ferrous gluconate oral tablet Ferate OTC; QL

ferrous sulfate er oral tablet extended release

OTC

ferrous sulfate oral elixir OTC

ferrous sulfate oral solution BProtected Pedia Iron OTC

ferrous sulfate oral syrup OTC

ferrous sulfate oral tablet 27 mg OTC

ferrous sulfate oral tablet 325 (65 fe) mg FeroSul OTC; QL

ferrous sulfate oral tablet delayed release OTC; QL

fe-vite iron oral solution BProtected Pedia Iron OTC

gnp iron oral tablet Feosol OTC; QL

23

Page 24: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

gnp iron oral tablet extended release Slow Fe OTC

GOODSENSE IRON ORAL TABLET OTC; QL

hm iron oral tablet Feosol OTC; QL

hm iron slow release oral tablet extended release

Slow Fe OTC

hm slow release iron oral tablet extended release

OTC

INFED INJECTION SOLUTION PA

iron (ferrous sulfate) oral tablet FeroSul OTC; QL

iron 27 oral tablet Ferate OTC; QL

iron high-potency oral tablet FeroSul OTC; QL

iron high-potency oral tablet extended release

Slow Fe OTC

iron oral tablet FeroSul OTC; QL

iron slow release oral tablet extended release

OTC

iron supplement childrens oral solution BProtected Pedia Iron OTC

iron supplement oral elixir OTC

kp ferrous gluconate oral tablet OTC; QL

kp ferrous sulfate oral tablet FeroSul OTC; QL

meijer ferrous sulfate oral tablet FeroSul OTC; QL

myferon 150 oral capsule Ferrex 150 OTC

na ferric gluc cplx in sucrose intravenous solution

Ferrlecit PA; QL

nat-rul iron oral tablet FeroSul OTC; QL

NU-IRON ORAL CAPSULE OTC

pc pediatric iron drops oral solution BProtected Pedia Iron OTC

POLY-IRON 150 ORAL CAPSULE OTC

polysaccharide iron complex oral capsule Ferrex 150 OTC

polysaccharide-iron complex oral capsule Ferrex 150 OTC

px iron oral tablet 200 (65 fe) mg Feosol OTC; QL

px iron oral tablet 27 mg OTC

qc ferrous sulfate oral tablet FeroSul OTC; QL

ra high potency iron oral tablet OTC

ra iron oral tablet 27 mg OTC

ra iron oral tablet 325 (65 fe) mg FeroSul OTC; QL

ra slow release iron oral tablet extended release

OTC

24

Page 25: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

slow iron oral tablet extended release OTC

slow release iron oral tablet extended release

OTC

sm iron oral tablet FeroSul OTC; QL

sm iron slow release oral tablet extended release

OTC

sm slow release iron oral tablet extended release

OTC

VENOFER INTRAVENOUS SOLUTION QL

wee care oral suspension Icar OTC; QL

AGENTES HEMOSTÁTICOS

AGENTES HEMOSTÁTICOS SISTÉMICOS

aminocaproic acid oral tablet Amicar QL

tranexamic acid oral tablet Lysteda QL

AGENTES NASALES - SISTÉMICOS Y TÓPICOS

AGENTES NASALES VARIOS

AFRIN SALINE NASAL MIST NASAL SOLUTION

AL; OTC

altamist spray nasal solution Afrin Saline Nasal Mist AL; OTC

AYR NASAL SOLUTION AL; OTC

AYR SALINE NASAL DROPS NASAL SOLUTION

OTC

BABY AYR SALINE NASAL SOLUTION AL; OTC

cvs nasal mist nasal aerosol solution Simply Saline OTC

cvs saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC

deep sea nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC

eq saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC

eql saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC

gnp nasal moisturizing nasal solution Afrin Saline Nasal Mist AL; OTC

hm saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC

meijer saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC

NASAL MOIST NASAL SOLUTION AL; OTC

nasal moisturizing spray nasal solution Afrin Saline Nasal Mist AL; OTC

OCEAN FOR KIDS NASAL SOLUTION AL; OTC

px saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC

qc saline nasal relief nasal solution Afrin Saline Nasal Mist AL; OTC

25

Page 26: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

ra saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC

ra sterile saline nasal mist nasal solution Simply Saline OTC

saline mist spray nasal solution Afrin Saline Nasal Mist AL; OTC

saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC

sb saline nose nasal solution Afrin Saline Nasal Mist AL; OTC

sm nasal spray saline nasal solution Afrin Saline Nasal Mist AL; OTC

sodium chloride nasal solution Afrin Saline Nasal Mist OTC

DESCONGESTIVOS SISTÉMICOS

12 hour decongestant oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

12 hour nasal decongestant oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

cvs 12 hour nasal decongestant oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

cvs nasal decongestant oral tablet SudoGest AL; OTC

decongestant 12hour max st oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

decongestant oral tablet SudoGest AL; OTC

eql nasal decongestant oral tablet SudoGest AL; OTC

genaphed oral tablet SudoGest AL; OTC

gnp nasal decongestant oral tablet SudoGest AL; OTC

gnp pseudoephedrine hcl 12 hr oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

hm nasal decongestant 12 hour oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

hm nasal decongestant oral tablet SudoGest AL; OTC

kp pseudoephedrine hcl oral tablet SudoGest AL; OTC

meijer nasal decongestant oral tablet SudoGest AL; OTC

nasal decongestant 12hr oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

nasal decongestant max st oral tablet SudoGest AL; OTC

nasal decongestant oral tablet SudoGest AL; OTC

pseudoephedrine hcl er oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

pseudoephedrine hcl oral tablet 30 mg SudoGest AL; OTC

pseudoephedrine hcl oral tablet 60 mg SudoGest AL

px nasal decongestant oral tablet SudoGest AL; OTC

px nasal decongestant oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

26

Page 27: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

qc suphedrine maximum strength oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

ra suphedrine oral tablet SudoGest AL; OTC

ra suphedrine oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

sinus 12 hour oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

sinus congestion max strength oral tablet SudoGest OTC

sm nasal decongestant max st oral tablet SudoGest AL; OTC

sm nasal decongestant oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

SUDAFED 12 HOUR ORAL TABLET EXTENDED RELEASE 12 HOUR

AL; OTC

SUDAFED SINUS CONGESTION 12HR ORAL TABLET EXTENDED RELEASE 12 HOUR

AL; OTC

sudogest 12 hour oral tablet extended release 12 hour

Sudafed 12 Hour AL; OTC

SUDOGEST MAXIMUM STRENGTH ORAL TABLET

AL; OTC

SUDOGEST ORAL TABLET AL; OTC

WAL-PHED 12 HOUR ORAL TABLET EXTENDED RELEASE 12 HOUR

AL; OTC

WAL-PHED D ORAL TABLET EXTENDED RELEASE 12 HOUR

AL; OTC

WAL-PHED ORAL TABLET AL; OTC

ESTABILIZADORES DE MASTOCITOS NASALES

cromolyn sodium nasal aerosol solution NasalCrom OTC

AGENTES NEUROMUSCULARES

BENZOTIAZOLES

riluzole oral tablet Rilutek PA

AGENTES OFTÁLMICOS

COMBINACIONES DE DESCONGESTIVOS OFTÁLMICOS

allergy eye ophthalmic solution Visine OTC; QL

cvs astringent eye drops ophthalmic solution Visine-AC OTC; QL

cvs eye allergy relief ophthalmic solution Opcon-A OTC

cvs eye drops ophthalmic solution Visine Advanced Relief OTC

cvs redness relief ophthalmic solution OTC

27

Page 28: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

eq eye allergy relief ophthalmic solution Opcon-A OTC

eql advanced relief ophthalmic solution Visine Advanced Relief OTC

eql eye drops ac ophthalmic solution Visine-AC OTC; QL

eye allergy relief ophthalmic solution 0.025-0.3 %

Visine OTC; QL

eye allergy relief ophthalmic solution 0.027-0.315 %

Opcon-A OTC

eye drops advanced relief ophthalmic solution

Visine Advanced Relief OTC

eye drops allergy relief ophthalmic solution Visine-AC OTC; QL

eye drops ar ophthalmic solution Visine-AC OTC; QL

eye drops maximum relief ophthalmic solution

Visine Advanced Relief OTC

eye drops ophthalmic solution OTC

gnp eye drops ophthalmic solution Visine Advanced Relief OTC

goodsense eye drops ophthalmic solution Visine Advanced Relief OTC

goodsense relief eye drops ophthalmic solution

Visine-AC OTC; QL

hm eye drops advanced relief ophthalmic solution

Visine Advanced Relief OTC

qc eye drops ophthalmic solution Visine Advanced Relief OTC

ra eye allergy relief ophthalmic solution Opcon-A OTC

ra sterile eye drops ophthalmic solution OTC

relief drops ophthalmic solution Visine-AC OTC; QL

relief eye drops ophthalmic solution Visine-AC OTC; QL

sm eye drops ophthalmic solution Visine Advanced Relief OTC

VISINE OPHTHALMIC SOLUTION OTC; QL

VISINE-AC OPHTHALMIC SOLUTION OTC; QL

COMBINACIONES DE LÁGRIMAS ARTIFICIALES Y LUBRICANTES

ALTALUBE OPHTHALMIC OINTMENT OTC

artificial eye ophthalmic ointment Altalube OTC

artificial tears ophthalmic ointment Altalube OTC

artificial tears ophthalmic solution OTC

artificial tears pf ophthalmic solutionGenTeal Tears Moderate PF

OTC

cvs artificial tears ophthalmic solution Moisture Eyes OTC

cvs dry eye relief ophthalmic solution Visine Dry Eye OTC

28

Page 29: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

cvs dry-eye relief nighttime ophthalmic ointment

Altalube OTC

cvs eye lubricant ophthalmic ointment Altalube OTC

cvs lubricant drops fast act ophthalmic solution

Vista Tears OTC

cvs lubricant drops long last ophthalmic solution

Vista Tears OTC

cvs lubricant eye drops (pf) ophthalmic solution

Systane Hydration PF OTC

cvs lubricant eye drops ophthalmic solution Vista Tears OTC

cvs lubricating eye/overnight ophthalmic ointment

Altalube OTC

cvs lubricating/dry eye ophthalmic solution Refresh Optive OTC

cvs natural tears pf ophthalmic solutionGenTeal Tears Moderate PF

OTC

cvs nighttime dry-eye relief ophthalmic ointment

Altalube OTC

dry eye relief drops ophthalmic solution Visine Dry Eye OTC

eq artificial tears ophthalmic solution Moisture Eyes OTC

eq lubricant eye drops ophthalmic solution Vista Tears OTC

EQ RESTORE PM OPHTHALMIC OINTMENT

OTC

eye lubricant ophthalmic ointment Altalube OTC

for sty relief ophthalmic ointment Altalube OTC

GENTEAL TEARS NIGHT-TIME OPHTHALMIC OINTMENT

OTC

GENTEAL TEARS OPHTHALMIC SOLUTION

OTC

gnp artificial tears ophthalmic solution OTC

gnp eye drops long lasting ophthalmic solution

Vista Tears OTC

goodsense artificial tears ophthalmic solution

OTC

goodsense lubricant eye drops ophthalmic solution

Systane Hydration PF OTC

goodsense ultra lubricant drop ophthalmic solution

Vista Tears OTC

hm dry eye relief ophthalmic solution Visine Dry Eye OTC

hm lubricating tears ophthalmic solution Vista Tears OTC

HYPOTEARS OPHTHALMIC OINTMENT OTC

29

Page 30: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

lubricant drops/dual-action ophthalmic solution

Refresh Optive OTC

lubricant eye drops ophthalmic solution Vista Tears OTC

lubricant eye fast acting ophthalmic ointment Altalube OTC

lubricant eye nighttime ophthalmic ointment Altalube OTC

lubricant eye ophthalmic ointment Altalube OTC

lubricant eye pm ophthalmic ointment Altalube OTC

lubricant pm ophthalmic ointment Altalube OTC

lubricating eye drops ophthalmic solution Refresh Optive OTC

lubricating tears eye drops ophthalmic solution

GenTeal Tears OTC

natural balance tears ophthalmic solution GenTeal Tears OTC

PURALUBE OPHTHALMIC OINTMENT OTC

px artificial tears ophthalmic solution OTC

qc artificial tears ophthalmic solution OTC

ra artificial tears ophthalmic solution Moisture Eyes OTC

ra lubricant eye ophthalmic solution Vista Tears OTC

REFRESH LACRI-LUBE OPHTHALMIC OINTMENT

OTC

REFRESH P.M. OPHTHALMIC OINTMENT OTC

RETAINE PM OPHTHALMIC OINTMENT OTC

sm dry eye relief ophthalmic solution Visine Dry Eye OTC

sm lubricant eye drops ophthalmic solution Vista Tears OTC

sm lubricating tears ophthalmic solution Vista Tears OTC

SOOTHE NIGHTTIME OPHTHALMIC OINTMENT

OTC

STYE OPHTHALMIC OINTMENT OTC

SYSTANE NIGHTTIME OPHTHALMIC OINTMENT

OTC

TEARS AGAIN OPHTHALMIC OINTMENT OTC

tears pure ophthalmic solution GenTeal Tears OTC

ULTRA FRESH PM OPHTHALMIC OINTMENT

OTC

ultra lubricating eye drops ophthalmic solution

Vista Tears OTC

VISTA TEARS OPHTHALMIC SOLUTION OTC

DESCONGESTIVOS OFTÁLMICOS

cvs eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

eq eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

30

Page 31: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

eql eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

gnp eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

goodsense eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

hm eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

px sterile eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

qc eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

redness reliever eye drops ophthalmic solution

Visine Red Eye Comfort OTC; QL

sm eye drops ophthalmic solution Visine Red Eye Comfort OTC; QL

tetrahydrozoline hcl ophthalmic solution Visine Red Eye Comfort OTC

LÁGRIMAS ARTIFICIALES Y LUBRICANTES

artificial tears ophthalmic solution OTC

BIOLLE TEARS OPHTHALMIC SOLUTION OTC

carboxymethylcellulose sodium ophthalmic solution

Ultra Fresh OTC

cvs lubricant drops ophthalmic solution Vista Meibo Tears OTC

cvs lubricant eye drops (pf) ophthalmic solution

Biolle Tears OTC

cvs lubricant eye drops ophthalmic solution Theratears OTC

eq restore plus lubricant eye ophthalmic solution

Biolle Tears OTC

eq restore tears ophthalmic solution Ultra Fresh OTC

eye drops ophthalmic solution Ultra Fresh OTC

gnp lubricating plus eye drops ophthalmic solution

Biolle Tears OTC

goodsense lubricating eye drop ophthalmic solution

Biolle Tears OTC

hm lubricating plus ophthalmic solution Biolle Tears OTC

liquitears ophthalmic solution OTC

lubricant eye drops ophthalmic solution Vista Meibo Tears OTC

lubricant eye drops pf ophthalmic solution Biolle Tears OTC

lubricating plus eye drops ophthalmic solution

Biolle Tears OTC

moisturizing lubricant eye ophthalmic solution

Theratears OTC

polyvinyl alcohol ophthalmic solution

ra lubricant eye drops ophthalmic solution Vista Meibo Tears OTC

31

Page 32: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

RETAINE CMC OPHTHALMIC SOLUTION OTC

sm lubricating plus ophthalmic solution Biolle Tears OTC

ULTRA FRESH OPHTHALMIC SOLUTION OTC

VISTA MEIBO TEARS OPHTHALMIC SOLUTION

OTC

SOLUCIONES DE LA GONIOSCOPIA

GONIOTAIRE OPHTHALMIC SOLUTION OTC

GONIOVISC OPHTHALMIC SOLUTION OTC

SOLUCIONES DE LÁGRIMAS ARTIFICIALES

GENTEAL TEARS OPHTHALMIC SOLUTION

OTC

just tears eye drops ophthalmic solution GenTeal Tears OTC

sm artificial tears ophthalmic solution GenTeal Tears OTC

SOOTHE HYDRATION OPHTHALMIC SOLUTION

OTC

SOOTHE XP OPHTHALMIC SOLUTION OTC

SOOTHE XP XTRA PROTECTION OPHTHALMIC SOLUTION

OTC

SYSTANE CONTACTS OPHTHALMIC SOLUTION

OTC

TEARS AGAIN ADVANCED EYELID OPHTHALMIC SOLUTION

OTC

AGENTES PARA EL CUIDADO DE BOCA/GARGANTA/DIENTES

ANESTÉSICOS TÓPICOS ORALES - COMBINACIONES

sore throat lozenges mouth/throat lozenge OTC

sore throat mouth/throat lozenge OTC

ultra throat mouth/throat lozenge OTC

ANESTÉSICOS TÓPICOS ORALES

lidocaine hcl mouth/throat solution QL

lidocaine viscous hcl mouth/throat solution QL

ANTISÉPTICOS - BOCA/GARGANTA

CHLORASEPTIC MOUTH/THROAT LIQUID

OTC

chlorhexidine gluconate mouth/throat solution

Paroex QL

cvs sore throat spray mouth/throat liquid Chloraseptic OTC

32

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DIABETIC TUSSIN SORE THROAT MOUTH/THROAT LIQUID

OTC

eql sore throat spray mouth/throat liquid Chloraseptic OTC

gnp sore throat spray mouth/throat liquid Chloraseptic OTC

goodsense sore throat spray mouth/throat liquid

Chloraseptic OTC

hm sore throat spray mouth/throat liquid Chloraseptic OTC

ora relief mouth/throat liquid Chloraseptic OTC

oral relief mouth/throat liquid Chloraseptic OTC

oralseptic mouth/throat liquid Chloraseptic OTC

PAROEX MOUTH/THROAT SOLUTION QL

PERIOGARD MOUTH/THROAT SOLUTION

QL

phenaseptic mouth/throat liquid Chloraseptic OTC

px sore throat mouth/throat liquid Chloraseptic OTC

qc sore throat spray mouth/throat liquid Chloraseptic OTC

ra sore throat mouth/throat liquid Chloraseptic OTC

sb sore throat spray mouth/throat liquid Chloraseptic OTC

sm sore throat spray mouth/throat liquid Chloraseptic OTC

sore throat mouth/throat liquid Chloraseptic OTC

sore throat spray mouth/throat liquid Chloraseptic OTC

ESTEROIDES - BOCA/GARGANTA

ORALONE MOUTH/THROAT PASTE

triamcinolone acetonide mouth/throat paste Oralone

ESTIMULANTES DE SALIVA

pilocarpine hcl oral tablet Salagen QL

PASTILLAS

cherry cough drops mouth/throat lozenge Dentiva OTC

cough drops menthol mouth/throat lozenge Dentiva OTC

cough drops mouth/throat lozenge Dentiva OTC

cvs cherry menthol drops mouth/throat lozenge

Dentiva OTC

cvs cough drops sugar free mouth/throat lozenge

OTC

cvs honey lemon drops mouth/throat lozenge

Dentiva OTC

cvs menthol drops mouth/throat lozenge Dentiva OTC

eql cough drops mouth/throat lozenge OTC

33

Page 34: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

gnp throat drops mouth/throat lozenge Ludens Throat Drops OTC

medikoff drops mouth/throat lozenge OTC

menthol cough drops mouth/throat lozenge Dentiva OTC

natural herb cough drops mouth/throat lozenge

Dentiva OTC

qc sore throat mouth/throat lozenge Dentiva OTC

ra cough drops mouth/throat lozenge OTC

sm cough drops mouth/throat lozenge OTC

throat discs mouth/throat lozenge Dentiva OTC

PRODUCTOS DENTALES CON FLUORURO

CAVAREST DENTAL GEL

DENTA 5000 PLUS DENTAL CREAM

DENTAGEL DENTAL GEL

PERIOMED MOUTH/THROAT CONCENTRATE

OTC

sf 5000 plus dental cream Denta 5000 Plus

sf dental gel Cavarest

sodium fluoride 5000 plus dental cream Denta 5000 Plus

sodium fluoride 5000 ppm dental cream Denta 5000 Plus

sodium fluoride dental cream Denta 5000 Plus

sodium fluoride dental gel Cavarest

sodium fluoride mouth/throat solution PreviDent

AGENTES PARA EL TRATAMIENTO OSTEOMUSCULAR

VISCOSUPLEMENTOS

EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

PA

GELSYN-3 INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

PA

SUPARTZ FX INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

PA

AGENTES PSICOTERAPÉUTICOS Y NEUROLÓGICOS VARIOS

BENZODIAZEPINAS Y AGENTES TRICÍCLICOS

chlordiazepoxide-amitriptyline oral tablet

34

Page 35: Lista de medicamentos preferidos aprobada por Medicaid

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PRODUCTOS PARA DEJAR DE BEBER ALCOHOL

acamprosate calcium oral tablet delayed release

disulfiram oral tablet

AGENTES RESPIRATORIOS VARIOS

ENZIMAS HIDROLÍTICAS

PULMOZYME INHALATION SOLUTION PA; QL

AGENTES TIROIDEOS

AGENTES ANTITIROIDEOS

methimazole oral tablet Tapazole

propylthiouracil oral tablet

HORMONAS TIROIDEAS

EUTHYROX ORAL TABLET

LEVO-T ORAL TABLET

levothyroxine sodium oral tablet Euthyrox

LEVOXYL ORAL TABLET

liothyronine sodium oral tablet Cytomel

UNITHROID ORAL TABLET

ANALGÉSICOS - ANTIINFLAMATORIOS

AGENTES ANTIINFLAMATORIOS NO ESTEROIDES (AINE)

ADVIL JUNIOR STRENGTH ORAL TABLET CHEWABLE

OTC

cvs ibuprofen junior strength oral tablet chewable

Advil Junior Strength OTC

eq ibuprofen junior oral tablet chewable Advil Junior Strength OTC

eql ibuprofen junior strength oral tablet chewable

Advil Junior Strength OTC

fenoprofen calcium oral capsule Fenortho PA

flurbiprofen oral tablet PA

gnp ibuprofen childrens oral tablet chewable Advil Junior Strength OTC

hm ibuprofen ib oral tablet chewable Advil Junior Strength OTC

ibuprofen 100 junior strength oral tablet chewable

Advil Junior Strength OTC

ibuprofen junior strength oral tablet chewable

Advil Junior Strength OTC

35

Page 36: Lista de medicamentos preferidos aprobada por Medicaid

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ibuprofen oral tablet chewable Advil Junior Strength OTC

ketoprofen oral capsule PA

px ibuprofen junior strength oral tablet chewable

Advil Junior Strength OTC

ra ibuprofen junior strength oral tablet chewable

Advil Junior Strength OTC

sm ibuprofen ib childrens oral tablet chewable

Advil Junior Strength OTC

sm ibuprofen ib oral tablet chewable Advil Junior Strength OTC

COMPUESTOS DE ORO

RIDAURA ORAL CAPSULE

INHIBIDORES DE LA SÍNTESIS DE PIRIMIDINA

leflunomide oral tablet Arava

ANALGÉSICOS - NO NARCÓTICOS

ANALGÉSICOS - OTROS

8 hour arthritis pain reliever oral tablet extended release

Midol OTC; QL

8 hour pain reliever oral tablet extended release

Midol OTC; QL

8 hr arthritis pain relief oral tablet extended release

Midol OTC; QL

8hr muscle aches & pain oral tablet extended release

Midol OTC; QL

acetaminophen 8 hour oral tablet extended release

Midol OTC; QL

acetaminophen childrens oral solution OTC; QL

acetaminophen childrens oral suspension Panadol Childrens OTC; QL

acetaminophen childrens oral tablet chewable

Mapap Childrens OTC

acetaminophen er oral tablet extended release

Midol OTC; QL

acetaminophen extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

acetaminophen infants oral suspension Panadol Childrens OTC; QL

acetaminophen junior strength oral tablet dispersible

OTC

acetaminophen oral liquid Little Remedies for Fever OTC; QL

acetaminophen oral solution OTC; QL

36

Page 37: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

acetaminophen oral suspension 160 mg/5ml, 650 mg/20.3ml

Panadol Childrens OTC; QL

acetaminophen oral suspension 325 mg/10.15ml

Panadol Childrens OTC

acetaminophen oral tablet 325 mg Aphen OTC

acetaminophen oral tablet 500 mgHealthy Mama Shake That Ache

OTC; QL

acetaminophen oral tablet chewable Childrens Medi-Tabs OTC

acetaminophen rapid tabs child oral tablet dispersible

OTC

acetaminophen rectal suppository FeverAll Childrens OTC

APHEN ORAL TABLET OTC

apra oral elixir Medi-Tabs Childrens OTC

arthritis pain relief oral tablet extended release

Midol OTC; QL

arthritis pain reliever oral tablet extended release

Midol OTC; QL

aurophen childrens oral suspension Panadol Childrens OTC; QL

betatemp childrens oral suspension Panadol Childrens OTC; QL

childrens acetaminophen oral suspension Panadol Childrens OTC; QL

childrens apap oral tablet chewable Childrens Medi-Tabs OTC

childrens aspirin free oral elixir Medi-Tabs Childrens OTC

CHILDRENS MEDI-TABS ORAL TABLET CHEWABLE

OTC

childrens non-aspirin oral suspension Panadol Childrens OTC; QL

childrens non-aspirin oral tablet chewable Childrens Medi-Tabs OTC

childrens pain reliever oral tablet chewable Childrens Medi-Tabs OTC

childrens silapap oral liquid Little Remedies for Fever OTC; QL

cvs 8hr arthritis pain relief oral tablet extended release

Midol OTC; QL

cvs 8hr muscle aches & pain oral tablet extended release

Midol OTC; QL

cvs acetaminophen ex st oral liquidMapap Acetaminophen Extra Str

OTC

cvs acetaminophen ex st oral tabletHealthy Mama Shake That Ache

OTC; QL

cvs acetaminophen oral capsule Tylenol OTC

cvs acetaminophen oral liquidMapap Acetaminophen Extra Str

OTC

cvs acetaminophen oral tablet Aphen OTC

37

Page 38: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

cvs arthritis pain relief oral tablet extended release

Midol OTC; QL

cvs childs non-aspirin oral tablet chewable Childrens Medi-Tabs OTC

cvs fever reducing childrens rectal suppository

FeverAll Childrens OTC

cvs infants pain relief drops oral suspension Panadol Childrens OTC; QL

cvs non-aspirin childrens oral tablet chewable

Childrens Medi-Tabs OTC

cvs non-aspirin extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

cvs pain & fever childrens oral suspension Panadol Childrens OTC; QL

cvs pain & fever infants oral suspension Panadol Childrens OTC; QL

cvs pain relief childrens oral suspension Panadol Childrens OTC; QL

cvs pain relief childrens oral tablet chewable Mapap Childrens OTC

cvs pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

cvs pain relief oral tabletHealthy Mama Shake That Ache

OTC; QL

cvs pain relief oral tablet extended release Midol OTC; QL

cvs pain relief regular st oral tablet Aphen OTC

ed-apap oral liquid Little Remedies for Fever OTC; QL

eq 8hr arthritis pain relief oral tablet extended release

Midol OTC; QL

eq acetaminophen oral tablet 325 mg Aphen OTC

eq acetaminophen oral tablet 500 mgHealthy Mama Shake That Ache

OTC; QL

eq arthritis pain oral tablet extended release Midol OTC; QL

eq pain & fever childrens oral suspension Panadol Childrens OTC; QL

eq pain & fever childrens oral tablet chewable

Mapap Childrens OTC

eq pain & fever infants oral suspension Panadol Childrens OTC; QL

eq pain relief/rapid burst oral liquidMapap Acetaminophen Extra Str

OTC

eq pain reliever oral tablet 325 mg Aphen OTC

eq pain reliever oral tablet 500 mgHealthy Mama Shake That Ache

OTC; QL

eql acetaminophen childrens oral suspension

Panadol Childrens OTC; QL

eql acetaminophen ex st oral tabletHealthy Mama Shake That Ache

OTC; QL

38

Page 39: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

eql acetaminophen infants oral suspension Panadol Childrens OTC; QL

eql acetaminophen oral tablet Aphen OTC

FEVERALL ADULTS RECTAL SUPPOSITORY

OTC

FEVERALL CHILDRENS RECTAL SUPPOSITORY

OTC

FEVERALL INFANTS RECTAL SUPPOSITORY

OTC

FEVERALL JUNIOR STRENGTH RECTAL SUPPOSITORY

OTC

gnp 8 hour arthritis relief oral tablet extended release

Midol OTC; QL

gnp 8 hour pain reliever oral tablet extended release

Midol OTC; QL

gnp acetaminophen oral tablet Aphen OTC

gnp acetaminophen oral tablet chewable Mapap Childrens OTC

gnp infants pain/fever oral suspension Panadol Childrens OTC; QL

gnp pain & fever childrens oral suspension Panadol Childrens OTC; QL

gnp pain & fever infants oral suspension Panadol Childrens OTC; QL

gnp pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

gnp pain relief oral tablet Aphen OTC

goodsense arthritis pain oral tablet extended release

Midol OTC; QL

goodsense pain & fever child oral suspension

Panadol Childrens OTC; QL

goodsense pain & fever infants oral suspension

Panadol Childrens OTC; QL

goodsense pain relief extra st oral tabletHealthy Mama Shake That Ache

OTC; QL

goodsense pain relief oral tablet Aphen OTC

HEALTHY MAMA SHAKE THAT ACHE ORAL TABLET

OTC; QL

hm acetaminophen childrens oral tablet chewable

Mapap Childrens OTC

hm arthritis pain relief oral tablet extended release

Midol OTC; QL

hm pain & fever childrens oral suspension Panadol Childrens OTC; QL

hm pain & fever infants oral suspension Panadol Childrens OTC; QL

hm pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

39

Page 40: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

hm pain relief oral tablet extended release Midol OTC; QL

hm pain relieve child dye-free oral suspension

Panadol Childrens OTC

hm pain reliever childrens oral suspension Panadol Childrens OTC

hm pain reliever infants oral suspension Panadol Childrens OTC

hm pain reliever oral tablet Aphen OTC

infants pain & fever oral suspension Panadol Childrens OTC; QL

kls acetaminophen ex st oral tabletHealthy Mama Shake That Ache

OTC; QL

liquid acetaminophen oral liquid Little Remedies for Fever OTC; QL

liquid pain relief oral liquid Little Remedies for Fever OTC; QL

LITTLE REMEDIES FOR FEVER ORAL LIQUID

OTC; QL

MAPAP ACETAMINOPHEN EXTRA STR ORAL LIQUID

OTC

mapap arthritis pain oral tablet extended release

Midol OTC; QL

MAPAP CHILDRENS ORAL TABLET CHEWABLE

OTC

mapap oral capsule OTC; QL

mapap oral liquid Little Remedies for Fever OTC; QL

mapap oral tablet Aphen OTC

mapap oral tablet chewable Childrens Medi-Tabs OTC

MEDI-TABS CHILDRENS ORAL ELIXIR OTC

MEDI-TABS EXTRA STRENGTH ORAL TABLET

OTC; QL

MEDI-TABS JUNIOR STRENGTH ORAL TABLET CHEWABLE

OTC

meijer aspirin free oral tablet 325 mg Aphen OTC

meijer aspirin free oral tablet 500 mgHealthy Mama Shake That Ache

OTC; QL

meijer jr st aspirin free oral tablet chewable Mapap Childrens OTC

MIDOL ORAL TABLET EXTENDED RELEASE

OTC; QL

mm arthritis pain oral tablet extended release

Midol OTC; QL

m-pap oral liquid Little Remedies for Fever OTC; QL

non-aspirin childrens oral suspension Panadol Childrens OTC; QL

non-aspirin extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

40

Page 41: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

non-aspirin jr strength oral tablet chewable Mapap Childrens OTC

non-aspirin oral tablet 325 mg Aphen OTC

non-aspirin oral tablet 500 mgHealthy Mama Shake That Ache

OTC; QL

non-aspirin pain relief oral tablet Aphen OTC

pain & fever childrens oral suspension Panadol Childrens OTC; QL

pain & fever childrens oral tablet chewable Mapap Childrens OTC

pain & fever infants oral suspension Panadol Childrens OTC; QL

pain relief childrens oral elixir Medi-Tabs Childrens OTC

pain relief childrens oral suspension Panadol Childrens OTC; QL

pain relief extra strength oral capsule OTC; QL

pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

pain relief oral liquidMapap Acetaminophen Extra Str

OTC

pain relief regular strength oral tablet Aphen OTC

pain reliever extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

pain reliever oral liquidMapap Acetaminophen Extra Str

OTC

pain reliever oral tablet Aphen OTC

pain reliever/fever reducer rectal suppository FeverAll Childrens OTC

PANADOL CHILDRENS ORAL SUSPENSION

OTC; QL

PANADOL EXTRA STRENGTH ORAL TABLET

OTC; QL

PANADOL INFANTS ORAL SUSPENSION OTC; QL

PEDIACARE CHILDREN ORAL SUSPENSION

OTC; QL

PEDIACARE INFANT FEVER/PAIN ORAL SUSPENSION

OTC; QL

PEDIACARE INFANTS ORAL SUSPENSION

OTC; QL

PHARBETOL EXTRA STRENGTH ORAL TABLET

OTC; QL

PHARBETOL ORAL TABLET OTC

px arthritis pain relief oral tablet extended release

Midol OTC; QL

px childrens pain relief oral suspension Panadol Childrens OTC; QL

41

Page 42: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

px pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

qc acetaminophen 8 hours oral tablet extended release

Midol OTC; QL

qc acetaminophen 8hr arth pain oral tablet extended release

Midol OTC; QL

qc acetaminophen 8hr musc ache oral tablet extended release

Midol OTC; QL

qc arthritis pain relief oral tablet extended release

Midol OTC; QL

qc non-aspirin 8 hour oral tablet extended release

Midol OTC; QL

qc non-aspirin childrens oral suspension Panadol Childrens OTC; QL

qc non-aspirin childrens oral tablet chewable Mapap Childrens OTC

qc non-aspirin extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

qc pain relief childrens oral suspension Panadol Childrens OTC; QL

qc pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

qc pain relief infants oral suspension Panadol Childrens OTC; QL

qc pain relief oral tablet Aphen OTC

ra 8 hour pain relief oral tablet extended release

Midol OTC; QL

ra acetaminophen childrens oral tablet chewable

Mapap Childrens OTC

ra acetaminophen ex st oral tabletHealthy Mama Shake That Ache

OTC; QL

ra acetaminophen oral tablet Aphen OTC

ra arthritis pain relief oral tablet extended release

Midol OTC; QL

ra childrens fever/pain oral suspension Panadol Childrens OTC; QL

ra fever reducer/pain reliever oral suspension

Panadol Childrens OTC; QL

ra pain relief acetaminophen oral tablet 325 mg

Aphen OTC

ra pain relief acetaminophen oral tablet 500 mg

Healthy Mama Shake That Ache

OTC; QL

ra pain reliever ex st oral liquidMapap Acetaminophen Extra Str

OTC

sb arthritis pain relief oral tablet extended release

Midol OTC; QL

42

Page 43: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

sb childrens non-aspirin oral tablet dispersible

OTC

sb non-aspirin extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

sb non-aspirin jr strength oral tablet dispersible

OTC

sb non-aspirin oral tablet Aphen OTC

sb non-aspirin oral tablet chewable Childrens Medi-Tabs OTC

sb pain reliever childrens oral suspension Panadol Childrens OTC; QL

sb pain reliever ex st oral tabletHealthy Mama Shake That Ache

OTC; QL

sm 8 hour pain relief oral tablet extended release

Midol OTC; QL

sm arthritis pain relief oral tablet extended release

Midol OTC; QL

sm arthritis pain reliever oral tablet extended release

Midol OTC; QL

sm pain & fever childrens oral suspension Panadol Childrens OTC; QL

sm pain & fever infants oral suspension Panadol Childrens OTC; QL

sm pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

sm pain relief oral tabletHealthy Mama Shake That Ache

OTC

sm pain reliever childrens oral suspension Panadol Childrens OTC; QL

sm pain reliever ex st oral tabletHealthy Mama Shake That Ache

OTC; QL

sm pain reliever ex st oral tablet extended release

Midol OTC; QL

sm pain reliever oral tablet Aphen OTC

sm rapid melts junior oral tablet dispersible OTC

tactinal oral tablet Aphen OTC

COMBINACIONES DE SALICILATOS

aspirin buf(cacarb-mgcarb-mgo) oral tablet Bufferin OTC

BUFFERIN ORAL TABLET OTC

sm aspirin tri-buffered oral tablet Bufferin OTC

tri-buffered aspirin oral tablet Bufferin OTC

SALICILATOS

adult aspirin regimen oral tablet delayed release

Aspir-Low OTC

aspirin 81 oral tablet chewable Bayer Low Dose OTC

43

Page 44: Lista de medicamentos preferidos aprobada por Medicaid

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aspirin adult low dose oral tablet delayed release

Aspir-Low OTC

aspirin adult low strength oral tablet delayed release

Aspir-Low OTC

aspirin childrens oral tablet chewable Bayer Low Dose OTC

aspirin ec adult low strength oral tablet delayed release

Aspir-Low OTC

aspirin ec low dose oral tablet delayed release

Aspir-Low OTC

aspirin ec low strength oral tablet delayed release

Aspir-Low OTC

aspirin ec oral tablet delayed release Bayer Aspirin OTC

aspirin low dose oral tablet chewable Bayer Low Dose OTC

aspirin low dose oral tablet delayed release Aspir-Low OTC

aspirin low strength oral tablet chewable Bayer Low Dose OTC

aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

aspirin oral tablet chewable Bayer Low Dose OTC

aspirin oral tablet delayed release Bayer Aspirin OTC

aspirin rectal suppository OTC

ASPIR-LOW ORAL TABLET DELAYED RELEASE

OTC

BAYER ADVANCED ASPIRIN EX ST ORAL TABLET

OTC

BAYER ADVANCED ASPIRIN REG ST ORAL TABLET

OTC

BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE

OTC

BAYER ASPIRIN EXTRA STRENGTH ORAL TABLET

OTC

BAYER ASPIRIN ORAL TABLET OTC

BAYER ASPIRIN ORAL TABLET DELAYED RELEASE

OTC

BAYER LOW DOSE ORAL TABLET CHEWABLE

OTC

BAYER LOW DOSE ORAL TABLET DELAYED RELEASE

OTC

childrens aspirin oral tablet chewable Bayer Low Dose OTC

cvs aspirin adult low dose oral tablet chewable

Bayer Low Dose OTC

44

Page 45: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

cvs aspirin adult low strength oral tablet delayed release

Aspir-Low OTC

cvs aspirin ec oral tablet delayed release Bayer Aspirin OTC

cvs aspirin low dose oral tablet delayed release

Aspir-Low OTC

cvs aspirin low strength oral tablet delayed release

Aspir-Low OTC

cvs aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

ECOTRIN LOW STRENGTH ORAL TABLET DELAYED RELEASE

OTC

ECOTRIN ORAL TABLET DELAYED RELEASE

OTC

ECPIRIN ORAL TABLET DELAYED RELEASE

OTC

eq aspirin adult low dose oral tablet delayed release

Aspir-Low OTC

eq aspirin low dose oral tablet chewable Bayer Low Dose OTC

eq aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

eql aspirin ec oral tablet delayed release Bayer Aspirin OTC

eql aspirin low dose oral tablet chewable Bayer Low Dose OTC

eql aspirin low dose oral tablet delayed release

Aspir-Low OTC

gnp adult aspirin low strength oral tablet chewable

Bayer Low Dose OTC

gnp aspirin low dose oral tablet delayed release

Aspir-Low OTC

gnp aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

gnp aspirin oral tablet delayed release Bayer Aspirin OTC

goodsense aspirin adult low st oral tablet chewable

Bayer Low Dose OTC

goodsense aspirin low dose oral tablet delayed release

Aspir-Low OTC

goodsense aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

goodsense aspirin oral tablet chewable Bayer Low Dose OTC

goodsense aspirin oral tablet delayed release

Bayer Aspirin OTC

h-e-b aspirin oral tablet delayed release Aspir-Low OTC

45

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Nombre del medicamento Referencia Notas

hm adult aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

hm aspirin ec low dose oral tablet delayed release

Aspir-Low OTC

hm aspirin ec oral tablet delayed release Bayer Aspirin OTC

hm aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

hm aspirin oral tablet chewable Bayer Low Dose OTC

hm aspirin oral tablet delayed release Bayer Aspirin OTC

kls aspirin low dose oral tablet delayed release

Aspir-Low OTC

kp aspirin oral tablet delayed release Aspir-Low OTC

meijer aspirin ec oral tablet delayed release Bayer Aspirin OTC

px aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

px aspirin oral tablet chewable Bayer Low Dose OTC

px enteric aspirin oral tablet delayed release Bayer Aspirin OTC

qc aspirin low dose oral tablet chewable Bayer Low Dose OTC

qc aspirin low dose oral tablet delayed release

Aspir-Low OTC

qc aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

qc aspirin oral tablet delayed release Bayer Aspirin OTC

qc childrens aspirin oral tablet chewable Bayer Low Dose OTC

qc enteric aspirin oral tablet delayed release Bayer Aspirin OTC

ra aspirin adult low dose oral tablet chewable

Bayer Low Dose OTC

ra aspirin adult low strength oral tablet chewable

Bayer Low Dose OTC

ra aspirin childrens oral tablet chewable Bayer Low Dose OTC

ra aspirin ec adult low st oral tablet delayed release

Aspir-Low OTC

ra aspirin ec oral tablet delayed release Bayer Aspirin OTC

ra aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

ra pain relief aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

salsalate oral tablet

sb aspirin adult low strength oral tablet delayed release

Aspir-Low OTC

46

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Nombre del medicamento Referencia Notas

sb aspirin ec oral tablet delayed release Bayer Aspirin OTC

sb aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

sb aspirin oral tablet delayed release Aspir-Low OTC

sb childrens aspirin oral tablet chewable Bayer Low Dose OTC

sb low dose asa ec oral tablet delayed release

Aspir-Low OTC

sm aspirin adult low strength oral tablet chewable

Bayer Low Dose OTC

sm aspirin adult low strength oral tablet delayed release

Aspir-Low OTC

sm aspirin ec low strength oral tablet delayed release

Aspir-Low OTC

sm aspirin ec oral tablet delayed release Bayer Aspirin OTC

sm aspirin low dose oral tablet chewable Bayer Low Dose OTC

sm aspirin oral tabletBayer Advanced Aspirin Reg St

OTC

sm childrens aspirin oral tablet chewable Bayer Low Dose OTC

ST JOSEPH ASPIRIN ORAL TABLET DELAYED RELEASE

OTC

ST JOSEPH LOW DOSE ORAL TABLET CHEWABLE

OTC

ST JOSEPH LOW DOSE ORAL TABLET DELAYED RELEASE

OTC

ANALGÉSICOS - OPIOIDES

COMBINACIONES DE HIDROCODONA

hydrocodone-acetaminophen oral solution PA

ANTIÁCIDOS

ANTIÁCIDO Y SIMETICONA

ALMACONE DOUBLE STRENGTH ORAL SUSPENSION

OTC

alum & mag hydroxide-simeth oral suspension

Mintox OTC

alumina-magnesia-simethicone oral suspension

Mintox OTC

aluminum-magnesium-simethicone oral suspension

Mintox OTC

antacid & antigas oral suspension Mintox OTC

antacid advanced oral suspensionAlmacone Double Strength

OTC

47

Page 48: Lista de medicamentos preferidos aprobada por Medicaid

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antacid anti-gas max strength oral suspension

Almacone Double Strength

OTC

antacid anti-gas oral suspension Mintox OTC

antacid anti-gas reg strength oral suspension

Mintox OTC

antacid extra strength oral suspensionAlmacone Double Strength

OTC

antacid fast relief oral suspension Mintox OTC

antacid i oral suspension Mintox OTC

antacid iii oral suspensionAlmacone Double Strength

OTC

antacid liquid oral suspension Mintox OTC

antacid m oral suspension Mintox OTC

antacid maximum strength oral suspensionAlmacone Double Strength

OTC

antacid oral suspension Mintox OTC

antacid plus anti-gas relief oral suspension Mintox OTC

antacid regular strength oral suspension Mintox OTC

antacid/antigas oral suspension Mintox OTC

antacid/anti-gas oral suspensionAlmacone Double Strength

OTC

antacid/simethicone ds oral suspensionAlmacone Double Strength

OTC

comfort gel antacid & anti-gas oral suspension

Mintox OTC

comfort gel antacid anti-gas oral suspension Mintox OTC

comfort gel oral suspension Mintox OTC

cvs antacid plus antigas oral suspensionAlmacone Double Strength

OTC

cvs antacid/anti-gas oral suspension Mintox OTC

eq antacid maximum strength oral suspension

Almacone Double Strength

OTC

eq antacid/anti-gas oral suspension Mintox OTC

eql antacid advanced max st oral suspension

Almacone Double Strength

OTC

eql antacid/anti-gas oral suspension Mintox OTC

geri-lanta oral suspension Mintox OTC

geri-mox oral suspension Mintox OTC

gnp antacid & anti-gas oral suspension Mintox OTC

gnp antacid regular strength oral suspension Mintox OTC

48

Page 49: Lista de medicamentos preferidos aprobada por Medicaid

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goodsense antacid & gas relief oral suspension

Mintox OTC

hm advanced antacid max st oral suspension

Almacone Double Strength

OTC

hm antacid anti-gas ex st oral suspensionAlmacone Double Strength

OTC

hm antacid oral suspension Mintox OTC

MAALOX MAX ORAL SUSPENSION OTC

MAALOX MULTI SYMPTOM MAX ST ORAL SUSPENSION

OTC

mag-al plus oral liquid Mintox OTC

mag-al plus xs oral liquidAlmacone Double Strength

OTC

meijer antacid anti-gas oral suspension Mintox OTC

meijer antacid oral suspensionAlmacone Double Strength

OTC

mintox maximum strength oral suspensionAlmacone Double Strength

OTC

MINTOX ORAL SUSPENSION OTC

MINTOX PLUS ORAL TABLET CHEWABLE

OTC

MYLANTA MAXIMUM STRENGTH ORAL SUSPENSION

OTC

px antacid maximum strength oral suspension

Almacone Double Strength

OTC

px antacid regular strength oral suspension Mintox OTC

qc antacid oral suspension Mintox OTC

qc antacid/anti-gas oral suspension Mintox OTC

ra antacid/anti-gas max st oral suspensionAlmacone Double Strength

OTC

ra antacid/anti-gas oral suspension Mintox OTC

ra antacid/gas relief max st oral suspensionAlmacone Double Strength

OTC

sb antacid anti-gas oral suspension Mintox OTC

sm antacid advanced max st oral suspension

Almacone Double Strength

OTC

sm antacid advanced oral suspension Mintox OTC

sm antacid anti-gas oral suspension Mintox OTC

sm antacid maximum strength oral suspension

Almacone Double Strength

OTC

49

Page 50: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

sm antacid oral suspension Mintox OTC

sm antacid/antigas oral suspension Mintox OTC

ANTIÁCIDOS - BICARBONATO

sodium bicarbonate oral tablet OTC

ANTIÁCIDOS - SULFATO DE ALUMINIO

aluminum hydroxide gel oral suspension OTC

ANTIÁCIDOS - SULFATO DE CALCIO

antacid calcium oral tablet chewable Cal-Gest Antacid OTC; QL

antacid calcium rich oral tablet chewable Cal-Gest Antacid OTC

antacid extra strength oral tablet chewable Antacid Flavor Chews OTC

ANTACID FLAVOR CHEWS ORAL TABLET CHEWABLE

OTC

antacid maximum oral tablet chewable Tums Ultra 1000 OTC; QL

antacid oral tablet chewable 500 mg Cal-Gest Antacid OTC; QL

antacid oral tablet chewable 750 mg Antacid Flavor Chews OTC

antacid regular strength oral tablet chewable Cal-Gest Antacid OTC; QL

antacid ultra strength oral tablet chewable Tums Ultra 1000 OTC; QL

calcium antacid extra strength oral tablet chewable

Antacid Flavor Chews OTC

calcium antacid oral tablet chewable Cal-Gest Antacid OTC; QL

calcium carbonate antacid oral suspension OTC

calcium carbonate antacid oral tablet OTC; QL

calcium carbonate antacid oral tablet chewable

Cal-Gest Antacid OTC; QL

calcium carbonate oral tablet chewable Cal-Gest Antacid OTC; QL

CAL-GEST ANTACID ORAL TABLET CHEWABLE

OTC; QL

childrens pepto oral tablet chewable Childrens Soothe OTC

CHILDRENS SOOTHE ORAL TABLET CHEWABLE

OTC

cvs antacid extra oral tablet chewable Antacid Flavor Chews OTC

cvs antacid extra strength oral tablet chewable

Antacid Flavor Chews OTC

cvs antacid kids oral tablet chewable Antacid Flavor Chews OTC

cvs antacid maximum strength oral tablet chewable

Tums Ultra 1000 OTC; QL

cvs antacid ultra strength oral tablet chewable

Tums Ultra 1000 OTC; QL

50

Page 51: Lista de medicamentos preferidos aprobada por Medicaid

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CVS CHEWY NOT CHALKY FLAVOR ORAL TABLET CHEWABLE

OTC

cvs smooth antacid extra st oral tablet chewable

Antacid Flavor Chews OTC

eq antacid extra strength oral tablet chewable

Antacid Flavor Chews OTC

eq antacid oral tablet chewable Cal-Gest Antacid OTC; QL

eq antacid ultra strength oral tablet chewable

Tums Ultra 1000 OTC; QL

eql antacid oral tablet chewable Cal-Gest Antacid OTC; QL

eql antacid ultra strength oral tablet chewable

Tums Ultra 1000 OTC; QL

gnp antacid extra strength oral tablet chewable

Antacid Flavor Chews OTC

gnp antacid oral tablet chewable Cal-Gest Antacid OTC; QL

gnp antacid ultra strength oral tablet chewable

Tums Ultra 1000 OTC; QL

goodsense antacid oral tablet chewable 1000 mg

Tums Ultra 1000 OTC; QL

goodsense antacid oral tablet chewable 500 mg

Cal-Gest Antacid OTC; QL

goodsense antacid oral tablet chewable 750 mg

Antacid Flavor Chews OTC

HEALTHY MAMA TAME THE FLAME ORAL TABLET CHEWABLE

OTC; QL

hm antacid extra strength oral tablet chewable

Antacid Flavor Chews OTC

hm antacid regular strength oral tablet chewable

Cal-Gest Antacid OTC; QL

hm calcium antacid ex st oral tablet chewable

Antacid Flavor Chews OTC

long lasting antacid oral tablet chewable Cal-Gest Antacid OTC; QL

MAALOX CHILDRENS ORAL TABLET CHEWABLE

OTC

px antacid extra strength oral tablet chewable

Antacid Flavor Chews OTC

px antacid maximum strength oral tablet chewable

Tums Ultra 1000 OTC; QL

px calcium antacid oral tablet chewable Cal-Gest Antacid OTC; QL

qc antacid extra strength oral tablet chewable

Antacid Flavor Chews OTC

51

Page 52: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

qc antacid oral tablet chewable Cal-Gest Antacid OTC; QL

qc antacid ultra strength oral tablet chewable Tums Ultra 1000 OTC; QL

ra antacid oral tablet chewable Cal-Gest Antacid OTC; QL

ra antacid ultra strength oral tablet chewable Tums Ultra 1000 OTC; QL

sb antacid extra strength oral tablet chewable

Antacid Flavor Chews OTC

sb antacid oral tablet chewable Cal-Gest Antacid OTC; QL

sm antacid oral tablet chewable Cal-Gest Antacid OTC; QL

sm calcium antacid ex st oral tablet chewable

Antacid Flavor Chews OTC

sm calcium antacid oral tablet chewable Cal-Gest Antacid OTC; QL

sm smooth antacid ex st oral tablet chewable

Antacid Flavor Chews OTC

TITRALAC ORAL TABLET CHEWABLE OTC

ANTIÁCIDOS - SULFATO DE MAGNESIO

gnp magnesium oxide oral tablet OTC

hm magnesium oral tablet OTC

magnesium oxide (antacid) oral capsule OTC

magnesium oxide oral tablet OTC

MAOX ORAL TABLET OTC

qc magnesium oral tablet OTC

COMBINACIONES DE ANTIÁCIDOS

ACID GONE ORAL SUSPENSION OTC

ACID GONE ORAL TABLET CHEWABLE OTC

antacid extra strength oral tablet chewable Acid Gone OTC

antacid oral tablet chewable Rolaids OTC

cvs antacid supreme oral suspension OTC

cvs heartburn relief oral tablet chewable Acid Gone OTC

geri-lanta supreme oral suspension OTC

gnp antacid extra strength oral tablet chewable

Acid Gone OTC

heartburn antacid ex st oral tablet chewable Acid Gone OTC

qc heartburn antacid oral tablet chewable Acid Gone OTC

ROLAIDS ORAL TABLET CHEWABLE OTC

52

Page 53: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

ANTICONCEPTIVOS

ANTICONCEPTIVOS BIFÁSICOS ORALES

AZURETTE ORAL TABLET AL; QL

BEKYREE ORAL TABLET AL; QL

desogestrel-ethinyl estradiol oral tablet Azurette AL; QL

KARIVA ORAL TABLET AL; QL

PIMTREA ORAL TABLET AL; QL

SIMLIYA ORAL TABLET AL; QL

viorele oral tablet Azurette AL; QL

VOLNEA ORAL TABLET AL; QL

ANTICONCEPTIVOS CONTINUOS ORALES

AMETHYST ORAL TABLET AL; QL

DOLISHALE ORAL TABLET

levonorgestrel-ethinyl estrad oral tablet Amethyst AL; QL

ANTICONCEPTIVOS DE CICLO EXTENDIDO ORALES

AMETHIA ORAL TABLET AL; QL

ASHLYNA ORAL TABLET AL; QL

CAMRESE LO ORAL TABLET AL; QL

CAMRESE ORAL TABLET AL; QL

DAYSEE ORAL TABLET AL; QL

FAYOSIM ORAL TABLET AL; QL

ICLEVIA ORAL TABLET AL; QL

INTROVALE ORAL TABLET AL; QL

JAIMIESS ORAL TABLET AL; QL

JOLESSA ORAL TABLET AL; QL

levonorgest-eth est & eth est oral tablet Fayosim AL; QL

levonorgest-eth estrad 91-day oral tablet Camrese Lo AL; QL

LOJAIMIESS ORAL TABLET AL; QL

RIVELSA ORAL TABLET AL; QL

SETLAKIN ORAL TABLET AL; QL

SIMPESSE ORAL TABLET AL; QL

ANTICONCEPTIVOS DE EMERGENCIA

AFTERA ORAL TABLET OTC; QL

ECONTRA EZ ORAL TABLET OTC; QL

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Page 54: Lista de medicamentos preferidos aprobada por Medicaid

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ECONTRA ONE-STEP ORAL TABLET OTC; QL

ELLA ORAL TABLET QL

levonorgestrel oral tablet Aftera OTC; QL

MY CHOICE ORAL TABLET OTC; QL

MY WAY ORAL TABLET OTC; QL

NEW DAY ORAL TABLET OTC; QL

OPCICON ONE-STEP ORAL TABLET OTC; QL

OPTION 2 ORAL TABLET OTC; QL

PREVENTEZA ORAL TABLET OTC; QL

REACT ORAL TABLET OTC; QL

TAKE ACTION ORAL TABLET OTC; QL

ANTICONCEPTIVOS DE PROGESTINA - INYECTABLES

medroxyprogesterone acetate intramuscular suspension

Depo-Provera AL; QL

medroxyprogesterone acetate intramuscular suspension prefilled syringe

Depo-Provera AL; QL

ANTICONCEPTIVOS DE PROGESTINA - ORALES

CAMILA ORAL TABLET AL

DEBLITANE ORAL TABLET AL

ERRIN ORAL TABLET AL

HEATHER ORAL TABLET AL

INCASSIA ORAL TABLET AL

JENCYCLA ORAL TABLET AL

LYLEQ ORAL TABLET AL

LYZA ORAL TABLET AL

NORA-BE ORAL TABLET AL

norethindrone oral tablet Camila AL

NORLYDA ORAL TABLET AL

NORLYROC ORAL TABLET AL

SHAROBEL ORAL TABLET AL

TULANA ORAL TABLET AL

ANTICONCEPTIVOS TRIFÁSICOS ORALES

alyacen 7/7/7 oral tablet Cyclafem 7/7/7 AL; QL

ARANELLE ORAL TABLET AL; QL

CAZIANT ORAL TABLET AL; QL

54

Page 55: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

CESIA ORAL TABLET

CYCLAFEM 7/7/7 ORAL TABLET AL; QL

DASETTA 7/7/7 ORAL TABLET AL; QL

ENPRESSE-28 ORAL TABLET AL; QL

LEENA ORAL TABLET AL; QL

LEVONEST ORAL TABLET AL; QL

levonorg-eth estrad triphasic oral tablet Enpresse-28 AL; QL

norgestim-eth estrad triphasic oral tablet Tri Femynor AL; QL

NORTREL 7/7/7 ORAL TABLET AL; QL

NYLIA 7/7/7 ORAL TABLET AL; QL

PIRMELLA 7/7/7 ORAL TABLET AL; QL

TILIA FE ORAL TABLET AL; QL

TRI FEMYNOR ORAL TABLET AL; QL

TRI-ESTARYLLA ORAL TABLET AL; QL

TRI-LEGEST FE ORAL TABLET AL; QL

TRI-LINYAH ORAL TABLET AL; QL

TRI-LO-ESTARYLLA ORAL TABLET AL; QL

TRI-LO-MARZIA ORAL TABLET AL; QL

TRI-LO-MILI ORAL TABLET AL; QL

TRI-LO-SPRINTEC ORAL TABLET AL; QL

TRI-MILI ORAL TABLET AL; QL

TRINESSA (28) ORAL TABLET AL; QL

TRI-NYMYO ORAL TABLET AL; QL

TRI-PREVIFEM ORAL TABLET AL; QL

TRI-SPRINTEC ORAL TABLET AL; QL

TRIVORA (28) ORAL TABLET AL; QL

TRI-VYLIBRA LO ORAL TABLET AL; QL

TRI-VYLIBRA ORAL TABLET AL; QL

VELIVET ORAL TABLET AL; QL

COMBINACIONES DE ANTICONCEPTIVOS ORALES

AFIRMELLE ORAL TABLET AL; QL

ALTAVERA ORAL TABLET AL; QL

alyacen 1/35 oral tablet Cyclafem 1/35 AL; QL

APRI ORAL TABLET AL; QL

AUBRA EQ ORAL TABLET AL; QL

AUBRA ORAL TABLET AL; QL

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Page 56: Lista de medicamentos preferidos aprobada por Medicaid

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AUROVELA 1.5/30 ORAL TABLET AL; QL

AUROVELA 1/20 ORAL TABLET AL; QL

AUROVELA 24 FE ORAL TABLET AL; QL

AUROVELA FE 1.5/30 ORAL TABLET AL; QL

AUROVELA FE 1/20 ORAL TABLET AL; QL

AVIANE ORAL TABLET AL; QL

AYUNA ORAL TABLET AL; QL

BALZIVA ORAL TABLET AL; QL

BLISOVI 24 FE ORAL TABLET AL; QL

BLISOVI FE 1.5/30 ORAL TABLET AL; QL

BLISOVI FE 1/20 ORAL TABLET AL; QL

briellyn oral tablet Balziva AL; QL

CHARLOTTE 24 FE ORAL TABLET CHEWABLE

AL; QL

CHATEAL EQ ORAL TABLET AL; QL

CHATEAL ORAL TABLET AL; QL

CRYSELLE-28 ORAL TABLET AL; QL

CYCLAFEM 1/35 ORAL TABLET AL; QL

CYRED EQ ORAL TABLET AL; QL

CYRED ORAL TABLET AL; QL

DASETTA 1/35 ORAL TABLET AL; QL

DELYLA ORAL TABLET AL; QL

desogestrel-ethinyl estradiol oral tablet Apri AL; QL

drospiren-eth estrad-levomefol oral tablet Beyaz AL; QL

drospirenone-ethinyl estradiol oral tablet Jasmiel AL; QL

ELINEST ORAL TABLET AL; QL

EMOQUETTE ORAL TABLET AL; QL

ENSKYCE ORAL TABLET AL; QL

ESTARYLLA ORAL TABLET AL; QL

ethynodiol diac-eth estradiol oral tablet Kelnor 1/35 AL; QL

FALMINA ORAL TABLET AL; QL

FEMYNOR ORAL TABLET AL; QL

GEMMILY ORAL CAPSULE

HAILEY 1.5/30 ORAL TABLET AL; QL

HAILEY 24 FE ORAL TABLET AL; QL

HAILEY FE 1.5/30 ORAL TABLET AL; QL

HAILEY FE 1/20 ORAL TABLET AL; QL

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Page 57: Lista de medicamentos preferidos aprobada por Medicaid

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ISIBLOOM ORAL TABLET AL; QL

JASMIEL ORAL TABLET AL; QL

JULEBER ORAL TABLET AL; QL

JUNEL 1.5/30 ORAL TABLET AL; QL

JUNEL 1/20 ORAL TABLET AL; QL

JUNEL FE 1.5/30 ORAL TABLET AL; QL

JUNEL FE 1/20 ORAL TABLET AL; QL

JUNEL FE 24 ORAL TABLET AL; QL

KAITLIB FE ORAL TABLET CHEWABLE AL; QL

KALLIGA ORAL TABLET AL; QL

KELNOR 1/35 ORAL TABLET AL; QL

KELNOR 1/50 ORAL TABLET AL; QL

KURVELO ORAL TABLET AL; QL

LARIN 1.5/30 ORAL TABLET AL; QL

LARIN 1/20 ORAL TABLET AL; QL

LARIN 24 FE ORAL TABLET AL; QL

LARIN FE 1.5/30 ORAL TABLET AL; QL

LARIN FE 1/20 ORAL TABLET AL; QL

LARISSIA ORAL TABLET AL; QL

LAYOLIS FE ORAL TABLET CHEWABLE AL; QL

LESSINA ORAL TABLET AL; QL

levonorgestrel-ethinyl estrad oral tablet Afirmelle AL; QL

LEVORA 0.15/30 (28) ORAL TABLET AL; QL

LILLOW ORAL TABLET AL; QL

LOESTRIN 1.5/30 (21) ORAL TABLET AL; QL

LOESTRIN 1/20 (21) ORAL TABLET AL; QL

LOESTRIN FE 1.5/30 ORAL TABLET AL; QL

LOESTRIN FE 1/20 ORAL TABLET AL; QL

LORYNA ORAL TABLET AL; QL

LOW-OGESTREL ORAL TABLET AL; QL

LO-ZUMANDIMINE ORAL TABLET AL; QL

LUTERA ORAL TABLET AL; QL

marlissa oral tablet Altavera AL; QL

MERZEE ORAL CAPSULE AL; QL

MICROGESTIN 1.5/30 ORAL TABLET AL; QL

MICROGESTIN 1/20 ORAL TABLET AL; QL

MICROGESTIN 24 FE ORAL TABLET

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Page 58: Lista de medicamentos preferidos aprobada por Medicaid

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MICROGESTIN FE 1.5/30 ORAL TABLET AL; QL

MICROGESTIN FE 1/20 ORAL TABLET AL; QL

MILI ORAL TABLET AL; QL

MONO-LINYAH ORAL TABLET AL; QL

NECON 0.5/35 (28) ORAL TABLET AL; QL

NECON 1/35 (28) ORAL TABLET

NIKKI ORAL TABLET AL; QL

norethin ace-eth estrad-fe oral capsule Gemmily

norethin ace-eth estrad-fe oral tablet Aurovela FE 1/20 AL; QL

norethin ace-eth estrad-fe oral tablet chewable

Charlotte 24 Fe AL; QL

norethindrone acet-ethinyl est oral tablet Aurovela 1/20 AL; QL

norethin-eth estradiol-fe oral tablet chewable Wymzya Fe AL; QL

norgestimate-eth estradiol oral tablet Estarylla AL; QL

NORTREL 0.5/35 (28) ORAL TABLET AL; QL

NORTREL 1/35 (21) ORAL TABLET AL; QL

NORTREL 1/35 (28) ORAL TABLET AL; QL

NYMYO ORAL TABLET AL; QL

OCELLA ORAL TABLET AL; QL

ORSYTHIA ORAL TABLET AL; QL

PHILITH ORAL TABLET AL; QL

PIRMELLA 1/35 ORAL TABLET AL; QL

PORTIA-28 ORAL TABLET AL; QL

PREVIFEM ORAL TABLET AL; QL

RECLIPSEN ORAL TABLET AL; QL

SOLIA ORAL TABLET

SPRINTEC 28 ORAL TABLET AL; QL

SRONYX ORAL TABLET AL; QL

SYEDA ORAL TABLET AL; QL

TARINA 24 FE ORAL TABLET AL; QL

TARINA FE 1/20 EQ ORAL TABLET AL; QL

TARINA FE 1/20 ORAL TABLET AL; QL

TYDEMY ORAL TABLET AL; QL

VESTURA ORAL TABLET AL; QL

VIENVA ORAL TABLET AL; QL

VYFEMLA ORAL TABLET AL; QL

VYLIBRA ORAL TABLET AL; QL

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Page 59: Lista de medicamentos preferidos aprobada por Medicaid

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WERA ORAL TABLET AL; QL

WYMZYA FE ORAL TABLET CHEWABLE AL; QL

ZARAH ORAL TABLET AL; QL

ZOVIA 1/35 (28) ORAL TABLET

ZOVIA 1/35E (28) ORAL TABLET AL; QL

ZUMANDIMINE ORAL TABLET AL; QL

COMBINACIONES DE ANTICONCEPTIVOS TRANSDÉRMICOS

XULANE TRANSDERMAL PATCH WEEKLY

AL; QL

ZAFEMY TRANSDERMAL PATCH WEEKLY

COMBINACIONES DE ANTICONCEPTIVOS VAGINALES

ELURYNG VAGINAL RING AL; QL

etonogestrel-ethinyl estradiol vaginal ring EluRyng AL; QL

ANTIDIABÉTICOS

OTROS AGENTES PARA LA DIABETES - COMBINACIONES

cvs glucose oral tablet chewable Dex4 OTC

DEX4 GLUCOSE ORAL TABLET CHEWABLE

OTC

DEX4 NATURALS ORAL TABLET CHEWABLE

OTC

DEX4 ORAL TABLET CHEWABLE OTC

DEX4 POUCH PACK ORAL TABLET CHEWABLE

OTC

glucose instant energy oral tablet chewable Dex4 OTC

glucose oral tablet chewable Dex4 OTC

glucose-vitamin c oral tablet chewable Dex4 OTC

gnp glucose oral tablet chewable Dex4 OTC

goodsense glucose oral tablet chewable Dex4 OTC

hm glucose oral tablet chewable Dex4 OTC

hy-vee glucose oral tablet chewable Dex4 OTC

kroger glucose oral tablet chewable Dex4 OTC

leader glucose oral tablet chewable Dex4 OTC

longs glucose oral tablet chewable Dex4 OTC

meijer glucose oral tablet chewable Dex4 OTC

59

Page 60: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

preferred plus glucose oral tablet chewable Dex4 OTC

px glucose oral tablet chewable Dex4 OTC

ra glucose oral tablet chewable Dex4 OTC

RELION GLUCOSE ORAL TABLET CHEWABLE

OTC

sm glucose oral tablet chewable Dex4 OTC

SMART SENSE GLUCOSE ORAL TABLET CHEWABLE

OTC

tgt glucose oral tablet chewable Dex4 OTC

up & up glucose oral tablet chewable Dex4 OTC

value plus glucose oral tablet chewable Dex4 OTC

walgreens glucose oral tablet chewable Dex4 OTC

OTROS AGENTES PARA LA DIABETES

cvs glucose bits oral tablet chewable OTC

cvs glucose oral gel Gluco Burst OTC

cvs glucose oral tablet chewableDex4 Quick Dissolve Glucose

OTC

cvs soft glucose oral tablet chewableDex4 Quick Dissolve Glucose

OTC

DEX4 QUICK DISSOLVE GLUCOSE ORAL TABLET CHEWABLE

OTC

GLUCO BURST ORAL GEL OTC

glucose oral gel Gluco Burst OTC

glucose oral tablet chewableDex4 Quick Dissolve Glucose

OTC

GLUTOSE 15 ORAL GEL OTC

GLUTOSE 45 ORAL GEL OTC

GLUTOSE 5 ORAL GEL OTC

gnp glucose oral tablet chewableDex4 Quick Dissolve Glucose

OTC

gnp quick dissolve glucose oral tablet chewable

Dex4 Quick Dissolve Glucose

OTC

leader quick dissolve glucose oral tablet chewable

Dex4 Quick Dissolve Glucose

OTC

RELION GLUCOSE ORAL GEL OTC

sm glucose oral tablet chewableDex4 Quick Dissolve Glucose

OTC

SWEET CHEEKS ORAL GEL OTC

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Page 61: Lista de medicamentos preferidos aprobada por Medicaid

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value plus glucose oral gel Gluco Burst OTC

walgreens glucose oral tablet chewableDex4 Quick Dissolve Glucose

OTC

ANTIDIARRÉICOS

AGENTES ANTIDIARRÉICOS VARIOS

bismatrol maximum strength oral suspensionKaopectate Extra Strength

OTC

bismatrol oral suspension Kaopectate OTC; QL

bismatrol oral tablet chewable Soothe OTC

bismuth oral tablet chewable Soothe OTC

bismuth subsalicylate oral suspension Kaopectate OTC; QL

bismuth subsalicylate oral tablet chewable Soothe OTC

cvs anti-diarrheal oral suspension Kaopectate OTC; QL

cvs stomach relief max st oral suspensionKaopectate Extra Strength

OTC

cvs stomach relief oral suspension 525 mg/15ml

Kaopectate Extra Strength

OTC

cvs stomach relief oral suspension 525 mg/30ml

Kaopectate OTC; QL

cvs stomach relief oral tablet Kaopectate OTC

cvs stomach relief oral tablet chewable Soothe OTC

diarrhea oral suspension Kaopectate OTC; QL

diotame instydose oral suspension Kaopectate OTC; QL

eq pink-bismuth oral tablet chewable Soothe OTC

eq stomach relief oral suspension Kaopectate OTC; QL

eql stomach relief oral suspension Kaopectate OTC; QL

eql stomach relief oral tablet chewable Soothe OTC

geri-pectate oral suspension Kaopectate OTC; QL

gnp pink bismuth oral tablet Kaopectate OTC

gnp pink bismuth oral tablet chewable Soothe OTC

gnp stomach relief oral suspension Kaopectate OTC; QL

goodsense stomach relief oral suspension 1050 mg/30ml

Kaopectate Extra Strength

OTC

goodsense stomach relief oral suspension 525 mg/30ml

Kaopectate OTC; QL

goodsense stomach relief oral tablet chewable

Soothe OTC

hm stomach relief max strength oral suspension

Kaopectate Extra Strength

OTC

61

Page 62: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

hm stomach relief oral suspension Kaopectate OTC; QL

hm stomach relief oral tablet chewable Soothe OTC

hm stomach relief ultra oral suspensionKaopectate Extra Strength

OTC

KAOPECTATE EXTRA STRENGTH ORAL SUSPENSION

OTC

KAOPECTATE ORAL SUSPENSION OTC; QL

KAOPECTATE ORAL TABLET OTC

medi-bismuth oral tablet chewable Soothe OTC

peptic relief oral tablet chewable Soothe OTC

pink bismuth maximum strength oral suspension

Kaopectate Extra Strength

OTC

pink bismuth oral suspension Kaopectate OTC; QL

px stomach relief max st oral suspensionKaopectate Extra Strength

OTC

px stomach relief oral suspension Kaopectate OTC; QL

px stomach relief oral tablet chewable Soothe OTC

qc diarrhea relief oral suspension Kaopectate OTC; QL

qc pink bismuth oral suspension Kaopectate OTC; QL

qc pink bismuth oral tablet Kaopectate OTC

qc pink bismuth oral tablet chewable Soothe OTC

ra stomach relief oral suspension Kaopectate OTC; QL

sb bismuth oral tablet Kaopectate OTC

sm stomach relief oral suspension Kaopectate OTC; QL

sm stomach relief oral tablet Kaopectate OTC

sm stomach relief oral tablet chewable Soothe OTC

SOOTHE MAXIMUM STRENGTH ORAL SUSPENSION

OTC

SOOTHE ORAL SUSPENSION OTC; QL

SOOTHE ORAL TABLET OTC

SOOTHE ORAL TABLET CHEWABLE OTC

stomach relief extra strength oral suspension

Kaopectate Extra Strength

OTC

stomach relief oral suspension 525 mg/15mlKaopectate Extra Strength

OTC

stomach relief oral suspension 525 mg/30ml, 527 mg/30ml

Kaopectate OTC; QL

stomach relief oral tablet chewable Soothe OTC

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stomach relief plus oral suspensionKaopectate Extra Strength

OTC

stomach relief ultra oral suspensionKaopectate Extra Strength

OTC

COMBINACIONES DE ANTIDIARRÉICOS - OPIÁCEOS

goodsense anti-diarr/ant-gas oral tabletImodium Multi-Symptom Relief

OTC

hm anti-diarrheal anti-gas oral tabletImodium Multi-Symptom Relief

OTC

ANTÍDOTOS

ANTAGONISTAS OPIÁCEOS

naloxone hcl injection solution

naloxone hcl injection solution cartridge

naloxone hcl injection solution prefilled syringe

NARCAN NASAL LIQUID

ANTÍDOTOS Y ANTAGONISTAS ESPECÍFICOS

deferoxamine mesylate injection solution reconstituted

Desferal

ANTIEMÉTICOS

ANTIEMÉTICOS - AGENTE ANTICOLINÉRGICO

meclizine hcl oral tablet chewable Bonine

ANTIESPASMÓDICOS URINARIOS

ANTIESPASMÓDICOS URINARIOS - AGONISTAS COLINÉRGICOS

bethanechol chloride oral tablet

ANTIHELMÍNTICOS

ANTIHELMÍNTICOS

cvs pinworm treatment oral suspension OTC

ivermectin oral tablet Stromectol

pin-away oral suspension OTC

pinworm medicine oral suspension OTC

praziquantel oral tablet Biltricide

reeses pinworm medicine oral suspension OTC

63

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ANTIHIPERTENSIVOS

ADRENOLÍTICOS: ACCIÓN CENTRAL Y DIURÉTICO TIAZÍDICO/COMBINACIÓN TIPO TIAZIDA

methyldopa-hydrochlorothiazide oral tablet

ANTIADRENÉRGICOS - ACTUACIÓN CENTRAL

clonidine hcl oral tablet

guanfacine hcl oral tablet

methyldopa oral tablet

ANTIADRENÉRGICOS - ACTUACIÓN PERIFÉRICA

prazosin hcl oral capsule Minipress

VASODILATADORES

hydralazine hcl oral tablet

minoxidil oral tablet

ANTIHISTAMÍNICOS

ANTIHISTAMÍNICOS - ALQUILAMINAS

aller-chlor oral tablet Wal-finate OTC

allergy oral tablet Wal-finate OTC

allergy oral tablet extended release Chlor-Trimeton Allergy OTC

allergy relief oral tablet Wal-finate OTC

chlorhist oral tablet Wal-finate OTC

chlorpheniramine maleate er oral tablet extended release

Chlor-Trimeton Allergy OTC

chlorpheniramine maleate oral tablet Wal-finate OTC

cvs allergy relief oral tablet Wal-finate OTC

cvs allergy relief oral tablet extended release Chlor-Trimeton Allergy OTC

DIABETIC TUSSIN ALLERGY ORAL SYRUP

OTC

ed chlorped jr oral syrup Diabetic Tussin Allergy OTC

eq chlortabs oral tablet Wal-finate OTC

eql allergy oral tablet Wal-finate OTC

gnp allergy relief oral tablet Wal-finate OTC

hm allergy relief oral tablet Wal-finate OTC

pharbechlor oral tablet Wal-finate OTC

qc allergy relief 4-hour oral tablet Wal-finate OTC

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qc chlor-pheniramine oral tablet Wal-finate OTC

ra allergy relief oral tablet Wal-finate OTC

ra chlorpheniramine maleate oral tablet Wal-finate OTC

sb chlorpheniramine oral tablet Wal-finate OTC

sm allergy 4 hour oral tablet Wal-finate OTC

WAL-FINATE ORAL TABLET OTC

ANTIHISTAMÍNICOS - ETANOLAMINAS

aler-cap oral capsule Banophen OTC; QL

alertab oral tablet Alka-Seltzer Plus Allergy OTC

ALKA-SELTZER PLUS ALLERGY ORAL TABLET

OTC

allergy childrens oral liquid Banophen OTC; QL

allergy relief childrens oral liquid Banophen OTC; QL

allergy relief childrens oral tablet dispersibleWal-Dryl Allergy Rel Childrens

OTC

allergy relief oral capsule Banophen OTC; QL

allergy relief oral tablet Alka-Seltzer Plus Allergy OTC

anti-hist allergy oral tablet Alka-Seltzer Plus Allergy OTC

aurodryl allergy childrens oral liquid Banophen OTC; QL

BANOPHEN ORAL CAPSULE 25 MG OTC; QL

BANOPHEN ORAL CAPSULE 50 MG OTC

BANOPHEN ORAL LIQUID OTC; QL

BANOPHEN ORAL TABLET OTC

carbinoxamine maleate oral solution

carbinoxamine maleate oral tablet

clemastine fumarate oral tabletDayhist Allergy 12 Hour Relief

OTC

complete allergy medicine oral capsule Banophen OTC; QL

complete allergy medicine oral tablet Alka-Seltzer Plus Allergy OTC

complete allergy relief oral tablet Alka-Seltzer Plus Allergy OTC

cvs allergy oral capsule Banophen OTC; QL

cvs allergy relief adult oral liquid Banophen OTC; QL

cvs allergy relief childrens oral liquid Banophen OTC; QL

cvs allergy relief childrens oral tablet dispersible

Wal-Dryl Allergy Rel Childrens

OTC

cvs allergy relief oral capsule Banophen OTC; QL

cvs allergy relief oral liquid Banophen OTC; QL

65

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cvs allergy relief oral tablet Alka-Seltzer Plus Allergy OTC

cvs childrens allergy oral liquid Banophen OTC; QL

DAYHIST ALLERGY 12 HOUR RELIEF ORAL TABLET

OTC

diphen oral tablet Alka-Seltzer Plus Allergy OTC

diphenhist oral capsule Banophen OTC; QL

diphenhydramine hcl childrens oral liquid Banophen OTC

diphenhydramine hcl oral capsule 25 mg Banophen QL

diphenhydramine hcl oral capsule 50 mg Banophen

diphenhydramine hcl oral liquid 12.5 mg/5ml Banophen OTC; QL

diphenhydramine hcl oral liquid 6.25 mg/ml OTC

diphenhydramine hcl oral tablet Alka-Seltzer Plus Allergy OTC

diphenhydramine hcl oral tablet chewableBenadryl Allergy Childrens

OTC

dye-free allergy relief oral liquid Banophen OTC; QL

eq allergy relief childrens oral liquid Banophen OTC; QL

eq allergy relief oral capsule Banophen OTC; QL

eq allergy relief oral tablet Alka-Seltzer Plus Allergy OTC

eql allergy oral tablet Alka-Seltzer Plus Allergy OTC

eql allergy relief childrens oral tablet dispersible

Wal-Dryl Allergy Rel Childrens

OTC

eql allergy relief oral tablet Alka-Seltzer Plus Allergy OTC

eql childrens allergy oral liquid Banophen OTC; QL

geri-dryl oral liquid Banophen OTC; QL

geri-dryl oral tablet Alka-Seltzer Plus Allergy OTC

gnp allergy antihistamine oral liquid Banophen OTC; QL

gnp allergy oral capsule Banophen OTC; QL

gnp allergy oral tablet Alka-Seltzer Plus Allergy OTC

gnp allergy relief oral capsule Banophen OTC; QL

gnp allergy relief oral tablet Alka-Seltzer Plus Allergy OTC

gnp allergy relief oral tablet chewableBenadryl Allergy Childrens

OTC

gnp childrens allergy oral liquid Banophen OTC; QL

h-e-b childrens allergy oral liquid Banophen OTC; QL

hm allergy relief childrens oral liquid Banophen OTC; QL

hm allergy relief oral capsule Banophen OTC; QL

hm allergy relief oral tablet Alka-Seltzer Plus Allergy OTC

kp diphenhydramine hcl oral capsule Banophen OTC

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liquid allergy relief oral liquid Banophen OTC; QL

m-dryl oral liquid Banophen OTC; QL

MEDI-PHEDRYL ORAL CAPSULE OTC; QL

meijer antihistamine allergy oral capsule Banophen OTC; QL

NARAMIN ORAL LIQUID OTC; QL

PEDIACARE CHILDRENS ALLERGY ORAL LIQUID

OTC; QL

pharbedryl oral capsule 25 mg Banophen OTC; QL

pharbedryl oral capsule 50 mg Banophen OTC

px allergy oral capsule Banophen OTC; QL

px allergy oral liquid Banophen OTC; QL

px allergy oral tablet Alka-Seltzer Plus Allergy OTC

PX DAYHIST ALLERGY ORAL TABLET OTC

qc allergy childrens oral liquid Banophen OTC; QL

qc allergy relief oral tablet Alka-Seltzer Plus Allergy OTC

qc complete allergy medicine oral tablet Alka-Seltzer Plus Allergy OTC

ra allergy medication oral capsule Banophen OTC; QL

ra allergy medication oral liquid Banophen OTC; QL

ra allergy medication oral tablet Alka-Seltzer Plus Allergy OTC

ra allergy oral liquid Banophen OTC; QL

ra allergy oral tablet Alka-Seltzer Plus Allergy OTC

ra allergy relief childrens oral liquid Banophen OTC; QL

ra allergy relief childrens oral tablet dispersible

Wal-Dryl Allergy Rel Childrens

OTC

ra allergy relief oral capsule Banophen OTC; QL

ra complete allergy oral tablet Alka-Seltzer Plus Allergy OTC

RA DIPHEDRYL ALLERGY ORAL LIQUID OTC; QL

sb allergy medicine oral liquid Banophen OTC; QL

sb allergy medicine oral tablet Alka-Seltzer Plus Allergy OTC

sb allergy oral capsule Banophen OTC; QL

siladryl allergy oral liquid Banophen OTC; QL

sm allergy relief childrens oral liquid Banophen OTC; QL

sm allergy relief oral capsule Banophen OTC; QL

sm allergy relief oral liquid Banophen OTC; QL

sm allergy relief oral tablet Alka-Seltzer Plus Allergy OTC

TOTAL ALLERGY MEDICINE ORAL LIQUID

OTC; QL

total allergy oral tablet Alka-Seltzer Plus Allergy OTC

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WAL-DRYL ALLERGY CHILDRENS ORAL LIQUID

OTC; QL

WAL-DRYL ALLERGY ORAL CAPSULE OTC; QL

WAL-DRYL ALLERGY ORAL LIQUID OTC; QL

WAL-DRYL ALLERGY ORAL TABLET OTC

WAL-DRYL ALLERGY REL CHILDRENS ORAL TABLET DISPERSIBLE

OTC

ANTIHISTAMÍNICOS - FENOTIAZINA

promethazine hcl oral solution AL

ANTIHISTAMÍNICOS - PIPERIDINAS

cyproheptadine hcl oral syrup

cyproheptadine hcl oral tablet

ANTINEOPLÁSICOS Y TERAPIAS COMPLEMENTARIAS

*ANTINEOPLASTIC - BCR-ABL KINASE INHIBITORS***

imatinib mesylate oral tablet Gleevec

*ANTINEOPLASTIC - EGFR INHIBITORS***

IRESSA ORAL TABLET PA

AGENTES ALQUILANTES

MYLERAN ORAL TABLET

AGENTES DE RESCATE ANTAGONISTAS DEL ÁCIDO FÓLICO

leucovorin calcium injection solution reconstituted

leucovorin calcium oral tablet

AGENTES PROTECTORES DEL TRACTO URINARIO

MESNEX ORAL TABLET PA

ANÁLOGOS DE LHRH

VANTAS SUBCUTANEOUS KIT PA

ANTIANDRÓGENOS

bicalutamide oral tablet Casodex

flutamide oral capsule

ANTIESTRÓGENOS

tamoxifen citrate oral tablet

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ANTIMETABOLITOS

mercaptopurine oral tablet

methotrexate oral tablet

methotrexate sodium (pf) injection solution

methotrexate sodium injection solution

methotrexate sodium injection solution reconstituted

methotrexate sodium oral tablet

TABLOID ORAL TABLET

TREXALL ORAL TABLET

ANTINEOPLÁSICOS - INHIBIDORES DEL PROTEASOMA

VELCADE INJECTION SOLUTION RECONSTITUTED

PA

ANTINEOPLÁSICOS - INMUNOTERAPIA CELULAR AUTÓLOGA

KYMRIAH INTRAVENOUS SUSPENSION

ANTINEOPLÁSICOS VARIOS

hydroxyurea oral capsule Hydrea

ESTRÓGENOS - ANTINEOPLÁSICOS

EMCYT ORAL CAPSULE PA

INHIBIDORES DE LA AROMATASA

anastrozole oral tablet Arimidex

exemestane oral tablet Aromasin

letrozole oral tablet Femara

INHIBIDORES MIÓTICOS

etoposide oral capsule

MOSTAZAS DE NITRÓGENO

cyclophosphamide oral capsule

LEUKERAN ORAL TABLET

melphalan oral tablet Alkeran

PROGESTINAS - ANTINEOPLÁSICOS

hydroxyprogesterone caproate intramuscular solution

PA

RETINIODES

tretinoin oral capsule PA

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ANTIPALÚDICOS

ANTIPALÚDICOS

chloroquine phosphate oral tablet

hydroxychloroquine sulfate oral tablet Plaquenil QL

mefloquine hcl oral tablet QL

primaquine phosphate oral tablet

COMBINACIONES DE ANTIPALÚDICOS

atovaquone-proguanil hcl oral tablet Malarone

ANTISÉPTICOS Y DESINFECTANTES

ANTISÉPTICOS DE CLORO

antiseptic skin cleanser external solution Dyna-Hex 4 OTC; QL

BETASEPT SURGICAL SCRUB EXTERNAL LIQUID

OTC; QL

cvs antiseptic skin cleanser external solution Dyna-Hex 4 OTC; QL

DYNA-HEX 4 EXTERNAL SOLUTION OTC; QL

gnp antiseptic skin cleanser external solution Dyna-Hex 4 OTC; QL

hm antiseptic skin cleanser external solution Dyna-Hex 4 OTC; QL

ra antiseptic skin cleanser external solution Dyna-Hex 4 OTC; QL

sm antiseptic skin cleanser external solution Dyna-Hex 4 OTC; QL

ANTISÉPTICOS Y DESINFECTANTES

cvs hydrogen peroxide external solution OTC

eq hydrogen peroxide external solution OTC

eql hydrogen peroxide external solution OTC

gnp hydrogen peroxide external solution OTC

goodsense hydrogen peroxide external solution

OTC

hm hydrogen peroxide external solution OTC

hydrogen peroxide external solution OTC

meijer hydrogen peroxide external solution OTC

px hydrogen peroxide external solution OTC

qc hydrogen peroxide external solution OTC

ra hydrogen peroxide external solution OTC

sm hydrogen peroxide external solution OTC

70

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ANTIVIRALES

AGENTES DEL CITOMEGALOVIRUS (CMV)

valganciclovir hcl oral solution reconstituted Valcyte

valganciclovir hcl oral tablet Valcyte

CARDIOTÓNICOS

GLUCÓSIDOS CARDÍACOS

DIGITEK ORAL TABLET

DIGOX ORAL TABLET

digoxin oral solution

digoxin oral tablet Digitek

CLASES VARIADAS

AGENTES LIBERADORES DE POTASIO

SPS ORAL SUSPENSION

AGENTES QUELANTES

CLOVIQUE ORAL CAPSULE PA; QL

penicillamine oral tablet Depen Titratabs PA; QL

trientine hcl oral capsule Clovique PA; QL

CORTICOESTEROIDES

MINERALCORTICOIDES

fludrocortisone acetate oral tablet

DISPOSITIVOS MÉDICOS

AGUJAS Y JERINGAS

BD INSULIN SYRINGE OTC; QL

BD INSULIN SYRINGE MICROFINE OTC; QL

BD INSULIN SYRINGE ULTRAFINE OTC; QL

BD LUER-LOK SYRINGE OTC; QL

BD SAFETYGLIDE INSULIN SYRINGE OTC; QL

BD SAFETY-LOK INSULIN SYRINGE OTC; QL

APLICADORES, BOLAS DE ALGODÓN, ETC.

alcohol prep padBD Swab Single Use Regular

OTC

alcohol swabs padBD Swab Single Use Regular

OTC

BD SWAB SINGLE USE REGULAR PAD OTC

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BD SWABS SINGLE USE BUTTERFLY PAD

OTC

CURITY ALCOHOL PREPS PAD OTC

cvs alcohol prep pads padBD Swab Single Use Regular

OTC

cvs prep padBD Swab Single Use Regular

OTC

EASY TOUCH ALCOHOL PREP MEDIUM PAD

OTC

FIFTY50 ALCOHOL PREP PAD OTC

gnp alcohol swabs padBD Swab Single Use Regular

OTC

hm sterile alcohol prep padBD Swab Single Use Regular

OTC

qc alcohol swabs padBD Swab Single Use Regular

OTC

RELION ALCOHOL SWABS PAD OTC

sm alcohol prep padBD Swab Single Use Regular

OTC

true comfort alcohol prep pads padBD Swab Single Use Regular

OTC

ULTICARE ALCOHOL SWABS PAD OTC

WEBCOL ALCOHOL PREP LARGE PAD OTC

WEBCOL ALCOHOL PREP MEDIUM PAD OTC

CÁMARAS Y SUMINISTROS PARA AEROSOLES/ESPACIADORES

AEROVENT PLUS DEVICE QL

COMPACT SPACE CHAMBER DEVICE QL

COMPACT SPACE CHAMBER/LG MASK DEVICE

QL

COMPACT SPACE CHAMBER/MED MASK DEVICE

QL

EASIVENT MASK LARGE QL

EASIVENT MASK MEDIUM QL

EASIVENT MASK SMALL QL

MICROCHAMBER DEVICE QL

OPTICHAMBER DIAMOND QL

OPTICHAMBER DIAMOND-MD MASK QL

OPTICHAMBER DIAMOND-SM MASK QL

POCKET CHAMBER DEVICE QL

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RITEFLO DEVICE QL

VORTEX VALVED HOLDING CHAMBER DEVICE

QL

MEDIDORES DE FLUJO MÁXIMO

AIRZONE PEAK FLOW METER DEVICE OTC

ASSESS PEAK FLOW METER DEVICE OTC

breathe ease peak flow meter device Airzone Peak Flow Meter OTC

CLEVER CHOICE PEAK FLOW METER DEVICE

OTC

lung perform peak flow meter device Airzone Peak Flow Meter OTC

MICROLIFE DIGITAL PEAK FLOW DEVICE

OTC

MINI WRIGHT PEAK FLOW METER DEVICE

OTC

peak a-i-r flow meter device Airzone Peak Flow Meter OTC

PEAK AIR PEAK FLOW METER DEVICE OTC

peak flow meter universal rang device Airzone Peak Flow Meter OTC

PERSONAL BEST FULL RANGE DEVICE OTC

PIKO 1 DEVICE OTC

POCKET PEAK FLOW METER DEVICE OTC

POCKETPEAK PEAK FLOW METER DEVICE

OTC

pure comfort flow meter adult device Airzone Peak Flow Meter OTC

pure comfort flow meter child device Airzone Peak Flow Meter OTC

TRUZONE PEAK FLOW METER DEVICE

PRODUCTOS PARA EL CUIDADO DE LOS PIES

DESENEX FOOT/SNEAKER SPRAY EXTERNAL AEROSOL

OTC

JOHNSONS FOOT SPRAY EXTERNAL AEROSOL

OTC

SUMINISTROS DE PRUEBA DE CONTROL DE LA GLUCOSA

DROPLET GENTEEL LANCING DEVICE OTC; QL

lancets 33gAccu-Chek FastClix Lancets

OTC; QL

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DISPOSITIVOS Y SUMINISTROS MÉDICOS

DIAFRAGMAS

CAYA VAGINAL DIAPHRAGM

OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM

WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM

WIDE-SEAL DIAPHRAGM 65 VAGINAL DIAPHRAGM

WIDE-SEAL DIAPHRAGM 70 VAGINAL DIAPHRAGM

WIDE-SEAL DIAPHRAGM 75 VAGINAL DIAPHRAGM

WIDE-SEAL DIAPHRAGM 80 VAGINAL DIAPHRAGM

WIDE-SEAL DIAPHRAGM 85 VAGINAL DIAPHRAGM

WIDE-SEAL DIAPHRAGM 90 VAGINAL DIAPHRAGM

WIDE-SEAL DIAPHRAGM 95 VAGINAL DIAPHRAGM

PRESERVATIVOS (FEMENINOS)

FC FEMALE CONDOM OTC; QL

FC2 FEMALE CONDOM OTC; QL

PRESERVATIVOS (MASCULINOS)

aimsco lubricated Durex Extra Sensitive OTC

condoms OTC

DUREX EXTRA SENSITIVE DEVICE OTC

DUREX REALFEEL DEVICE OTC

FANTASY LUBRICATED OTC

FANTASY LUBRICATED/SPERMICIDE OTC

KAMELEON LUBRICATED OTC

kimono Durex Extra Sensitive OTC

KIMONO COLORS DEVICE OTC

kimono micro thin Trustex Non-Lubricated OTC

kimono micro thin plus Durex Extra Sensitive OTC

kimono plus Durex Extra Sensitive OTC

kimono ps Durex Extra Sensitive OTC

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kimono ps plus Durex Extra Sensitive OTC

kimono sensation Durex Extra Sensitive OTC

kimono sensation plus Durex Extra Sensitive OTC

KIMONO SPECIAL DEVICE OTC

K-Y ME & YOU EXTRA LUBRICATED DEVICE

OTC

K-Y ME & YOU INTENSE DEVICE OTC

maxx Durex Extra Sensitive OTC

maxx plus Durex Extra Sensitive OTC

premium condoms lubricated Durex Extra Sensitive OTC

REALITY LATEX CONDOMS OTC

REALITY LATEX/ULTRA TEXTURED DEVICE

OTC

REALITY LATEX/ULTRA THIN DEVICE OTC

TRUSTEX COLOR CONDOMS + LUBE OTC

TRUSTEX LUB/RIBBED/STUDDED OTC

TRUSTEX LUB/SPERMICIDE EX ST OTC

TRUSTEX LUB/SPERMICIDE XL OTC

TRUSTEX LUBRICATED OTC

TRUSTEX LUBRICATED EX LARGE OTC

TRUSTEX LUBRICATED EXTRA ST OTC

TRUSTEX LUBRICATED/SPERMICIDE OTC

TRUSTEX NATURAL CONDOMS + LUBE OTC

TRUSTEX NON-LUBRICATED OTC

TRUSTEX RIA LUB/SPERMICIDE OTC

TRUSTEX RIA LUBRICATED OTC

TRUSTEX RIA NON-LUBRICATED OTC

TRUSTEX-NONOXYNOL-9/RIB/STUD OTC

SUMINISTROS PARA LA TERAPIA RESPIRATORIA

AEROTRACH PLUS

BREATHERITE VALVED MDI CHAMBER DEVICE

QL

IN-CHECK INSPIRATORY FLOW MTR DEVICE

QL

VORTEX HOLD CHMBR/MASK/CHILD DEVICE

QL

VORTEX HOLD CHMBR/MASK/TODDLER DEVICE

QL

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DIURÉTICOS

COMBINACIONES DE DIURÉTICOS

amiloride-hydrochlorothiazide oral tablet

spironolactone-hctz oral tablet Aldactazide

triamterene-hctz oral capsule

triamterene-hctz oral tablet Maxzide

DIURÉTICOS AHORRADORES DE POTASIO

amiloride hcl oral tablet

spironolactone oral tablet Aldactone

DIURÉTICOS DEL ASA

bumetanide oral tablet

furosemide oral solution

furosemide oral tablet Lasix

torsemide oral tablet

DIURÉTICOS TIAZÍDICOS Y DIURÉTICOS TIPO TIAZÍDICOS

chlorthalidone oral tablet

hydrochlorothiazide oral capsule QL

hydrochlorothiazide oral tablet 12.5 mg QL

hydrochlorothiazide oral tablet 25 mg, 50 mg

indapamide oral tablet

metolazone oral tablet

INHIBIDORES DE LA ANHIDRASA CARBÓNICA

acetazolamide er oral capsule extended release 12 hour

acetazolamide oral tablet

methazolamide oral tablet

ESTRÓGENOS

ESTRÓGENO Y PROGESTINA

AMABELZ ORAL TABLET

estradiol-norethindrone acet oral tablet Amabelz

FYAVOLV ORAL TABLET

JINTELI ORAL TABLET

MIMVEY ORAL TABLET

norethindrone-eth estradiol oral tablet Fyavolv

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ESTRÓGENOS

estradiol oral tablet Estrace

estradiol transdermal patch weekly Climara QL

HIPNÓTICOS

COMBINACIONES DE HIPNÓTICOS ANTIHISTAMÍNICOS

acetaminophen pm ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

acetaminophen pm oral tabletHealthy Mama eaZZZe the Pain

OTC

cvs acetaminophen pm ext st oral tabletHealthy Mama eaZZZe the Pain

OTC

cvs ibuprofen pm oral tablet Motrin PM OTC

cvs non-aspirin headache pm oral tablet Excedrin PM OTC

cvs pain relief pm ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

eq acetaminophen pm oral tabletHealthy Mama eaZZZe the Pain

OTC

eq ibuprofen pm oral tablet Motrin PM OTC

eql acetaminophen pm oral tabletHealthy Mama eaZZZe the Pain

OTC

eql ibuprofen pm oral tablet Motrin PM OTC

eql pain relief pm ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

goodsense headache pm oral tabletHealthy Mama eaZZZe the Pain

OTC

goodsense ibuprofen pm oral tablet Motrin PM OTC

goodsense pain relief pm ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

headache relief pm oral tablet Excedrin PM OTC

HEALTHY MAMA EAZZZE THE PAIN ORAL TABLET

OTC

hm ibuprofen pm oral tablet Motrin PM OTC

hm pain reliever pm ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

ibuprofen pm oral tablet Motrin PM OTC

kls rapid release apap pm oral tabletHealthy Mama eaZZZe the Pain

OTC

MEDI-TABS PM EXTRA STRENGTH ORAL TABLET

OTC

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MOTRIN PM ORAL TABLET OTC

night time pain medicine ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

non-aspirin pm oral tabletHealthy Mama eaZZZe the Pain

OTC

pain relief pm extra strength oral tabletHealthy Mama eaZZZe the Pain

OTC

pain reliever pm ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

pain reliever pm oral tabletHealthy Mama eaZZZe the Pain

OTC

PANDOL PM EXTRA STRENGTH ORAL TABLET

OTC

px pain relief pm ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

qc headache relief pm oral tablet Excedrin PM OTC

ra acetaminophen pm ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

ra ibuprofen pm oral tablet Motrin PM OTC

sb non-asa night time oral tabletHealthy Mama eaZZZe the Pain

OTC

sb non-aspirin nighttime oral tabletHealthy Mama eaZZZe the Pain

OTC

sb pain reliever pm oral tabletHealthy Mama eaZZZe the Pain

OTC

sm headache relief pm oral tablet Excedrin PM OTC

sm ibuprofen pm oral tablet Motrin PM OTC

sm pain reliever pm ex st oral tabletHealthy Mama eaZZZe the Pain

OTC

HIPNÓTICOS ANTIHISTAMÍNICOS

cvs sleep aid nighttime oral capsule Unisom Sleepgels OTC

cvs sleep aid nighttime oral tablet Simply Sleep OTC

cvs sleep aid oral tablet Simply Sleep OTC

cvs sleepaid (diphenhydramine) oral tablet Simply Sleep OTC

cvs sleep-aid (doxylamine) oral tablet Unisom SleepTabs OTC

cvs sleep-aid nighttime oral capsule Unisom Sleepgels OTC

cvs ultra sleep oral tablet Unisom SleepTabs OTC

diphenhydramine hcl (sleep) oral tablet OTC

eq nighttime sleep aid max st oral capsule Unisom Sleepgels OTC

eql nighttime sleep aid oral tablet Simply Sleep OTC

78

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eql sleep aid oral capsule Unisom Sleepgels OTC

eql sleep aid oral tablet Unisom SleepTabs OTC

gnp sleep aid oral tablet Unisom SleepTabs OTC

goodsense sleep aid oral capsule Unisom Sleepgels OTC

hm nighttime sleep aid oral tablet Simply Sleep OTC

hm sleep aid oral tablet Unisom SleepTabs OTC

kls sleep aid oral tablet Unisom SleepTabs OTC

night time sleep aid oral tablet Simply Sleep OTC

nighttime sleep aid oral tablet Simply Sleep OTC

qc rest simply oral tablet Simply Sleep OTC

qc sleep aid max st oral capsule Unisom Sleepgels OTC

qc sleep-aid max st oral capsule Unisom Sleepgels OTC

ra night sleep aid oral tablet Unisom SleepTabs OTC

ra nighttime sleep aid oral tablet Simply Sleep OTC

ra sleep aid (diphenhydramine) oral tablet Simply Sleep OTC

ra sleep aid oral capsule Unisom Sleepgels OTC

ra sleep aid oral tablet Unisom SleepTabs OTC

sb sleep oral tablet Simply Sleep OTC

SIMPLY SLEEP ORAL TABLET OTC

sleep aid (diphenhydramine) oral tablet Simply Sleep OTC

sleep aid oral tablet Unisom SleepTabs OTC

sleep ii oral tablet Simply Sleep OTC

sleep tabs oral tablet Simply Sleep OTC

sleep-aid oral capsule Unisom Sleepgels OTC

sleep-aid oral tablet Unisom SleepTabs OTC

sleep-tabs oral tablet Simply Sleep OTC

sm nighttime sleep aid oral tablet Simply Sleep OTC

sm sleep aid oral tablet Unisom SleepTabs OTC

wal-som maximum strength oral capsule Unisom Sleepgels OTC

wal-som oral tablet Unisom SleepTabs OTC

LAXANTES

LAXANTES A GRANEL

clear fiber powder oral powder OTC

cvs daily fiber oral capsule Medi-Mucil OTC

cvs easy fiber oral powder OTC

cvs fiber gummies oral tablet chewable Fiber Select Gummies OTC

79

Page 80: Lista de medicamentos preferidos aprobada por Medicaid

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cvs fiber gummy bears children oral tablet chewable

Fiber Select Gummies OTC

cvs fiber laxative oral tablet FiberCon OTC

cvs fiber oral capsule Medi-Mucil OTC

cvs natural daily fiber oral powder Reguloid OTC

cvs soluble fiber therapy oral tablet Citrucel OTC

cvs yogurt + fiber gummies oral tablet chewable

Fiber Select Gummies OTC

daily fiber oral powder Reguloid OTC

eq daily fiber oral capsule OTC

eq fiber supplement oral tablet chewable Fiber Select Gummies OTC

eq fiber therapy oral capsule Medi-Mucil OTC

eq fiber therapy oral tablet Citrucel OTC

eql fiber laxative oral tablet FiberCon OTC

eql fiber supplement oral powder OTC

eql fiber therapy oral powder Reguloid OTC

eql fiber therapy oral tablet Citrucel OTC

eql natural fiber oral powderMetamucil Smooth Texture

OTC

eql smooth texture fiber oral powder Reguloid OTC

fiber (corn dextrin) oral powder OTC

fiber adult gummies oral tablet chewable Fiber Select Gummies OTC

fiber laxative + calcium oral tablet FiberCon OTC

fiber laxative oral tablet FiberCon OTC

fiber oral powder Metamucil OTC

fiber oral tablet FiberCon OTC

FIBER SELECT GUMMIES ORAL TABLET CHEWABLE

OTC

fiber therapy oral powder OTC

fiber therapy oral tablet Citrucel OTC

fiber-lax oral tablet FiberCon OTC

gnp fiber therapy oral tablet Citrucel OTC

gnp fiber-caps oral tablet FiberCon OTC

gnp natural fiber oral capsule Medi-Mucil OTC

gnp natural fiber oral powder Metamucil OTC

goodsense fiber oral tablet Citrucel OTC

goodsense psyllium fiber oral powder Reguloid OTC

hm fiber oral capsule OTC

80

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hm fiber oral powder Metamucil OTC

hm fiber oral tablet Citrucel OTC

hm fiber powder oral powder OTC

hm trueplus fiber oral tablet chewable Fiber Select Gummies OTC

konsyl daily fiber oral powder Metamucil OTC

MEDI-MUCIL ORAL CAPSULE OTC

METAMUCIL ORAL POWDER OTC

METAMUCIL SMOOTH TEXTURE ORAL POWDER

OTC

natural fiber laxative oral powder OTC

natural fiber oral powderMetamucil Smooth Texture

OTC

natural vegetable fiber oral powder Reguloid OTC

PEDIA-LAX FIBER GUMMIES ORAL TABLET CHEWABLE

OTC

psyllium fiber oral capsule Medi-Mucil OTC

px fiber oral capsule Medi-Mucil OTC

px fiber oral tablet FiberCon OTC

qc fiber laxative oral capsule Medi-Mucil OTC

qc fiber therapy oral tablet Citrucel OTC

qc natural vegetable oral powder Hydrocil OTC

ra multihealth fiber oral powder Reguloid OTC

REGULOID ORAL CAPSULE OTC

REGULOID ORAL POWDER OTC

sb fiber laxative oral powder Reguloid OTC

sb fiber laxative oral tablet FiberCon OTC

sm fiber laxative oral tablet Citrucel OTC

sm fiber oral capsule OTC

sm fiber oral powder Metamucil OTC

sm fiber oral tablet FiberCon OTC

sm fiber powder oral powder OTC

SOLUBLE FIBER THERAPY ORAL POWDER

OTC

WAL-MUCIL ORAL CAPSULE OTC

WAL-MUCIL ORAL POWDER OTC

LAXANTES ESTIMULANTES

ALOPHEN ORAL TABLET DELAYED RELEASE

OTC; QL

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bisacodyl ec oral tablet delayed release Alophen OTC; QL

bisacodyl laxative rectal suppository The Magic Bullet OTC

bisacodyl rectal suppository The Magic Bullet OTC

chocolated laxative oral tablet chewable Ex-Lax OTC

CORRECTOL ORAL TABLET DELAYED RELEASE

OTC; QL

cvs bisacodyl oral tablet delayed release Alophen OTC; QL

cvs chocolate laxative pieces oral tablet chewable

Ex-Lax OTC

cvs c-lax laxative oral tablet delayed release Alophen OTC; QL

cvs gentle laxative oral tablet delayed release

Alophen OTC; QL

cvs gentle laxative rectal suppository The Magic Bullet OTC

cvs gentle laxative womens oral tablet delayed release

Alophen OTC; QL

cvs laxative pills max st oral tablet OTC

cvs senna oral tabletDr Edwards Olive Laxative

OTC

cvs senna-extra oral tablet Senokot Extra Strength OTC

DR EDWARDS OLIVE LAXATIVE ORAL TABLET

OTC

eq gentle laxative oral tablet delayed release Alophen OTC; QL

eq laxative maximum strength oral tablet OTC; QL

eq natural laxative oral tabletDr Edwards Olive Laxative

OTC

eq natural vegetable laxative oral tabletDr Edwards Olive Laxative

OTC

eql gentle laxative oral tablet delayed release

Alophen OTC; QL

eql laxative maximum strength oral tablet OTC; QL

eql laxative oral tablet chewable Ex-Lax OTC

eql laxative oral tablet delayed release Alophen OTC; QL

eql senna laxative oral tabletDr Edwards Olive Laxative

OTC

EVAC-U-GEN ORAL TABLET OTC

EX-LAX ULTRA ORAL TABLET DELAYED RELEASE

OTC; QL

FEENAMINT ORAL TABLET DELAYED RELEASE

OTC; QL

gentle laxative oral tablet delayed release Alophen OTC; QL

82

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gentle laxative rectal suppository The Magic Bullet OTC

geri-kot oral tabletDr Edwards Olive Laxative

OTC

gnp gentle laxative oral tablet delayed release

Alophen OTC; QL

gnp gentle laxative rectal suppository The Magic Bullet OTC

gnp senna lax oral tabletDr Edwards Olive Laxative

OTC

gnp womens gentle laxative oral tablet delayed release

Alophen OTC; QL

goodsense bisacodyl ec oral tablet delayed release

Alophen OTC; QL

goodsense laxative pills oral tablet OTC; QL

goodsense senna laxative oral tabletDr Edwards Olive Laxative

OTC

goodsense womens laxative oral tablet delayed release

Alophen OTC; QL

hm laxative oral tablet delayed release Alophen OTC; QL

hm laxative rectal suppository The Magic Bullet OTC

hm senna oral tabletDr Edwards Olive Laxative

OTC

kp bisacodyl oral tablet delayed release Alophen OTC; QL

kp senna oral tabletDr Edwards Olive Laxative

OTC

laxative max str oral tablet OTC; QL

laxative oral tablet delayed release Alophen OTC; QL

laxative pills oral tablet Medi-Lax OTC

laxative rectal suppository The Magic Bullet OTC

laxative regular strength oral tablet Medi-Lax OTC

MEDI-LAX ORAL TABLET OTC

medi-natural oral tabletDr Edwards Olive Laxative

OTC

natural senna laxative oral tabletDr Edwards Olive Laxative

OTC

PERDIEM OVERNIGHT RELIEF ORAL TABLET

OTC

px laxative oral tablet delayed release Alophen OTC; QL

px vegetable laxative oral tabletDr Edwards Olive Laxative

OTC

qc gentle laxative oral tablet delayed release Alophen OTC; QL

83

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qc gentle laxative rectal suppository The Magic Bullet OTC

qc natural vegetable laxative oral tabletDr Edwards Olive Laxative

OTC

qc senna oral tabletDr Edwards Olive Laxative

OTC

ra fast relief laxative rectal suppository The Magic Bullet OTC

ra laxative oral tablet chewable Ex-Lax OTC

ra laxative oral tablet delayed release Alophen OTC; QL

ra womens laxative oral tablet delayed release

Alophen OTC; QL

sb bisacodyl laxative ec oral tablet delayed release

Alophen OTC; QL

sb gentle lax-women oral tablet delayed release

Alophen OTC; QL

sb laxative rectal suppository The Magic Bullet OTC

sb senna-lax oral tabletDr Edwards Olive Laxative

OTC

senexon oral liquid OTC

senna lax oral tabletDr Edwards Olive Laxative

OTC

senna laxative oral tabletDr Edwards Olive Laxative

OTC

senna oral capsule OTC

senna oral liquid OTC

senna oral syrup

senna oral tabletDr Edwards Olive Laxative

OTC

SENNA SMOOTH ORAL TABLET OTC

senna-lax oral tabletDr Edwards Olive Laxative

OTC

senna-tabs oral tabletDr Edwards Olive Laxative

OTC

senna-time oral tabletDr Edwards Olive Laxative

OTC

sennazon oral syrup OTC

sennosides oral tabletDr Edwards Olive Laxative

OTC

SENOKOT EXTRA STRENGTH ORAL TABLET

OTC

sm gentle laxative oral tablet delayed release

Alophen OTC; QL

84

Page 85: Lista de medicamentos preferidos aprobada por Medicaid

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sm laxative maximum strength oral tablet OTC; QL

sm laxative rectal suppository The Magic Bullet OTC

sm senna laxative oral tabletDr Edwards Olive Laxative

OTC

THE MAGIC BULLET RECTAL SUPPOSITORY

OTC

veracolate oral tablet delayed release Alophen OTC; QL

womans laxative oral tablet delayed release Alophen OTC; QL

womens laxative oral tablet delayed release Alophen OTC; QL

LAXANTES LUBRICANTES

cvs mineral oil enema rectal enema Fleet Oil OTC

cvs mineral oil oral oil OTC

enema mineral oil rectal enema Fleet Oil OTC

eq mineral oil oral oil OTC

gnp mineral oil oral oil OTC

goodsense mineral oil oral oil OTC

hm enema mineral oil rectal enema Fleet Oil OTC

hm mineral oil oral oil OTC

mineral oil oral oil OTC

qc mineral oil heavy oral oil OTC

ra mineral oil oral oil OTC

sm mineral oil oral oil OTC

sm mineral oil rectal enema Fleet Oil OTC

LAXANTES SURFACTANTES

CORRECTOL EXTRA GENTLE ORAL CAPSULE

OTC; QL

cvs stool softener oral capsule 100 mg Correctol Extra Gentle OTC; QL

cvs stool softener oral capsule 240 mg Surfak OTC

cvs stool softener oral capsule 250 mg OTC

cvs stool softener oral capsule 50 mg Colace Clear OTC

docqlace oral capsule Correctol Extra Gentle OTC; QL

DOCU LIQUID ORAL LIQUID OTC

docu oral liquid Docu Liquid OTC

docuprene oral tablet DOK OTC; QL

docusate calcium oral capsule Surfak OTC

docusate sodium oral capsule 100 mg Correctol Extra Gentle OTC; QL

docusate sodium oral capsule 250 mg

docusate sodium oral liquid Docu Liquid OTC

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docusate sodium oral syrup OTC

docusate sodium oral tablet DOK OTC; QL

DOK ORAL CAPSULE OTC; QL

DOK ORAL TABLET OTC; QL

DQZATE ORAL CAPSULE OTC

dss oral capsule 100 mg Correctol Extra Gentle OTC; QL

dss oral capsule 250 mg OTC

DULCOLAX PINK STOOL SOFTENER ORAL CAPSULE

OTC; QL

DULCOLAX STOOL SOFTENER ORAL CAPSULE

OTC; QL

easy-lax oral capsule Correctol Extra Gentle OTC; QL

eq stool softener oral capsule 100 mg Correctol Extra Gentle OTC; QL

eq stool softener oral capsule 250 mg OTC

eql stool softener oral capsule Correctol Extra Gentle OTC; QL

gnp stool softener ex st oral capsule OTC

gnp stool softener oral capsule 100 mg Correctol Extra Gentle OTC; QL

gnp stool softener oral capsule 250 mg OTC

HEALTHY MAMA MOVE IT ALONG ORAL TABLET

OTC; QL

hm stool softener oral capsule Correctol Extra Gentle OTC; QL

hm stool softener oral tablet DOK OTC; QL

mm stool softener laxative oral capsule Correctol Extra Gentle OTC; QL

PHILLIPS STOOL SOFTENER ORAL CAPSULE

OTC; QL

PROMOLAXIN ORAL TABLET OTC; QL

px docusate sodium oral capsule Correctol Extra Gentle OTC; QL

qc docusate calcium oral capsule Surfak OTC

qc stool softener oral capsule Correctol Extra Gentle OTC; QL

ra col-rite oral capsule 100 mg Correctol Extra Gentle OTC; QL

ra col-rite oral capsule 250 mg OTC

ra stool softener oral capsule Correctol Extra Gentle OTC; QL

sb docusate sodium oral capsule Correctol Extra Gentle OTC; QL

sb stool softener oral capsule Surfak OTC

silace oral liquid Docu Liquid OTC

silace oral syrup OTC

sm docusate calcium oral capsule Surfak OTC

sm stool softener oral capsule 100 mg Correctol Extra Gentle OTC; QL

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sm stool softener oral capsule 240 mg Surfak OTC

sm stool softener oral capsule 250 mg OTC

sm stool softener oral tablet DOK OTC; QL

stool softener laxative oral capsule 100 mg Correctol Extra Gentle OTC; QL

stool softener laxative oral capsule 250 mg OTC

stool softener oral capsule 100 mg Correctol Extra Gentle OTC; QL

stool softener oral capsule 240 mg Surfak OTC

stool softener oral capsule 250 mg OTC

stool softener oral liquid Docu Liquid OTC

stool softener oral tablet DOK OTC; QL

SURFAK ORAL CAPSULE OTC

LAXANTES VARIOS

cvs glycerin adult rectal suppository OTC

cvs glycerin child rectal suppository Pedia-Lax OTC

CVS PURELAX ORAL PACKET OTC

CVS PURELAX ORAL POWDER OTC

EQ CLEARLAX ORAL POWDER OTC

EQL CLEARLAX ORAL POWDER OTC

gavilax oral packet CVS Purelax OTC

gentlelax oral powder CVS Purelax OTC

glycerin (adult) rectal suppository OTC

glycerin (child) rectal suppository OTC

glycerin (infants & children) rectal suppository

Pedia-Lax OTC

glycerin (pediatric) rectal suppository Pedia-Lax OTC

glycerin adult rectal suppository OTC

glycerin childrens rectal suppository Pedia-Lax OTC

gnp glycerin (adult) rectal suppository OTC

gnp glycerin child rectal suppository OTC

HM CLEARLAX ORAL PACKET OTC

KLS LAXACLEAR ORAL POWDER OTC

MM CLEARLAX ORAL POWDER OTC

px glycerin rectal suppository OTC

ra glycerin adult rectal suppository OTC

ra glycerin child rectal suppository OTC

ra laxative oral powder CVS Purelax OTC

sb glycerin adult rectal suppository OTC

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sb glycerin pediatric rectal suppository OTC

sb polyethylene glycol 3350 oral powder CVS Purelax OTC

sm glycerin pediatric rectal suppository OTC

SMOOTH LAX ORAL PACKET OTC

SMOOTH LAX ORAL POWDER OTC

MEDICAMENTOS PARA LA TOS/EL RESFRÍO/LA ALERGIA

ANTITUSIVOS - ANTIHISTAMÍNICOS - DESCONGESTIVOS OPIÁCEOS

promethazine-phenyleph-codeine oral syrup

ANTITUSIVOS - ANTIHISTAMÍNICOS NO NARCÓTICOS

promethazine-dm oral syrup AL

ANTITUSIVOS - ANTIHISTAMÍNICOS OPIÁCEOS

promethazine-codeine oral solution

promethazine-codeine oral syrup

ANTITUSIVOS - EXPECTORANTES

guaiatussin ac oral syrup OTC

ANTITUSIVOS - NO NARCÓTICOS

benzonatate oral capsule Tessalon Perles

cough dm childrens oral suspension extended release

Robitussin 12 Hour Cough

OTC

cough dm oral suspension extended releaseRobitussin 12 Hour Cough

OTC

cvs cough dm childrens oral suspension extended release

Robitussin 12 Hour Cough

OTC

cvs cough dm oral suspension extended release

Robitussin 12 Hour Cough

OTC

cvs tussin long-acting oral liquidWal-Tussin Cough Long Acting

OTC

cvs tussin maximum strength oral syrup Wal-Tussin Cough OTC

daytime cough oral liquid Vicks DayQuil Cough OTC

dextromethorphan polistirex er oral suspension extended release

Robitussin 12 Hour Cough

OTC

eq cough dm oral suspension extended release

Robitussin 12 Hour Cough

OTC

eql cough dm oral suspension extended release

Robitussin 12 Hour Cough

OTC

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eql tussin cough long-acting oral syrup Wal-Tussin Cough OTC

gnp cough dm er oral suspension extended release

Robitussin 12 Hour Cough

OTC

gnp tussin cough long acting oral syrup Wal-Tussin Cough OTC

goodsense cough dm childrens oral suspension extended release

Robitussin 12 Hour Cough

OTC

goodsense cough dm oral suspension extended release

Robitussin 12 Hour Cough

OTC

hm cough dm oral suspension extended release

Robitussin 12 Hour Cough

OTC

hm cough relief oral liquidWal-Tussin Cough Long Acting

OTC

px tussin max oral syrup Wal-Tussin Cough OTC

ra cough dm oral suspension extended release

Robitussin 12 Hour Cough

OTC

ROBITUSSIN 12 HOUR COUGH CHILD ORAL SUSPENSION EXTENDED RELEASE

OTC

ROBITUSSIN 12 HOUR COUGH ORAL SUSPENSION EXTENDED RELEASE

OTC

sm cough dm childrens oral suspension extended release

Robitussin 12 Hour Cough

OTC

sm cough dm oral suspension extended release

Robitussin 12 Hour Cough

OTC

sm cough relief oral syrup Wal-Tussin Cough OTC

tussin cough oral syrup Wal-Tussin Cough OTC

WAL-TUSSIN COUGH LONG ACTING ORAL LIQUID

OTC

WAL-TUSSIN COUGH LONG ACTING ORAL SYRUP

OTC

WAL-TUSSIN COUGH ORAL SYRUP OTC

ANTITUSIVOS - OPIOIDES

hydrocodone-homatropine oral syrup Hycodan AL

hydrocodone-homatropine oral tablet AL

hydromet oral syrup Hycodan AL

DESCONGESTIVO Y ANTIHISTAMÍNICO

12 hour allergy-d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

all day allergy d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

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all day allergy d-12 oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

all day allergy-d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

allergy d-12 oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

allergy relief d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

allergy relief/nasal decongest oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

cetirizine-pseudoephedrine er oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

cvs allergy relief-d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

eq allergy relief oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

eql all day allergy-d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

gnp all day allergy-d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

hm allergy complete-d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

KLS ALLER-TEC D ORAL TABLET EXTENDED RELEASE 12 HOUR

AL; OTC

promethazine-phenylephrine oral syrup AL

px allergy relief d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

ra cetiri-d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

sm all day allergy-d oral tablet extended release 12 hour

KLS Aller-Tec D AL; OTC

WAL-ZYR D ORAL TABLET EXTENDED RELEASE 12 HOUR

AL; OTC

EXPECTORANTES

altarussin oral syrup Diabetic Tussin EX OTC

BUCKLEYS CHEST CONGESTION ORAL LIQUID

AL; OTC

chest congestion childrens oral liquidBuckleys Chest Congestion

AL; OTC

chest congestion relief oral syrup Diabetic Tussin EX OTC

chest congestion relief oral tablet Xpect OTC

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coughtab oral tablet OTC

cvs chest congestion relief oral tablet Xpect OTC

cvs mucus extended release oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

cvs tussin adult chest congest oral liquidBuckleys Chest Congestion

AL; OTC

DIABETIC TUSSIN EX ORAL SYRUP OTC

DIABETIC TUSSIN ORAL LIQUID AL; OTC

eq 12 hour mucus relief oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

EQ MUCUS ER ORAL TABLET EXTENDED RELEASE 12 HOUR

AL; OTC

eql tussin mucus/chest congest oral liquidBuckleys Chest Congestion

AL; OTC

geri-tussin oral liquidBuckleys Chest Congestion

AL; OTC

gnp mucus er oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

gnp mucus relief oral tablet Xpect OTC

gnp tab tussin oral tablet Xpect OTC

gnp tussin mucus & chest cong oral liquidBuckleys Chest Congestion

AL; OTC

goodsense mucus relief oral tablet Xpect OTC

guaifenesin er oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

guaifenesin oral liquidBuckleys Chest Congestion

AL; OTC

guaifenesin oral solutionBuckleys Chest Congestion

AL; OTC

guaifenesin oral syrup Diabetic Tussin EX OTC

guaifenesin oral tablet Xpect OTC

hm chest congestion relief oral tablet Xpect OTC

hm mucus relief max st oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

hm tussin adult oral liquidBuckleys Chest Congestion

AL; OTC

kls mucus relief chest oral tablet Xpect OTC

liquibid oral tablet Xpect OTC

MUCINEX FAST-MAX CHEST CONG MS ORAL LIQUID

OTC

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mucosa oral tablet Xpect OTC

mucus & chest congestion oral liquidBuckleys Chest Congestion

AL; OTC

mucus relief chest congestion oral liquidBuckleys Chest Congestion

AL; OTC

mucus relief chest congestion oral tablet Xpect OTC

mucus relief er oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

mucus relief max st oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

mucus relief oral tablet Xpect OTC

mucus+chest congestion oral liquidBuckleys Chest Congestion

AL; OTC

organ-i nr oral tablet OTC

pharbinex oral tablet Xpect OTC

px tussin oral solutionBuckleys Chest Congestion

AL; OTC

qc medifin 400 oral tablet Xpect OTC

qc medifin mucus relief child oral liquidBuckleys Chest Congestion

AL; OTC

qc mucus relief childrens oral liquidBuckleys Chest Congestion

AL; OTC

qc mucus relief er oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

qc mucus relief max st oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

qc tussin mucus/congestion oral liquidBuckleys Chest Congestion

AL; OTC

ra mucus relief max st oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

ra tussin chest congestion oral syrup Diabetic Tussin EX OTC

ra tussin oral syrup Diabetic Tussin EX OTC

refenesen 400 oral tablet Xpect OTC

ROBAFEN MUCUS/CHEST CONGESTION ORAL LIQUID

AL; OTC

sb cough control oral syrup Diabetic Tussin EX OTC

sb coughtab oral tablet OTC

sb mucus relief oral tablet Xpect OTC

scot-tussin expectorant oral liquidBuckleys Chest Congestion

AL; OTC

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siltussin das oral liquidBuckleys Chest Congestion

AL; OTC

siltussin sa oral syrup Diabetic Tussin EX OTC

sm chest congestion relief oral tablet Xpect OTC

sm mucus relief childrens oral liquidBuckleys Chest Congestion

AL; OTC

sm mucus relief max strength oral tablet extended release 12 hour

EQ Mucus ER AL; OTC

sm tussin mucus+chest congest oral liquidBuckleys Chest Congestion

AL; OTC

TUSNEL-EX ORAL LIQUID OTC

tussin mucus & chest congest oral liquidBuckleys Chest Congestion

AL; OTC

tussin mucus+chest congestion oral liquidBuckleys Chest Congestion

AL; OTC

tussin mucus+chest congestion oral syrup Diabetic Tussin EX OTC

WAL-TUSSIN CHEST CONGESTION ORAL LIQUID

AL; OTC

XPECT ORAL TABLET OTC

INHALANTES RESPIRATORIOS VARIOS

nasal mist inhalation aerosol solution Simply Saline Baby OTC

SIMPLY SALINE BABY INHALATION AEROSOL SOLUTION

OTC

sodium chloride inhalation nebulization solution

MUCOLÍTICOS

acetylcysteine inhalation solution

MEDICINAS ALTERNATIVAS

MEDICINAS ALTERNATIVAS

glucosamine chondroitin complx oral capsule

Glucosamine Chondr 500 Complex

OTC

MINERALES Y ELECTROLITOS

CALCIO

calcium 600 high potency oral tablet OTC

calcium 600 oral tablet OTC

calcium carbonate oral tablet 1250 (500 ca) mg

OTC; QL

calcium carbonate oral tablet 1500 (600 ca) mg, 600 mg

OTC

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calcium citrate oral tablet OTC

calcium high potency oral tablet OTC

calcium oral tablet OTC

calcium oyster shell oral tablet OTC; QL

cvs calcium carbonate oral tablet OTC; QL

cvs calcium oral tablet OTC

gnp calcium oral tablet OTC

hm calcium oral tablet OTC

oyster shell calcium oral tablet Oystercal OTC; QL

OYSTERCAL ORAL TABLET OTC; QL

pure calcium carbonate oral tablet OTC

qc calcium fast dissolution oral tablet OTC

ra calcium 600 oral tablet OTC

ra calcium high potency oral tablet OTC

sb oyster shell calcium oral tablet Oystercal OTC; QL

super calcium oral tablet OTC

COMBINACIONES DE CALCIO

CALCITRATE ORAL TABLET OTC

calcitrate plus d oral tablet OTC

calcium + d oral tablet OTC

calcium + d3 oral tablet Pronutrients Calcium+D3 OTC; QL

calcium + vitamin d3 oral tablet 600-10 mg-mcg

OTC; QL

calcium + vitamin d3 oral tablet 600-5 mg-mcg

OTC

calcium 500 + d oral tablet OTC

calcium 500 + d3 oral tablet Os-Cal Calcium + D3 OTC

calcium 500 +d oral tablet Oystercal-D OTC

calcium 500/d oral tablet RA Hi Cal OTC

calcium 500/d oral tablet chewable OTC

calcium 500/vitamin d oral tablet OTC

calcium 500+d high potency oral tablet OTC

calcium 500+d oral tablet Os-Cal Calcium + D3 OTC

calcium 500+d3 oral tablet Oystercal-D OTC

calcium 600 + d oral tablet OTC

calcium 600 + minerals oral tablet OTC

calcium 600/vitamin d oral tablet OTC; QL

94

Page 95: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

calcium 600/vitamin d oral tablet chewable OTC; QL

calcium 600/vitamin d3 oral tablet Pronutrients Calcium+D3 OTC; QL

calcium 600+d high potency oral tablet OTC; QL

calcium 600+d oral tablet 600-200 mg-unit OTC

calcium 600+d oral tablet 600-400 mg-unit OTC; QL

calcium 600+d oral tablet 600-800 mg-unit Pronutrients Calcium+D3 OTC; QL

calcium 600+d plus minerals oral tablet OTC; QL

calcium 600+d plus minerals oral tablet chewable

OTC; QL

calcium 600+d3 oral tablet 600-200 mg-unit OTC

calcium 600+d3 oral tablet 600-400 mg-unit OTC; QL

calcium 600+d3 oral tablet 600-800 mg-unit Pronutrients Calcium+D3 OTC; QL

calcium 600+d3 plus minerals oral tabletCaltrate 600+D Plus Minerals

OTC

calcium 600+d3 plus minerals oral tablet chewable

Caltrate 600+D Plus Minerals

OTC

calcium carb-cholecalciferol oral tablet 500-125 mg-unit

OTC

calcium carb-cholecalciferol oral tablet 600-400 mg-unit

OTC; QL

calcium carb-cholecalciferol oral tablet chewable

OTC

calcium carbonate-vitamin d oral capsule OTC; QL

calcium carbonate-vitamin d oral tablet 500-400 mg-unit, 600-200 mg-unit

OTC

calcium carbonate-vitamin d oral tablet 600-400 mg-unit

OTC; QL

calcium carbonate-vitamin d3 oral tablet OTC; QL

calcium citrate + d oral tablet OTC

calcium citrate + d3 maximum oral tablet Calcitrate OTC

calcium citrate + d3 oral tablet Citracal Petites/Vitamin D OTC

calcium citrate + oral tablet OTC

calcium citrate +d oral tablet Calcitrate OTC

calcium citrate+d3 oral tablet Calcitrate OTC

calcium citrate+d3 petites oral tablet Citracal Petites/Vitamin D OTC

calcium citrate-vitamin d oral tablet Calcitrate OTC

calcium citrate-vitamin d3 oral tablet Calcitrate OTC

calcium creamies oral tablet chewable OTC; QL

calcium extra d3 oral tablet Os-Cal Extra D3 OTC

95

Page 96: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

calcium for women oral tablet chewable OTC

calcium high potency/vitamin d oral tablet OTC

calcium oral tablet chewable OTC; QL

calcium plus vitamin d oral tablet Os-Cal Calcium + D3 OTC

calcium plus vitamin d3 oral capsule OTC

calcium plus vitamin d3 oral tablet Pronutrients Calcium+D3 OTC; QL

calcium/c/d oral tablet chewable OTC; QL

calcium/vitamin d oral tablet OTC

calcium+d3 gradual release oral tablet extended release 24 hour

Citracal Slow Release OTC

calcium+d3 oral tablet 500-10 mg-mcg Oystercal-D OTC

calcium+d3 oral tablet 500-15 mg-mcg Os-Cal Extra D3 OTC

calcium+d3 oral tablet 600-20 mg-mcg, 600-800 mg-unit

Pronutrients Calcium+D3 OTC; QL

calcium-magnesium oral tablet Cal-Mag OTC

calcium-magnesium-zinc oral tablet OTC

calcium-vitamin d oral tablet 500-400 mg-unit

Oystercal-D OTC

calcium-vitamin d oral tablet 600-400 mg-unit

OTC; QL

calcium-vitamin d3 oral capsule 600-400 mg-unit

OTC; QL

calcium-vitamin d3 oral capsule 600-500 mg-unit

OTC

calcium-vitamin d3 oral tablet 250-125 mg-unit, 600-400 mg-unit

OTC; QL

calcium-vitamin d3 oral tablet 500-400 mg-unit

Oystercal-D OTC

calcium-vitamin d3 oral tablet 600-200 mg-unit

OTC

calcium-vitamin d-minerals oral tablet chewable 600-400 mg-unit

OTC; QL

calcium-vitamin d-minerals oral tablet chewable 600-800 mg-unit

Caltrate 600+D Plus Minerals

OTC

CAL-MAG ORAL TABLET OTC

chewable calcium oral tablet chewable OTC

citrus calcium/vitamin d oral tablet Citracal Petites/Vitamin D OTC

cvs calcium + d3 oral tablet Pronutrients Calcium+D3 OTC

cvs calcium 600 & vitamin d3 oral tablet Pronutrients Calcium+D3 OTC; QL

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Page 97: Lista de medicamentos preferidos aprobada por Medicaid

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cvs calcium 600 + d/minerals oral tabletCaltrate 600+D Plus Minerals

OTC

cvs calcium 600 + d/minerals oral tablet chewable

Caltrate 600+D Plus Minerals

OTC

cvs calcium 600+d oral tablet Pronutrients Calcium+D3 OTC; QL

cvs calcium citrate+d3 oral tablet Calcitrate OTC

cvs calcium citrate+d3 petites oral tablet Citracal Petites/Vitamin D OTC

cvs calcium-magnesium-zinc oral tablet OTC

cvs oyster shell calcium-vit d oral tablet OTC

eq calcium 500+d oral tablet Os-Cal Calcium + D3 OTC

eq calcium 600+d oral tablet Pronutrients Calcium+D3 OTC; QL

eq calcium 600+d+minerals oral tabletCaltrate 600+D Plus Minerals

OTC

eq calcium citrate+d oral tablet Calcitrate OTC

eq calcium citrate+d3 oral tablet Calcitrate OTC

eq calcium citrate+d3 petites oral tablet Citracal Petites/Vitamin D OTC

eql calcium citrate/vitamin d oral tablet Calcitrate OTC

eql calcium citrate/vitamin d3 oral tablet Calcitrate OTC

eql calcium soft chews oral tablet chewable OTC

eql calcium/vitamin d oral tablet OTC; QL

eql calcium/vitamin d3 oral tablet Pronutrients Calcium+D3 OTC; QL

gnp calcium 500 +d3 oral tablet Os-Cal Extra D3 OTC

gnp calcium 600 +d/minerals oral tabletCaltrate 600+D Plus Minerals

OTC

gnp calcium 600 +d3 oral tablet Pronutrients Calcium+D3 OTC; QL

gnp calcium 600 +d3/minerals oral tablet chewable

Caltrate 600+D Plus Minerals

OTC

gnp calcium citrate +d3 oral tablet Calcitrate OTC

gnp calcium plus 600 +d oral tablet OTC

hm calcium 600+d plus minerals oral tablet chewable

Caltrate 600+D Plus Minerals

OTC

hm calcium citrate+d3 petite oral tablet Citracal Petites/Vitamin D OTC

hm calcium citrate+vitamin d oral tablet Calcitrate OTC

hm calcium-vitamin d oral tablet 500-200 mg-unit

Os-Cal Calcium + D3 OTC

hm calcium-vitamin d oral tablet 600-400 mg-unit

OTC; QL

hm calcium-vitamin d-minerals oral tablet OTC; QL

kp calcium 600+d oral capsule OTC

97

Page 98: Lista de medicamentos preferidos aprobada por Medicaid

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kp calcium 600+d oral tablet OTC; QL

kp calcium 600+d3 oral capsule OTC

kp calcium citrate+d oral tablet Calcitrate OTC

kp calcium-magnesium-zinc oral tablet OTC

liquid calcium with d3 oral capsule OTC

liquid calcium/vitamin d oral capsule OTC; QL

nat-rul oyster calcium+vit d oral tablet OTC

OS-CAL CALCIUM + D3 ORAL TABLET OTC

OS-CAL EXTRA D3 ORAL TABLET OTC

OYSCO 500+D ORAL TABLET OTC

oyster calcium/d3 oral tablet Os-Cal Calcium + D3 OTC

oyster shell calcium + d oral tablet Os-Cal Calcium + D3 OTC

oyster shell calcium + d3 oral tablet Oystercal-D OTC

oyster shell calcium 250+d oral tablet OTC; QL

oyster shell calcium 500 + d oral tablet OTC

oyster shell calcium 500+d oral tablet chewable

OTC

oyster shell calcium oral tablet Oystercal-D OTC

oyster shell calcium plus d oral tablet OTC

oyster shell calcium/d oral tablet 250-125 mg-unit

OTC; QL

oyster shell calcium/d oral tablet 500-200 mg-unit

RA Hi Cal OTC

oyster shell calcium/d oral tablet 500-400 mg-unit

OTC

oyster shell calcium/d oral tablet 500-5 mg-mcg

Os-Cal Calcium + D3 OTC

oyster shell calcium/d3 oral tablet OTC

oyster shell calcium/vit d3 oral tablet OTC; QL

oyster shell calcium/vitamin d oral tablet 250-125 mg-unit

OTC; QL

oyster shell calcium/vitamin d oral tablet 500-200 mg-unit

Os-Cal Calcium + D3 OTC

OYSTERCAL-D ORAL TABLET OTC

PRONUTRIENTS CALCIUM+D3 ORAL TABLET

OTC; QL

px calcium&d oral tablet OTC; QL

qc calcium 600 +d3/minerals oral tablet chewable

Caltrate 600+D Plus Minerals

OTC

98

Page 99: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

qc calcium/minerals/vitamin d oral tablet OTC; QL

ra calcium 600/vit d/minerals oral tablet OTC

ra calcium 600/vit d/minerals oral tablet chewable

OTC; QL

ra calcium 600/vitamin d-3 oral tablet OTC; QL

ra calcium cit plus vit d-3 oral tablet Calcitrate OTC

ra calcium citrate plus vit d oral tablet OTC

ra calcium cit-vit d-3 petites oral tablet Citracal Petites/Vitamin D OTC

ra calcium plus vitamin d oral tablet 600-200 mg-unit

OTC

ra calcium plus vitamin d oral tablet 600-400 mg-unit

OTC; QL

ra calcium plus vitamin d3 oral tablet OTC; QL

ra calcium/vitamin d/minerals oral tablet OTC; QL

RA HI CAL ORAL TABLET OTC

risacal-d oral tablet OTC

sb calcium + d oral tablet OTC

sm calcium 500/vitamin d3 oral tablet OTC

sm calcium 600/vitamin d oral tablet OTC; QL

sm calcium 600+d plus minerals oral tablet chewable

Caltrate 600+D Plus Minerals

OTC

sm calcium 600+d3 oral tablet Pronutrients Calcium+D3 OTC; QL

sm calcium citrate+/vit d3 oral tablet Calcitrate OTC

sm calcium citrate+d3 petite oral tablet Citracal Petites/Vitamin D OTC

sm calcium citrate+vit d3 max oral tablet Calcitrate OTC

sm calcium citrate-vit d oral tablet OTC

sm calcium soft chews oral tablet chewable OTC

sm calcium/vitamin d oral tablet 500-200 mg-unit

Os-Cal Calcium + D3 OTC

sm calcium/vitamin d oral tablet 600-800 mg-unit

Pronutrients Calcium+D3 OTC; QL

sm calcium/vitamin d3 oral tabletCaltrate 600+D Plus Minerals

OTC

sm calcium-magnesium-zinc oral tablet OTC

sm calcium-vitamin d oral tablet 500-200 mg-unit

Os-Cal Calcium + D3 OTC

sm calcium-vitamin d oral tablet 600-400 mg-unit

OTC; QL

sm oyster shell calcium/vit d oral tablet OTC

99

Page 100: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

sm oyster shell calcium/vit d3 oral tablet Oystercal-D OTC

super calcium 600 + d 400 oral tablet OTC; QL

super calcium 600 + d3 oral tablet OTC; QL

COMBINACIONES MINERALES

calcium citrate + oral tabletAdvanced Calcium/D/Magnesium

OTC

calcium citrate plus oral tabletAdvanced Calcium/D/Magnesium

OTC

calcium citrate plus/magnesium oral tabletAdvanced Calcium/D/Magnesium

OTC

calcium citrate-mag-minerals oral tabletAdvanced Calcium/D/Magnesium

OTC

gnp cal mag zinc +d3 oral tabletAdvanced Calcium/D/Magnesium

OTC

ELECTROLITOS ORALES

ADVANTAGE CARE ELECTROLYTE PED ORAL SOLUTION

OTC; QL

CERALYTE 70 ORAL SOLUTION OTC; QL

cvs electrolyte solution oral solutionAdvantage Care Electrolyte Ped

OTC; QL

cvs ped electrolyte freeze pop oral solutionAdvantage Care Electrolyte Ped

OTC; QL

cvs pediatric electrolyte oral solutionAdvantage Care Electrolyte Ped

OTC; QL

h-e-b oral electrolyte oral solutionAdvantage Care Electrolyte Ped

OTC; QL

hm pediatric electrolyte oral solutionAdvantage Care Electrolyte Ped

OTC; QL

oral electrolyte freezer pops oral solutionAdvantage Care Electrolyte Ped

OTC; QL

oral electrolytes oral solutionAdvantage Care Electrolyte Ped

OTC; QL

ORALYTE FREEZER POPS ORAL SOLUTION

OTC; QL

ORALYTE ORAL SOLUTION OTC; QL

ped electrolyte freeze pops oral solutionAdvantage Care Electrolyte Ped

OTC; QL

ped electrolyte freezer pops oral solutionAdvantage Care Electrolyte Ped

OTC; QL

PEDIA VANCE ORAL SOLUTION OTC; QL

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Page 101: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

pediatric electrolyte oral solutionAdvantage Care Electrolyte Ped

OTC; QL

pediatric electrolyte-zinc oral solutionAdvantage Care Electrolyte Ped

OTC; QL

ra pediatric electrolyte oral solutionAdvantage Care Electrolyte Ped

OTC; QL

REHYDRALYTE ORAL SOLUTION OTC; QL

sb pediatric electrolyte oral solutionAdvantage Care Electrolyte Ped

OTC; QL

sm pediatric electrolyte oral solutionAdvantage Care Electrolyte Ped

OTC; QL

FLUORURO

NAFRINSE ORAL TABLET CHEWABLE

sodium fluoride oral solution 0.5 mg/ml OTC

sodium fluoride oral solution 1.1 (0.5 f) mg/ml

QL

sodium fluoride oral tablet chewable

FOSFATO

PHOSPHA 250 NEUTRAL ORAL TABLET

phosphorous oral tablet Phospha 250 Neutral

PHOSPHO-TRIN 250 NEUTRAL ORAL TABLET

virt-phos 250 neutral oral tablet Phospha 250 Neutral

POTASIO

cvs potassium gluconate oral tablet OTC

gnp potassium gluconate oral tablet OTC; QL

hm potassium oral tablet OTC; QL

KLOR-CON 10 ORAL TABLET EXTENDED RELEASE

KLOR-CON M10 ORAL TABLET EXTENDED RELEASE

KLOR-CON M15 ORAL TABLET EXTENDED RELEASE

KLOR-CON M20 ORAL TABLET EXTENDED RELEASE

KLOR-CON ORAL PACKET

KLOR-CON ORAL TABLET EXTENDED RELEASE

potassium chloride crys er oral tablet extended release

Klor-Con M10

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Page 102: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

potassium chloride er oral capsule extended release

potassium chloride er oral tablet extended release

Klor-Con

potassium chloride oral packet Klor-Con

potassium chloride oral solution

potassium gluconate oral tablet OTC; QL

qc potassium oral tablet OTC; QL

ra potassium gluconate oral tablet OTC; QL

sm potassium oral tablet OTC; QL

ZINC

chelated zinc oral tablet IS-ZC 50 OTC; QL

cvs zinc gluconate oral tablet OTC; QL

eql natural zinc oral tablet IS-ZC 50 OTC; QL

gnp zinc chelated oral tablet IS-ZC 50 OTC; QL

hm zinc oral tablet IS-ZC 50 OTC; QL

IS-ZC 50 ORAL TABLET OTC; QL

ORAZINC ORAL CAPSULE OTC

qc zinc oral tablet IS-ZC 50 OTC; QL

ra zinc oral tablet OTC; QL

sm zinc gluconate oral tablet OTC; QL

sm zinc oral tablet IS-ZC 50 OTC; QL

zinc chelated oral tablet IS-ZC 50 OTC; QL

zinc gluconate oral tablet 100 mg, 30 mg OTC

zinc gluconate oral tablet 50 mg OTC; QL

zinc oral capsule Orazinc OTC

zinc oral tablet 30 mg OTC

zinc oral tablet 50 mg IS-ZC 50 OTC; QL

zinc sulfate oral capsule Orazinc OTC

zinc sulfate oral tablet OTC

MULTIVITAMINAS

MULTIVITAMINAS

anti-oxidant oral tablet One Daily Essential OTC; QL

daily multiple vitamins oral tablet One Daily Essential OTC; QL

daily value multivitamin oral tablet One Daily Essential OTC; QL

daily vitamin oral tablet One Daily Essential OTC; QL

daily vitamins oral tablet One Daily Essential OTC; QL

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Nombre del medicamento Referencia Notas

daily vite oral tablet One Daily Essential OTC; QL

daily vites oral tablet One Daily Essential OTC; QL

daily-vitamin oral tablet One Daily Essential OTC; QL

daily-vite multivitamin oral tablet One Daily Essential OTC; QL

daily-vite oral tablet One Daily Essential OTC; QL

gnp essential one daily oral tablet One Daily Essential OTC; QL

healthy hair/skin/nails oral tablet One Daily Essential OTC; QL

multi vitamin daily oral tablet One Daily Essential OTC; QL

multi-day oral tablet One Daily Essential OTC; QL

multiple vitamin oral tablet One Daily Essential OTC

multiple vitamin-folic acid oral tablet One Daily Essential OTC; QL

multiple vitamins essential oral tablet One Daily Essential OTC; QL

multiple vitamins oral tablet One Daily Essential OTC; QL

multi-vitamin daily oral tablet One Daily Essential OTC; QL

multivitamin iron-free oral tablet One Daily Essential OTC; QL

multi-vitamin oral tablet One Daily Essential OTC; QL

multivitamins oral capsule Chlorocaps AL; OTC

multi-vitamins oral tablet One Daily Essential OTC; QL

once daily oral tablet One Daily Essential OTC; QL

ONE DAILY ESSENTIAL ORAL TABLET OTC; QL

one daily oral tablet One Daily Essential OTC; QL

one-daily multi vitamins oral tablet One Daily Essential OTC; QL

one-daily multi-vitamin oral tablet One Daily Essential OTC; QL

qc essentials oral tablet One Daily Essential OTC; QL

sm multiple vitamins essential oral tablet One Daily Essential OTC; QL

STRESSTABS ENERGY ORAL TABLET OTC; QL

TAB-A-VITE/BETA CAROTENE ORAL TABLET

OTC; QL

THERA ORAL TABLET OTC; QL

thera-mill oral tablet One Daily Essential OTC; QL

thera-tabs oral tablet One Daily Essential OTC; QL

THEREMS ORAL TABLET OTC; QL

vit e-vit c-beta carotene oral tablet One Daily Essential OTC; QL

vitalee oral tablet One Daily Essential OTC; QL

NIACINA CON INOSITOL

cvs niacin flush free oral capsule OTC

gnp niacin flush free oral capsule OTC

103

Page 104: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

niacin flush free oral capsule OTC

no flush niacin oral capsule OTC

PRODUCTOS DE BIOFLAVONOIDE

c complex oral tablet extended release Ester-C OTC

c1000 tr/rose hip/bioflavonoid oral tablet extended release

Ester-C OTC

c1500 tr/rose hip/bioflavonoid oral tablet extended release

Ester-C OTC

c1500/rose hips/bioflavonoid oral tablet extended release

Ester-C OTC

ESTER-C ORAL TABLET EXTENDED RELEASE

OTC

ra vitamin c cr oral tablet extended release Ester-C OTC

vitamin c-bioflavonoids oral tablet extended release

Ester-C OTC

PRODUCTOS DE VITAMINAS ESPECIALIZADAS

a thru z advantage oral tablet Milltrium Stamina Plus OTC; QL

cvs menopause support oral tablet Milltrium Stamina Plus OTC; QL

MILLTRIUM STAMINA PLUS ORAL TABLET

OTC; QL

ultimate fat burner oral tablet Milltrium Stamina Plus OTC; QL

varisan vitality oral tablet Milltrium Stamina Plus OTC; QL

vitamins for hair oral tablet Milltrium Stamina Plus OTC; QL

weight loss daily multi oral tablet Milltrium Stamina Plus OTC; QL

VITAMINAS CON LIPOTRÓPICOS

b-100 complex oral tablet CVS Balanced B50 OTC; QL

b-100 cr oral tablet extended release OTC

b-100 oral tablet CVS Balanced B50 OTC; QL

b-50 oral tablet CVS Balanced B50 OTC; QL

balance b-100 oral tablet CVS Balanced B50 OTC; QL

balanced b-100 complex cr oral tablet extended release

OTC

balanced b-100 oral tablet CVS Balanced B50 OTC; QL

balanced b-50 complex oral capsule OTC

balanced b-50 complex oral tablet CVS Balanced B50 OTC; QL

b-stress oral capsule OTC

complex b-100 oral tablet extended release OTC

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Page 105: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

complex b-100-inositol oral tablet extended release

OTC

CVS BALANCED B50 ORAL TABLET OTC; QL

cvs inner ear plus oral tablet CVS Balanced B50 OTC; QL

ear health formula oral tablet CVS Balanced B50 OTC; QL

ear health plus oral tablet CVS Balanced B50 OTC; QL

inner ear plus oral tablet CVS Balanced B50 OTC

LIPO FLAVONOID PLUS ORAL TABLET OTC; QL

LIPOFLAVONOID ORAL TABLET OTC; QL

LIPOFLAVOVIT ORAL TABLET OTC; QL

mega multiple/chelated mineral oral tablet CVS Balanced B50 OTC; QL

methacholine/liver oral capsule OTC

multi-vitamin hp/minerals oral capsule OTC

nat-rul b-50 oral tablet CVS Balanced B50 OTC; QL

PX B-50 ORAL TABLET OTC; QL

risanoid plus oral tablet CVS Balanced B50 OTC; QL

super stress b-complex cr oral tablet extended release

OTC

ultra b-100 complex oral tablet CVS Balanced B50 OTC; QL

VITAMINAS DEL COMPLEJO B

advanced stress formula/zinc oral tablet OTC; QL

ALLBEE/C ORAL TABLET OTC; QL

APETIGEN-PLUS ORAL SOLUTION OTC

b complex 100 tr oral tablet extended release

Endur-B OTC

b complex formula 1 oral tablet OTC

b complex oral capsule OTC

b complex oral tablet OTC; QL

b complex plus oral tablet OTC

b complex vitamins oral capsule OTC

b complex-b12 oral tablet OTC

b complex-biotin-fa oral tablet Big 100 OTC

b complex-c oral capsule OTC; QL

b complex-c oral tablet Allbee/C OTC; QL

b complex-c-biotin-e-fa oral tablet OTC

b complex-c-folic acid oral tablet OTC; QL

b complex-vitamin c oral capsule OTC; QL

b-100 b-complex oral tablet Big 100 OTC

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Page 106: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

b-100 complex cr oral tablet extended release

Endur-B OTC

b-100 tr oral tablet extended release Endur-B OTC

b-50 complex oral tablet extended release Endur-B OTC

balance b-50 oral tablet Big 100 OTC

balanced b complex oral tablet Big 100 OTC

balanced b-100 oral tablet extended release Endur-B OTC

balanced b-50/fa oral tablet Big 100 OTC

b-compleet-100 oral tablet Big 100 OTC

b-compleet-50 oral tablet Big 100 OTC

b-complex balanced oral tablet OTC; QL

b-complex oral tablet Big 100 OTC

b-complex/b-12 oral tablet OTC

b-complex/vitamin c oral tablet OTC; QL

b-complex-c oral tablet Allbee/C OTC; QL

bec/zinc oral tablet OTC; QL

benfotiamine multi-b oral capsule OTC

better b complex oral tablet Allbee/C OTC; QL

BIG 100 (BIOTIN) ORAL TABLET OTC

BIG 100 ORAL TABLET OTC

complex b-50 prolonged release oral tablet extended release

Endur-B OTC

cvs b complex plus c oral tablet Allbee/C OTC; QL

cvs stress formula/zinc oral tablet OTC; QL

cvs super b complex/c oral tablet Allbee/C OTC; QL

DIALYVITE 800 ORAL TABLET OTC

ELDERTONIC ORAL LIQUID OTC; QL

ENDUR-B ORAL TABLET EXTENDED RELEASE

OTC

eql b complex 50 oral tablet Big 100 OTC

eql b-100 complex oral tablet extended release

Endur-B OTC

eql stress b-complex c/zinc oral tablet OTC; QL

eql super b complex/vitamin c oral tablet OTC; QL

folika-nc oral tablet Dialyvite OTC

gnp b-100 complex oral tablet extended release

Endur-B OTC

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Page 107: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

gnp b-50 complex oral tablet extended release

Endur-B OTC

gnp b-complex plus vitamin c oral tablet OTC; QL

hm b complex/c oral tablet Allbee/C OTC; QL

hm vitamin b complex/vitamin c oral tablet OTC; QL

hm vitamin b100 complex oral tablet Big 100 OTC

hm vitamin b50 complex oral tablet Big 100 OTC

kobee oral tablet OTC

kp b complex-c oral tablet OTC; QL

nephro vitamins oral tablet Dialyvite 800 OTC

NEPHRONEX ORAL LIQUID OTC

px b complex/vitamin c oral tablet OTC; QL

qc b50 prolonged release oral tablet extended release

Endur-B OTC

qc b-complex/vitamin c oral tablet OTC; QL

quin b strong b-25 oral tablet Big 100 OTC

ra balanced b-100 cr oral tablet extended release

Endur-B OTC

ra balanced b-100 oral tablet Big 100 OTC

ra balanced b-50 oral tablet Big 100 OTC

ra balanced b-50 tr oral tablet extended release

Endur-B OTC

ra b-complex oral tablet OTC

ra b-complex with b-12 oral tablet OTC

RENAL MULTIVITAMIN FORMULA ORAL TABLET

OTC

renal vitamin oral tablet Dialyvite 800 OTC

renal-vite oral tablet Dialyvite 800 OTC

rena-vite oral tablet Dialyvite 800 OTC

rena-vite rx oral tablet Dialyvite OTC

reno caps oral capsule Mynephron

senior tonic oral liquid Eldertonic OTC; QL

sm b super vitamin complex oral tablet OTC; QL

sm b100 complex oral tablet Big 100 OTC

sm balanced b-100 oral tablet OTC

sm balanced b-50 oral tablet OTC

sm b-complex oral tablet Big 100 OTC

sm super b complex/c oral tablet Allbee/C OTC; QL

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Page 108: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

sm vitamin b complex/vitamin c oral tablet Allbee/C OTC; QL

stress b/zinc oral tablet OTC; QL

stress b-complex/vit c/zinc oral tablet OTC; QL

stress formula oral tablet OTC; QL

stress formula/zinc oral tablet OTC; QL

stress plus zinc oral tablet OTC; QL

super b complex maxi oral tablet OTC

super b complex/fa/vit c oral tablet OTC; QL

super b complex/vitamin c oral tablet Allbee/C OTC; QL

super b/c oral capsule OTC; QL

super b-100 oral tablet Big 100 OTC

super b-50 oral tablet Big 100 OTC

super b-complex + vitamin c oral tablet Allbee/C OTC; QL

super b-complex oral tablet Big 100 OTC

super b-complex/vit c/fa oral tablet OTC; QL

SUPER DEC B-100 ORAL TABLET OTC

SUPER QUINTS B-50 ORAL TABLET OTC

vitamin b + c complex oral tablet Allbee/C OTC; QL

vitamin b complex oral tablet OTC

vitamin b complex-c oral capsule OTC; QL

vitamin b50 complex oral tablet extended release

Endur-B OTC

vitamin b-complex oral tablet OTC

vitamin-b complex oral tablet OTC

yl balanced b-100 oral tablet Big 100 OTC

zinc-vites oral tablet OTC; QL

VITAMINAS MÚLTIPLES CON CALCIO

eql one daily womens oral tabletHM Vita-Mini Multi Complete

OTC; QL

essential one daily multivit oral tabletHM Vita-Mini Multi Complete

OTC; QL

gnp one daily womens health oral tabletHM Vita-Mini Multi Complete

OTC; QL

HM VITA-MINI MULTI COMPLETE ORAL TABLET

OTC; QL

multi-day/calcium/extra iron oral tabletHM Vita-Mini Multi Complete

OTC; QL

signacal oral tabletHM Vita-Mini Multi Complete

OTC; QL

108

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Nombre del medicamento Referencia Notas

VITAMINAS MÚLTIPLES CON HIERRO

daily multiple vitamins/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

daily vitamin formula+iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

daily vitamin/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC

daily vite multivitamin/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

daily-vitamin/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

hm one daily/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

multi-day plus iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

multiple vitamins/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

multiple vitamins-iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC

multivitamin plus iron adult oral tabletTab-A-Vite/Iron/Beta Carotene

OTC

multi-vitamin/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

nat-rul daily-vite+iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

one daily multivitamin/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

one-daily multi-vitamin/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

one-daily/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

qc daily multivitamins/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

sm multiple vitamins/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

stress b complex/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

stress formula/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

tab-a-vite/iron oral tabletTab-A-Vite/Iron/Beta Carotene

OTC; QL

109

Page 110: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

VITAMINAS MÚLTIPLES CON MINERALES

50+ adult eye health oral capsule Amoryn Mood Booster OTC; QL

a thru z advanced adult oral tablet ABC Plus Senior OTC; QL

a thru z advanced oral tablet ABC Plus Senior OTC; QL

a thru z high potency oral tablet ABC Plus Senior OTC; QL

a thru z select 50+ advanced oral tablet ABC Plus Senior OTC; QL

a thru z select 50+ mens oral tablet ABC Plus Senior OTC; QL

a thru z select advanced oral tablet ABC Plus Senior OTC; QL

a thru z select oral tablet ABC Plus Senior OTC; QL

a thru z select ultimate women oral tablet ABC Plus Senior OTC; QL

a thru z ultimate mens oral tablet ABC Plus Senior OTC; QL

abc plus oral tablet ABC Plus Senior OTC; QL

ABC PLUS SENIOR ADULTS 50+ ORAL TABLET

OTC; QL

ABC PLUS SENIOR ORAL TABLET OTC; QL

advanced eye health oral capsule Amoryn Mood Booster OTC; QL

AMORYN MOOD BOOSTER ORAL CAPSULE

OTC; QL

antioxidant a/c/e/selenium oral tablet ABC Plus Senior OTC; QL

anti-oxidant formula oral capsule Amoryn Mood Booster OTC; QL

antioxidant formula/minerals oral capsule Amoryn Mood Booster OTC; QL

antioxidant oral capsule Amoryn Mood Booster OTC; QL

antioxidant protection formula oral tablet ABC Plus Senior OTC; QL

antioxidant vitamins oral tablet ABC Plus Senior OTC; QL

ANTIOXIN 4000 ORAL CAPSULE OTC; QL

biotin plus/calcium/vit d3 oral tablet ABC Plus Senior OTC; QL

body/hair/skin/nails oral capsule Amoryn Mood Booster OTC; QL

BPROTECTED MULTI-VITE ORAL LIQUID OTC; QL

centavite a-z complete-mineral oral tablet ABC Plus Senior OTC; QL

centravites 50 plus oral tablet ABC Plus Senior OTC; QL

centravites oral tablet ABC Plus Senior OTC; QL

century mature oral tablet ABC Plus Senior OTC; QL

century oral tablet ABC Plus Senior OTC; QL

CEROVITE SENIOR ORAL TABLET OTC; QL

certa plus oral tablet ABC Plus Senior OTC; QL

CERTA-VITE ORAL LIQUID OTC

110

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Nombre del medicamento Referencia Notas

CERTAVITE/ANTIOXIDANTS ORAL TABLET

OTC; QL

companion oral tablet ABC Plus Senior OTC; QL

COMPETE ORAL TABLET OTC; QL

complete daily/lutein oral tablet ABC Plus Senior OTC; QL

complete energy oral tablet ABC Plus Senior OTC; QL

complete multivitamin/mineral oral liquid BProtected Multi-Vite OTC; QL

complete pms support complex oral capsule Amoryn Mood Booster OTC; QL

complete womens oral tablet ABC Plus Senior OTC; QL

coral calcium plus oral capsule Amoryn Mood Booster OTC; QL

cvs daily multiple for men oral tablet ABC Plus Senior OTC; QL

cvs daily multiple women 50+ oral tablet ABC Plus Senior OTC; QL

cvs eye health & lutein oral tablet ABC Plus Senior OTC; QL

cvs one daily essential oral tablet ABC Plus Senior OTC; QL

cvs one daily mens formula oral tablet ABC Plus Senior OTC

cvs one daily womens formula oral tablet ABC Plus Senior OTC; QL

cvs spectravite advanced oral tablet ABC Plus Senior OTC; QL

cvs spectravite senior oral tablet ABC Plus Senior OTC; QL

cvs spectravite ultra mens oral tablet ABC Plus Senior OTC; QL

cvs spectravite womens senior oral tablet ABC Plus Senior OTC; QL

cvs womens active daily oral tablet ABC Plus Senior OTC; QL

daily betic oral tablet ABC Plus Senior OTC; QL

daily combo multi vitamins oral tablet ABC Plus Senior OTC; QL

daily mens health formula oral tablet ABC Plus Senior OTC; QL

daily multi 50+ oral tablet ABC Plus Senior OTC; QL

daily multi oral tablet ABC Plus Senior OTC; QL

daily multiple vitamins/min oral tablet ABC Plus Senior OTC; QL

daily multivitamin oral capsule Amoryn Mood Booster OTC; QL

daily vitamin formula+minerals oral tablet ABC Plus Senior OTC; QL

daily vitamin plus oral capsule Amoryn Mood Booster OTC; QL

daily womens health formula oral tablet ABC Plus Senior OTC; QL

daily-vitamin maximum formula oral tablet ABC Plus Senior OTC; QL

diabetes health formula oral tablet ABC Plus Senior OTC; QL

dialyvite 800/ultra d oral tablet ABC Plus Senior OTC; QL

DOCTORS CHOICE MEN ORAL TABLET OTC; QL

DRY EYE FORMULA ORAL CAPSULE OTC; QL

eq complete multivit adult 50+ oral tablet ABC Plus Senior OTC; QL

111

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Nombre del medicamento Referencia Notas

eq vision formula 50+ oral capsule Amoryn Mood Booster OTC; QL

eql century mature men 50+ oral tablet ABC Plus Senior OTC; QL

eql century mature oral tablet ABC Plus Senior OTC; QL

eql century mature women 50+ oral tablet ABC Plus Senior OTC; QL

eql century oral tablet ABC Plus Senior OTC; QL

eql one daily mens 50+ advance oral tablet ABC Plus Senior OTC; QL

eql one daily mens health oral tablet ABC Plus Senior OTC; QL

eql one daily womens 50+ adv oral tablet ABC Plus Senior OTC; QL

eql vision formula oral tablet ABC Plus Senior OTC; QL

ESSENTIA ORAL TABLET OTC; QL

essential balance oral tablet ABC Plus Senior OTC; QL

EYE VITAMINS ORAL CAPSULE OTC; QL

eyeprotect oral tablet ABC Plus Senior OTC; QL

EYE-VITES ORAL TABLET OTC; QL

gerivite complete oral tablet ABC Plus Senior OTC; QL

glucoten oral capsule Amoryn Mood Booster OTC; QL

gnp century adult formula oral tablet ABC Plus Senior OTC; QL

gnp century adults 50+ senior oral tablet ABC Plus Senior OTC; QL

gnp century mature women's 50+ oral tablet ABC Plus Senior OTC; QL

gnp century oral tablet ABC Plus Senior OTC; QL

gnp century ultimate mens oral tablet ABC Plus Senior OTC; QL

gnp century ultimate womens oral tablet ABC Plus Senior OTC; QL

gnp hair/skin/nails oral tablet ABC Plus Senior OTC; QL

gnp healthy eyes oral tablet ABC Plus Senior OTC; QL

gnp healthy eyes supervision 2 oral capsule Amoryn Mood Booster OTC; QL

gnp healthy eyes supervision oral capsule Amoryn Mood Booster OTC; QL

gnp mega multi for men oral tablet ABC Plus Senior OTC; QL

gnp mega multi for women oral tablet ABC Plus Senior OTC; QL

gnp one daily mens health 50+ oral tablet ABC Plus Senior OTC; QL

gnp one daily mens/lycopene oral tablet ABC Plus Senior OTC; QL

gnp one daily womens 50+ oral tablet ABC Plus Senior OTC; QL

gnp one daily womens oral tablet ABC Plus Senior OTC; QL

gnp therapeutic-m oral tablet ABC Plus Senior OTC; QL

hair formula extra strength oral tablet ABC Plus Senior OTC; QL

hair skin and nails formula oral tablet ABC Plus Senior OTC; QL

hair skin nails oral capsule Amoryn Mood Booster OTC; QL

hair vitamins oral tablet ABC Plus Senior OTC; QL

112

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Nombre del medicamento Referencia Notas

hair/skin/nails oral capsule Amoryn Mood Booster OTC; QL

hair/skin/nails oral tablet ABC Plus Senior OTC; QL

healthy eyes oral tablet ABC Plus Senior OTC; QL

healthy eyes/lutein oral tablet ABC Plus Senior OTC; QL

healthy eyes/lutein-zeaxanthin oral capsule Amoryn Mood Booster OTC

hi-kovite 2-part formula oral tablet ABC Plus Senior OTC; QL

hi-potency multi-vitamin oral tablet ABC Plus Senior OTC; QL

hm antioxidant vitamins oral tablet ABC Plus Senior OTC; QL

hm complete 50+ oral tablet ABC Plus Senior OTC; QL

hm complete women oral tablet ABC Plus Senior OTC; QL

hm womens 50+ advanced daily oral tablet ABC Plus Senior OTC; QL

ICAPS LUTEIN & OMEGA-3 ORAL CAPSULE

OTC; QL

ICAPS MV ORAL TABLET OTC; QL

ICAPS ORAL CAPSULE OTC; QL

i-vite oral tablet ABC Plus Senior OTC; QL

kp adults 50+ daily formula oral tablet ABC Plus Senior OTC; QL

kp adults daily formula oral tablet ABC Plus Senior OTC; QL

kp mens 50+ daily formula oral tablet ABC Plus Senior OTC; QL

kp mens daily formula oral tablet ABC Plus Senior OTC; QL

KP VISION FORMULA ORAL TABLET OTC; QL

KP VISION FORMULA/LUTEIN ORAL TABLET

OTC; QL

kp womens 50+ daily formula oral tablet ABC Plus Senior OTC; QL

kp womens daily formula oral tablet ABC Plus Senior OTC; QL

LYSIPLEX PLUS ORAL LIQUID OTC; QL

MACULAR HEALTH FORMULA ORAL CAPSULE

OTC; QL

MACUVITE EYE CARE ORAL TABLET OTC; QL

MACUVITE ORAL TABLET OTC; QL

MACUVITE/LUTEIN ORAL TABLET OTC; QL

magnum-75 oral tablet extended release Endur-VM OTC; QL

maximum daily green oral tablet ABC Plus Senior OTC; QL

mega vm-80 oral tablet ABC Plus Senior OTC; QL

mega-marathon 100 tr oral tablet extended release

Endur-VM OTC; QL

meijer advanced formula oral tablet ABC Plus Senior OTC; QL

mens daily formula/lycopene oral capsule Amoryn Mood Booster OTC; QL

113

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Nombre del medicamento Referencia Notas

MENS HAIR FORMULA ULTRA MAN ORAL TABLET

OTC; QL

MENS LIFE PACK ORAL TABLET OTC; QL

MILLTRIUM ADVANCED FORMULA ORAL TABLET

OTC; QL

MILLTRIUM CARDIO ORAL TABLET OTC; QL

MILLTRIUM SENIOR ORAL TABLET OTC; QL

MULTI COMPLETE ORAL CAPSULE OTC; QL

multi complete/iron oral tablet ABC Plus Senior OTC; QL

multi for her 50+ oral capsule Amoryn Mood Booster OTC; QL

multi for her 50+ oral tablet ABC Plus Senior OTC; QL

multi for her oral capsule Amoryn Mood Booster OTC; QL

multi for her oral tablet ABC Plus Senior OTC; QL

multi for him 50+ oral tablet ABC Plus Senior OTC; QL

MULTI FOR HIM ORAL CAPSULE OTC; QL

MULTI FOR HIM ORAL TABLET OTC; QL

multi vitamin/minerals oral tablet ABC Plus Senior OTC; QL

multi-day plus minerals oral tablet ABC Plus Senior OTC; QL

MULTI-DAY WEIGHT TRIM ORAL TABLET OTC; QL

MULTI-LEAN ORAL TABLET OTC; QL

multiple vit/minerals/no iron oral tablet ABC Plus Senior OTC; QL

multiple vitamins/womens oral tablet ABC Plus Senior OTC; QL

multivitamin & mineral oral liquid BProtected Multi-Vite OTC; QL

multivitamin adults 50+ oral tablet ABC Plus Senior OTC; QL

multivitamin adults oral tablet ABC Plus Senior OTC; QL

multivitamin men 50+ oral tablet ABC Plus Senior OTC; QL

multi-vitamin menopausal oral tablet ABC Plus Senior OTC; QL

multivitamin oral liquid BProtected Multi-Vite OTC; QL

multivitamin women 50+ oral tablet ABC Plus Senior OTC; QL

multivitamin women oral tablet ABC Plus Senior OTC; QL

multivitamin womens 50+ adv oral tablet ABC Plus Senior OTC; QL

multi-vitamin/minerals oral tablet ABC Plus Senior OTC; QL

multivitamins/minerals adult oral liquid BProtected Multi-Vite OTC; QL

myamulti oral tablet ABC Plus Senior OTC; QL

my-vitalife oral capsule Amoryn Mood Booster OTC; QL

ocutabs oral tablet ABC Plus Senior OTC; QL

ocutabs-lutein oral tablet ABC Plus Senior OTC; QL

114

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Nombre del medicamento Referencia Notas

OCUVITE EXTRA ORAL TABLET OTC; QL

OCUVITE EYE + MULTI ORAL TABLET OTC; QL

OCUVITE EYE HEALTH FORMULA ORAL CAPSULE

OTC; QL

OCUVITE-LUTEIN ORAL TABLET OTC; QL

one daily 50 plus oral tablet ABC Plus Senior OTC; QL

one daily adults 50+ oral tablet ABC Plus Senior OTC; QL

one daily calcium/iron oral tablet ABC Plus Senior OTC; QL

one daily complete for men oral tablet ABC Plus Senior OTC; QL

one daily complete oral tablet ABC Plus Senior OTC; QL

one daily for men 50+ advanced oral tablet ABC Plus Senior OTC; QL

one daily for men/lycopene oral tablet ABC Plus Senior OTC; QL

one daily for women 50+ adv oral tablet ABC Plus Senior OTC; QL

one daily for women oral tablet ABC Plus Senior OTC; QL

one daily healthy weight adv oral tablet ABC Plus Senior OTC; QL

one daily healthy weight oral tablet ABC Plus Senior OTC; QL

one daily maximum oral tablet ABC Plus Senior OTC; QL

one daily mens 50+ multivit oral tablet ABC Plus Senior OTC; QL

one daily mens 50+/lycopene oral tablet ABC Plus Senior OTC; QL

one daily mens health oral tablet ABC Plus Senior OTC; QL

one daily mens oral tablet ABC Plus Senior OTC; QL

one daily multivit/iron-free oral tablet ABC Plus Senior OTC; QL

one daily multivitamin adult oral tablet ABC Plus Senior OTC; QL

one daily multivitamin men oral tablet ABC Plus Senior OTC; QL

one daily multivitamin women oral tablet ABC Plus Senior OTC; QL

one daily multivit-min adult oral tablet ABC Plus Senior OTC; QL

ONE DAILY PLUS IRON ORAL TABLET OTC; QL

one daily plus minerals oral tablet ABC Plus Senior OTC; QL

one daily womens 50 plus oral tablet ABC Plus Senior OTC; QL

one daily womens 50+ oral tablet ABC Plus Senior OTC; QL

one daily/minerals oral tablet ABC Plus Senior OTC; QL

ONE-A-DAY TEEN ADVANTAGE/HER ORAL TABLET

OTC; QL

optic-vites oral tablet ABC Plus Senior OTC; QL

optic-vites with lutein oral tablet ABC Plus Senior OTC; QL

optimum pms oral tablet ABC Plus Senior OTC; QL

OSTEOPRIME ULTRA ORAL TABLET OTC; QL

115

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Nombre del medicamento Referencia Notas

PROSIGHT ORAL TABLET OTC; QL

px advanced formula multivits oral tablet ABC Plus Senior OTC; QL

px complete senior multivits oral tablet ABC Plus Senior OTC; QL

px mens multivitamins oral tablet ABC Plus Senior OTC; QL

qc daily multivit/multimineral oral tablet ABC Plus Senior OTC; QL

qc hair skin & nails oral tablet ABC Plus Senior OTC; QL

qc mens daily multivitamin oral tablet ABC Plus Senior OTC; QL

qc multi-vite 50 & over oral tablet ABC Plus Senior OTC; QL

qc therin-m oral tablet ABC Plus Senior OTC; QL

qc womens daily multivitamin oral tablet ABC Plus Senior OTC; QL

ra central-vite mens mature oral tablet ABC Plus Senior OTC; QL

ra central-vite womens mature oral tablet ABC Plus Senior OTC; QL

ra one daily maximum oral tablet ABC Plus Senior OTC; QL

ra one daily mens 50+ w/vit d3 oral tablet ABC Plus Senior OTC; QL

ra one daily mens multi oral tablet ABC Plus Senior OTC; QL

ra one daily mens/vit d-3 oral tablet ABC Plus Senior OTC; QL

RENAPLEX ORAL TABLET OTC; QL

senior tabs oral tablet ABC Plus Senior OTC; QL

sentry adult oral tablet ABC Plus Senior OTC; QL

sentry oral tablet ABC Plus Senior OTC; QL

sentry senior oral tablet ABC Plus Senior OTC; QL

sm antioxidant vitamins oral tablet ABC Plus Senior OTC; QL

sm complete 50+ oral tablet ABC Plus Senior OTC; QL

sm complete 50+ ultimate mens oral tablet ABC Plus Senior OTC; QL

sm complete 50+ ultimate women oral tablet ABC Plus Senior OTC; QL

sm complete advanced formula oral tablet ABC Plus Senior OTC; QL

sm complete oral tablet ABC Plus Senior OTC; QL

sm complete senior formula oral tablet ABC Plus Senior OTC; QL

sm daily diet support oral tablet ABC Plus Senior OTC; QL

sm hair/skin/nails oral tablet ABC Plus Senior OTC; QL

sm opti-vitamins oral tablet ABC Plus Senior OTC; QL

stress b-complex/c/zinc oral tablet ABC Plus Senior OTC; QL

STRESSTABS ADVANCED ORAL TABLET

OTC; QL

SUNVITE ACTIVE ADULT 50+ ORAL TABLET

OTC; QL

SUNVITE ADVANCED ORAL TABLET OTC; QL

116

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Nombre del medicamento Referencia Notas

super antioxidants protector oral capsule Amoryn Mood Booster OTC; QL

super aytinal 50 plus oral tablet ABC Plus Senior OTC; QL

super aytinal oral tablet ABC Plus Senior OTC; QL

super multiple oral capsule Amoryn Mood Booster OTC; QL

super multiple oral tablet ABC Plus Senior OTC; QL

super natrul-100 oral tablet extended release

Endur-VM OTC; QL

SUPER NU-THERA ORAL LIQUID OTC; QL

SUPER NU-THERA ORAL TABLET OTC; QL

super thera vite m oral tablet ABC Plus Senior OTC; QL

super vita-mins oral tablet ABC Plus Senior OTC; QL

superior 35 oral tablet extended release Endur-VM OTC; QL

SYSTANE ICAPS AREDS2 ORAL CAPSULE

OTC; QL

TAB-A-VITE ORAL TABLET OTC; QL

thera vital m oral tablet ABC Plus Senior OTC; QL

thera vital-m oral tablet ABC Plus Senior OTC; QL

therabasic-m oral tablet ABC Plus Senior OTC; QL

THERADEX M ORAL TABLET OTC; QL

THERADEX M/BETA CAROTENE ORAL TABLET

OTC; QL

thera-m oral tablet ABC Plus Senior OTC; QL

THERA-MILL M ORAL TABLET OTC; QL

therapeutic formula/hematinics oral tablet ABC Plus Senior OTC; QL

therapeutic m oral tablet ABC Plus Senior OTC; QL

therapeutic multivit/mineral oral tablet ABC Plus Senior OTC

therapeutic-m oral tablet ABC Plus Senior OTC; QL

therapeutic-m/lutein oral tablet ABC Plus Senior OTC; QL

THERATRUM COMPLETE 50 PLUS ORAL TABLET

OTC; QL

THERATRUM COMPLETE ORAL TABLET OTC; QL

theravim-m oral tablet ABC Plus Senior OTC; QL

THRIVE FOR LIFE WOMENS ORAL TABLET

OTC; QL

totalday multiple oral tablet extended release Endur-VM OTC; QL

tropical liquid nutrition oral liquid BProtected Multi-Vite OTC; QL

ultra antioxidant formula oral tablet ABC Plus Senior OTC; QL

ultra freeda oral tablet ABC Plus Senior OTC; QL

117

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Nombre del medicamento Referencia Notas

ultra freeda/iron oral tablet ABC Plus Senior OTC; QL

ultra multi formula/iron oral capsule Amoryn Mood Booster OTC; QL

ULTRA VITA-TIME ORAL TABLET OTC; QL

ULTRACHOICE ADV FORMULA MATURE ORAL TABLET

OTC; QL

ULTRACHOICE ADVANCED FORMULA ORAL TABLET

OTC; QL

ultra-mega oral tablet extended release Endur-VM OTC; QL

vision formula 2 oral capsule Amoryn Mood Booster OTC; QL

vision formula eye health oral capsule Amoryn Mood Booster OTC; QL

vision formula/lutein oral tablet ABC Plus Senior OTC; QL

vision plus oral capsule Amoryn Mood Booster OTC; QL

vision vitamins oral tablet ABC Plus Senior OTC; QL

visivites oral tablet ABC Plus Senior OTC; QL

visivites/lutein oral tablet ABC Plus Senior OTC; QL

vita hair oral tablet ABC Plus Senior OTC; QL

vitabasic complete oral tablet ABC Plus Senior OTC; QL

vitabasic senior oral tablet ABC Plus Senior OTC; QL

vitamins a-d-e/selenium oral tablet ABC Plus Senior OTC; QL

VITATRUM COMPLETE ORAL TABLET OTC; QL

VITEYES COMPLETE ORAL CAPSULE OTC; QL

VITRUM SENIOR ORAL TABLET OTC; QL

womens 50+ advanced oral capsule Amoryn Mood Booster OTC; QL

womens daily form/fa/ca/fe oral tablet ABC Plus Senior OTC; QL

womens daily formula oral tablet ABC Plus Senior OTC; QL

WOMENS LIFE PACK ORAL TABLET OTC; QL

womens multi oral capsule Amoryn Mood Booster OTC; QL

womens multivitamin oral tablet ABC Plus Senior OTC; QL

womens one daily oral tablet ABC Plus Senior OTC; QL

YOUR LIFE MULTI MENS 50+ ORAL TABLET

OTC; QL

YOUR LIFE MULTI WOMENS 50+ ORAL TABLET

OTC; QL

VITAMINAS PEDIÁTRICAS

adc/f (0.5mg/ml) oral solution AL

ALIVE GUMMIES FOR CHILDREN ORAL TABLET CHEWABLE

AL; OTC

118

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Nombre del medicamento Referencia Notas

ALIVE MULTI-VITAMIN CHILDRENS ORAL TABLET CHEWABLE

OTC

animal chews oral tablet chewable Bounty Bears/C OTC

bite-a-mins oral tablet chewable Bounty Bears/C OTC

bite-a-mins/iron oral tablet chewableLand Before Time Multivitamin

OTC

BOUNTY BEARS/C ORAL TABLET CHEWABLE

OTC

BPROTECTED PEDIA POLY-VITE/FE ORAL SOLUTION

OTC; QL

BPROTECTED PEDIA TRI-VITE ORAL SOLUTION

OTC

CEROVITE JR ORAL TABLET CHEWABLE

OTC

childrens animal shapes oral tablet chewable

Cerovite Jr OTC

childrens chew multivitamin oral tablet chewable

Bounty Bears/C OTC

childrens chewable multi vits oral tablet chewable

Bounty Bears/C OTC

childrens chewable vitamins oral tablet chewable

Bounty Bears/C OTC

childrens gummies oral tablet chewableAlive Gummies for Children

AL; OTC

childrens multivitamin oral tablet chewable Bounty Bears/C OTC; QL

childrens multivitamin/iron oral tablet chewable

Land Before Time Multivitamin

OTC

childrens vitamins/iron oral tablet chewableLand Before Time Multivitamin

OTC

complete multi-vitamin oral tablet chewableAlive Gummies for Children

AL; OTC

cvs chewable childrens vitamin oral tablet chewable

Cerovite Jr OTC

cvs childrens complete oral tablet chewable Cerovite Jr OTC

cvs gummy dinos oral tablet chewableAlive Gummies for Children

AL; OTC

cvs gummy multivitamin kids oral tablet chewable

Alive Gummies for Children

AL; OTC

DINO-LIFE ORAL TABLET CHEWABLE OTC

DINO-LIFE W/EXTRA C ORAL TABLET CHEWABLE

OTC

119

Page 120: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

disney cars gummies oral tablet chewableAlive Gummies for Children

AL; OTC

disney princess gummies oral tablet chewable

Alive Gummies for Children

AL; OTC

eq complete multivitamin child oral tablet chewable

Cerovite Jr OTC

eq multivitamin gummies oral tablet chewable

Alive Gummies for Children

AL; OTC

eq multivitamins gummy child oral tablet chewable

Alive Gummies for Children

AL; OTC

eql child multivit/minerals oral tablet chewable

Cerovite Jr OTC

eql gummies childrens oral tablet chewableAlive Gummies for Children

AL; OTC

FLINSTONES GUMMIES OMEGA-3 DHA ORAL TABLET CHEWABLE

OTC

FLINTSTONES COMPLETE ORAL TABLET CHEWABLE

OTC

FLINTSTONES GUMMIES BONE BUILD ORAL TABLET CHEWABLE

OTC

FLINTSTONES PLUS CALCIUM ORAL TABLET CHEWABLE

OTC

FLINTSTONES W/IRON ORAL TABLET CHEWABLE

OTC

FLINTSTONES/EXTRA C ORAL TABLET CHEWABLE

OTC

FLINTSTONES/MY FIRST ORAL TABLET CHEWABLE

OTC

fruity chews oral tablet chewable Bounty Bears/C OTC

fruity chews/iron oral tablet chewableLand Before Time Multivitamin

OTC

GERBER GROW MIGHTY ORAL TABLET CHEWABLE

OTC

gnp childrens chewables/ex c oral tablet chewable

Dino-Life w/Extra C OTC

gnp childrens chewables/iron oral tablet chewable

Land Before Time Multivitamin

OTC

gnp little ones childrens oral tablet chewable Bounty Bears/C OTC

GUMMI BEAR MULTIVITAMIN/MIN ORAL TABLET CHEWABLE

AL; OTC

HEALTHY KIDS OVERALL HEALTH ORAL TABLET CHEWABLE

AL; OTC

120

Page 121: Lista de medicamentos preferidos aprobada por Medicaid

Nombre del medicamento Referencia Notas

hm animal shapes oral tablet chewable Cerovite Jr OTC

LAND BEFORE TIME MULTIVITAMIN ORAL TABLET CHEWABLE

OTC

little animals oral tablet chewable Bounty Bears/C OTC

little animals plus iron oral tablet chewableLand Before Time Multivitamin

OTC

multi-vit/iron/fluoride oral solution

multivitamin childrens oral tablet chewable Culturelle Kids Complete OTC

multivitamin select/fluoride oral solution OTC

multivitamin/fluoride oral solution Floriva Plus

multi-vitamin/fluoride oral solution Floriva Plus

multivitamin/fluoride oral tablet chewable Quflora Pediatric

multivitamin/fluoride/iron oral solution

multi-vitamin/fluoride/iron oral solution

multivit-min gummies childrens oral tablet chewable

Alive Gummies for Children

AL; OTC

MVW COMPLETE FORMULATION D3000 ORAL TABLET CHEWABLE

AL; OTC

MVW COMPLETE FORMULATION D5000 ORAL TABLET CHEWABLE

AL; OTC

MVW COMPLETE FORMULATION ORAL TABLET CHEWABLE

AL; OTC

pc pediatric poly-vita/fe drop oral solutionBProtected Pedia Poly-Vite/Fe

OTC; QL

pc pediatric tri-vitamin drops oral solution BProtected Pedia Tri-Vite OTC

POLY-VI-SOL/IRON ORAL SOLUTION OTC; QL

poly-vita/iron oral solutionBProtected Pedia Poly-Vite/Fe

OTC; QL

polyvitamin/fluoride oral solution Floriva Plus

poly-vitamin/fluoride oral solution Quflora Pediatric

poly-vitamin/iron oral solutionBProtected Pedia Poly-Vite/Fe

OTC

poly-vite/iron oral solution Poly-Vi-Sol/Iron OTC; QL

PX CHILDRENS VITAMIN ORAL TABLET CHEWABLE

OTC

qc childrens complete oral tablet chewable Cerovite Jr OTC

qc childrens vitamins/extra c oral tablet chewable

Dino-Life w/Extra C OTC

qc childrens vitamins/iron oral tablet chewable

Land Before Time Multivitamin

OTC

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ra vitamins complete childrens oral tablet chewable

Cerovite Jr OTC

SEA BUDDIES DAILY MULTIPLE ORAL TABLET CHEWABLE

OTC

sm animal shapes complete oral tablet chewable

Cerovite Jr OTC

sm animal shapes kids first oral tablet chewable

Bounty Bears/C OTC

SMARTY PANTS KIDS COMPLETE ORAL TABLET CHEWABLE

AL; OTC

SPIDER-MAN COMPLETE MULTI-VIT ORAL TABLET CHEWABLE

AL; OTC

SPONGEBOB SQUAREPANTS GUMMIES ORAL TABLET CHEWABLE

AL; OTC

tri-vitamin/fluoride oral solution AL

tri-vite pediatric oral solution BProtected Pedia Tri-Vite OTC

tri-vite/fluoride oral solution AL

ULTRA CHOICE MULTIVITAMIN KIDS ORAL TABLET CHEWABLE

OTC

vitachew multiple vitamin oral tablet chewable

Alive Gummies for Children

AL; OTC

vitamins acd-fluoride oral solution AL

zoo friends gummies oral tablet chewableAlive Gummies for Children

AL; OTC

zoo friends gummies plus d oral tablet chewable

Alive Gummies for Children

AL; OTC

ZOO FRIENDS MULTI GUMMIES ORAL TABLET CHEWABLE

AL; OTC

zoo friends oral tablet chewableAlive Gummies for Children

OTC

zoo friends plus extra c oral tablet chewable Dino-Life w/Extra C OTC

zoo friends plus iron oral tablet chewableLand Before Time Multivitamin

OTC

ZOO FRIENDS/EXTRA C ORAL TABLET CHEWABLE

OTC

VITAMINAS PRENATALES

ALIVE PRENATAL ORAL TABLET CHEWABLE

AL; OTC

ATABEX ORAL TABLET CHEWABLE OTC

BRAINSTRONG PRENATAL ORAL AL; OTC; QL

cadeau dha oral capsule AL; OTC; QL

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CENTRUM SPECIALIST PRENATAL ORAL

AL; OTC; QL

classic prenatal oral tablet AL; OTC; QL

CLINICAL NUTRIENTS PRENATAL ORAL TABLET

OTC

cvs prenatal gummy oral tablet chewable 0.4 mg

OTC

cvs prenatal gummy oral tablet chewable 0.4-113.5 mg

AL; OTC; QL

cvs prenatal gummy oral tablet chewable 0.4-25 mg

Alive Prenatal AL; OTC

cvs prenatal multi+dha oral capsule AL; OTC; QL

cvs prenatal oral tablet NeoNatal Vitamin AL; OTC; QL

ENFAMIL EXPECTA ORAL AL; OTC; QL

eql prenatal formula oral tablet AL; OTC; QL

gnp prenatal oral tablet AL; OTC; QL

HEALTHY MAMA BE WELL ROUNDED ORAL THERAPY PACK

OTC

hm one daily prenatal oralOne-A-Day Womens Prenatal

AL; OTC; QL

hm prenatal oral tablet AL; OTC; QL

kp prenatal multivitamins oral tablet AL; OTC; QL

kpn prenatal oral tablet AL; OTC; QL

multi prenatal oral tablet NeoNatal Vitamin AL; OTC; QL

NEONATAL VITAMIN ORAL TABLET AL; OTC; QL

NESTABS ORAL TABLET AL; QL

ONE A DAY PRENATAL ORAL TABLET CHEWABLE

AL; OTC

one vite womens oral tablet NeoNatal Vitamin AL; OTC; QL

ONE-A-DAY WOMENS PRENATAL 1 ORAL CAPSULE

AL; OTC; QL

ONE-A-DAY WOMENS PRENATAL ORAL AL; OTC; QL

PERRY PRENATAL ORAL CAPSULE AL; OTC; QL

prenatabs fa oral tablet Co-Natal FA AL; OTC; QL

prenatal + complete multi oral therapy pack AL; OTC; QL

prenatal 19 oral tablet AL; OTC; QL

prenatal adult gummy/dha/fa oral tablet chewable

Alive Prenatal AL; OTC

prenatal complete oral tablet AL; OTC; QL

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prenatal formula a-free oral tablet AL; OTC; QL

prenatal formula oral capsule AL; OTC; QL

pre-natal formula oral tablet AL; OTC; QL

prenatal forte oral tablet AL; OTC; QL

prenatal gummies/dha & fa oral tablet chewable

AL; OTC; QL

prenatal multi +dha oral capsule 27-0.8-200 mg, 27-0.8-228 mg

OTC

prenatal multi +dha oral capsule 27-0.8-250 mg

AL; OTC; QL

PRENATAL MULTIVITAMIN + DHA ORAL AL; OTC; QL

prenatal multivitamin plus dha oral capsule AL; OTC; QL

prenatal one daily oral tablet NeoNatal Vitamin AL; OTC; QL

prenatal oral tablet 27-0.8 mg NeoNatal Vitamin AL; QL

prenatal oral tablet 28-0.8 mg, 6.75-0.2 mg AL; OTC; QL

prenatal vitamin and mineral oral tablet AL; OTC; QL

prenatal vitamin oral tablet NeoNatal Vitamin AL; OTC; QL

prenatal/iron oral tablet AL; OTC; QL

prenatal/omega-3/fa/iron oral capsule Your Life Multi Prenatal OTC

prenatal+dha oral AL; OTC; QL

px prenatal multivitamins oral tablet AL; OTC; QL

qc prenatal oral tablet AL; OTC; QL

ra prenatal formula oral tablet AL; OTC; QL

ra prenatal oral tablet AL; OTC; QL

RIGHT STEP PRENATAL ORAL TABLET AL; OTC; QL

SIMILAC PRENATAL EARLY SHIELD ORAL

AL; OTC; QL

sm one daily prenatal oralOne-A-Day Womens Prenatal

AL; OTC; QL

sm prenatal vitamins oral tablet AL; OTC; QL

STUART ONE ORAL CAPSULE AL; OTC; QL

THERANATAL COMPLETE ORAL AL; OTC; QL

THERANATAL CORE NUTRITION ORAL TABLET

AL; OTC; QL

THERANATAL ONE ORAL CAPSULE AL; OTC; QL

THERANATAL OVAVITE ORAL THERAPY PACK

AL; OTC; QL

UPSPRING PRENATAL COMPLETE ORAL CAPSULE

OTC

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VINATE CARE ORAL TABLET CHEWABLE

AL; OTC; QL

YOUR LIFE MULTI PRENATAL ORAL CAPSULE

OTC

NUTRIENTES

CARBOHIDRATOS

GERBER GOOD START WATER ORAL SOLUTION

OTC

GOOD START 5% GLUCOSE WATER ORAL SOLUTION

OTC

SIMILAC GLUCOSE WATER ORAL SOLUTION

OTC

COMBINACIONES DE LIPOTRÓPICOS

cvs lecithin oral capsule OTC

gram-o-leci oral tablet chewable OTC

lecithin 3500 oral capsule OTC

lecithin oral capsule OTC

sm soya lecithin oral capsule OTC

soya lecithin oral capsule OTC

COMBINACIONES DE SUSTANCIAS NUTRICIONALES VARIAS

kelp-b6-lecithin-vinegar oral capsule OTC

pyridoxine-kelp-lect-vinegar oral tablet OTC

LIPOTRÓPICOS

inositol oral tablet OTC

SUSTANCIAS NUTRICIONALES VARIAS

algal omega-3 dha oral capsule OTC

atabex dha 200 oral capsule OTC

dha complete oral capsule OTC

dha natural omega-3 oral capsule OTC

dha oral capsule OTC

fish oil concentrate oral capsule Super Omega-3 OTC

omega 3 oral capsule Super Omega-3 OTC

omega-3 fish oil oral capsule Ovega-3 OTC

omega-3 oral capsule Super Omega-3 OTC

prenatal dha oral capsule OTC

sm fish oil oral capsule Super Omega-3 OTC

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SUPER OMEGA-3 ORAL CAPSULE OTC

OXITÓCICOS

OXITÓCICOS

METHERGINE ORAL TABLET

methylergonovine maleate injection solution

methylergonovine maleate oral tablet Methergine

PRODUCTOS DE DIAGNÓSTICO

MEDICAMENTOS DE DIAGNÓSTICO

cosyntropin injection solution reconstituted Cortrosyn

GLUCAGEN DIAGNOSTIC INJECTION SOLUTION RECONSTITUTED

PRODUCTOS PARA TRATAR LAS MIGRAÑAS

COMBINACIONES DE ERGOTAMINA

ergotamine-caffeine oral tablet Cafergot

MIGERGOT RECTAL SUPPOSITORY

PRODUCTOS VAGINALES

ANTIMICÓTICOS RELACIONADOS CON EL IMIDAZOL

3 day vaginal vaginal cream Gyne-Lotrimin 3 OTC

clotrimazole 3 vaginal cream Gyne-Lotrimin 3 OTC

clotrimazole vaginal cream Gyne-Lotrimin OTC

clotrimazole-7 vaginal cream Gyne-Lotrimin OTC

cvs clotrimazole 3 vaginal cream Gyne-Lotrimin 3 OTC

cvs miconazole 1 combo pack vaginal kit Monistat 1 Combo Pack OTC

cvs miconazole 1 combo-wipes vaginal kit OTC

cvs miconazole 3 combo pack vaginal kit Vagistat-3 OTC

cvs miconazole 3 combo-supp vaginal kit Vagistat-3 OTC

cvs miconazole 7 vaginal cream Monistat 7 Simply Cure OTC

cvs tioconazole 1 vaginal ointment Monistat 1-Day OTC

eq miconazole 1 vaginal kit Monistat 1 Combo Pack OTC

eq miconazole 7 day treatment vaginal cream

Monistat 7 Simply Cure OTC

eq tioconazole 1 vaginal ointment Monistat 1-Day OTC

eql miconazole 3 vaginal kit Vagistat-3 OTC

eql miconazole 7 vaginal cream Monistat 7 Simply Cure OTC

eql tioconazole-1 vaginal ointment Monistat 1-Day OTC

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gnp clotrimazole 3 vaginal cream Gyne-Lotrimin 3 OTC

gnp miconazole 3 vaginal kit Vagistat-3 OTC

gnp miconazole 7 vaginal cream Monistat 7 Simply Cure OTC

goodsense miconazole 1 vaginal kit Monistat 1 Combo Pack OTC

miconazole 1 vaginal kit Monistat 1 Combo Pack OTC

miconazole 3 applicator vaginal kitMonistat 3 Combo Pack App

OTC

miconazole 3 combo pack app vaginal kitMonistat 3 Combo Pack App

OTC

miconazole 3 combo pack vaginal kit Vagistat-3 OTC

miconazole 3 combo-supp vaginal kit Vagistat-3 OTC

miconazole 3 vaginal suppository

miconazole 7 vaginal cream Monistat 7 Simply Cure OTC

miconazole 7 vaginal suppository OTC

miconazole nitrate vaginal cream Monistat 7 Simply Cure OTC

MONISTAT 1-DAY VAGINAL OINTMENT OTC

px miconazole 3-day combo vaginal kit Vagistat-3 OTC

qc 3 day vaginal cream Monistat 3 OTC

qc miconazole 7 vaginal cream Monistat 7 Simply Cure OTC

ra clotrimazole 7 vaginal cream Gyne-Lotrimin OTC

ra miconazole 3 combo pack vaginal kit Vagistat-3 OTC

ra miconazole 7 vaginal cream Monistat 7 Simply Cure OTC

ra tioconazole 1 vaginal ointment Monistat 1-Day OTC

sm 3-day vaginal vaginal cream Gyne-Lotrimin 3 OTC

sm clotrimazole vaginal vaginal cream Gyne-Lotrimin OTC

sm miconazole 3 applicator vaginal kitMonistat 3 Combo Pack App

OTC

sm miconazole 3 vaginal kit Vagistat-3 OTC

sm miconazole 7 vaginal cream Monistat 7 Simply Cure OTC

sm miconazole 7 vaginal suppository OTC

sm tioconazole-1 vaginal ointment Monistat 1-Day OTC

terconazole vaginal cream

terconazole vaginal suppository

tioconazole-1 vaginal ointment Monistat 1-Day OTC

VAGISTAT-3 VAGINAL KIT OTC

ESPERMICIDAS

TODAY SPONGE VAGINAL OTC

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VCF VAGINAL CONTRACEPTIVE VAGINAL FILM

OTC

VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM

OTC

ESTRÓGENOS VAGINALES

estradiol vaginal tablet Yuvafem

YUVAFEM VAGINAL TABLET

PROGESTINAS

PROGESTINAS

hydroxyprogesterone caproate intramuscular oil

Makena PA

MAKENA SUBCUTANEOUS SOLUTION AUTO-INJECTOR

PA

norethindrone acetate oral tablet Aygestin

progesterone oral capsule Prometrium

QUÍMICOS

SOLVENTES

cvs rubbing alcohol solution OTC

eql isopropyl rubbing alcohol solution OTC

goodsense isopropyl alcohol solution OTC

hm isopropyl alcohol solution OTC

isopropanol solution

isopropyl alcohol (rubbing) solution OTC

isopropyl alcohol solution

isopropyl alcohol, rubbing solution OTC

ra isopropyl rubbing alcohol solution OTC

rubbing alcohol solution OTC

sm alcohol solution OTC

sm isopropyl alcohol solution OTC

TDAH/ANTINARCOLEPSIA/ANTIOBÉSICOS/ANOREXÍGENOS

ANALÉPTICOS

caffeine citrate intravenous solution Cafcit

caffeine citrate oral solution

INHIBIDORES DE LA LIPASA

ALLI ORAL CAPSULE PA; OTC; QL

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TOXOIDES

COMBINACIONES DE TOXOIDES

ADACEL INTRAMUSCULAR SUSPENSION

AL

BOOSTRIX INTRAMUSCULAR SUSPENSION

AL

DAPTACEL INTRAMUSCULAR SUSPENSION

AL

PENTACEL INTRAMUSCULAR SUSPENSION RECONSTITUTED

AL

VACUNAS

COMBINACIONES DE VACUNAS VIRALES

M-M-R II INJECTION SOLUTION RECONSTITUTED

AL

PROQUAD SUBCUTANEOUS SUSPENSION RECONSTITUTED

AL

TWINRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

AL

VACUNAS BACTERIANAS

ACTHIB INTRAMUSCULAR SOLUTION RECONSTITUTED

AL

BEXSERO INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

AL

HIBERIX INJECTION SOLUTION RECONSTITUTED

AL

MENACTRA INTRAMUSCULAR INJECTABLE

AL

MENQUADFI INTRAMUSCULAR INJECTABLE

AL

MENVEO INTRAMUSCULAR SOLUTION RECONSTITUTED

AL

PEDVAX HIB INTRAMUSCULAR SUSPENSION

AL

PNEUMOVAX 23 INJECTION INJECTABLE

AL

PREVNAR 13 INTRAMUSCULAR SUSPENSION

AL

TRUMENBA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

AL

TYPHIM VI INTRAMUSCULAR SOLUTION AL

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VACUNAS VIRALES

AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION

QL

AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

QL

ENGERIX-B INJECTION SUSPENSION

FLUAD INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

QL

FLUAD QUADRIVALENT INTRAMUSCULAR PREFILLED SYRINGE

QL

FLUARIX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

QL

FLUBLOK QUADRIVALENT INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

QL

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION

QL

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

QL

FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

QL

FLUZONE HIGH-DOSE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

QL

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION

QL

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

QL

GARDASIL 9 INTRAMUSCULAR SUSPENSION

AL

GARDASIL 9 INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

AL

HAVRIX INTRAMUSCULAR SUSPENSION AL

HEPLISAV-B INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

IPOL INJECTION INJECTABLE AL

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janssen covid-19 vaccine intramuscular suspension

moderna covid-19 vaccine intramuscular suspension

AL

pfizer-biontech covid-19 vacc intramuscular suspension

AL

RECOMBIVAX HB INJECTION SUSPENSION

ROTARIX ORAL SUSPENSION RECONSTITUTED

AL

ROTATEQ ORAL SOLUTION AL

SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED

AL; QL

VAQTA INTRAMUSCULAR SUSPENSION AL

VARIVAX SUBCUTANEOUS INJECTABLE AL

VASOPRESORES

VASOPRESORES

midodrine hcl oral tablet

VITAMINAS

BIOTINA

biotin 5000 oral capsule Meribin OTC

biotin maximum strength oral capsule Meribin OTC

biotin oral capsule Meribin OTC

biotin oral tablet OTC

cvs biotin high potency oral tablet OTC

cvs biotin oral capsule Meribin OTC

eql biotin oral capsule Meribin OTC

gnp biotin oral capsule Meribin OTC

hm biotin oral capsule Meribin OTC

MERIBIN ORAL CAPSULE OTC

qc biotin oral tablet OTC

ra biotin oral capsule Hard Nails OTC

ra biotin oral tablet OTC

sm biotin oral capsule Meribin OTC

super biotin oral capsule Meribin OTC

VITAMINA A

a-10000 oral capsule OTC

cvs vitamin a oral capsule OTC

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gnp vitamin a oral capsule OTC

natural vitamin a oral capsule OTC

px vitamin a oral capsule OTC

ra vitamin a oral capsule OTC

vitamin a oral capsule OTC

VITAMINA B

b-1 high potency oral tablet OTC

b1 oral tablet OTC

b-1 oral tablet OTC

b2 oral tablet OTC

b-2 oral tablet OTC

b6 natural oral tablet OTC

b-6 oral tablet OTC

calcium pantothenate oral tablet OTC

cvs b-1 oral tablet OTC

cvs b6 oral tablet OTC

cvs vitamin b-2 oral tablet OTC

ENDUR-ACIN ORAL TABLET EXTENDED RELEASE

OTC

eql b-6 oral tablet OTC

gnp vitamin b-1 oral tablet OTC

gnp vitamin b-6 oral tablet OTC

hm niacin oral tablet extended release Endur-Acin OTC

hm niacin tr oral tablet extended release Endur-Acin OTC

hm vitamin b1 oral tablet OTC

kp niacin oral tablet OTC

kp vitamin b-6 oral tablet OTC

niacin er oral capsule extended release OTC; QL

niacin er oral tablet extended release Endur-Acin OTC

niacin oral tablet OTC

niacinamide oral tablet OTC

plain niacin oral tablet OTC

px niacin oral tablet OTC

pyridoxine hcl injection solution

pyridoxine hcl oral tablet OTC

qc niacin oral tablet OTC

qc vitamin b1 oral tablet OTC

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qc vitamin b6 oral tablet OTC

ra niacin oral tablet OTC

ra no flush niacin oral tablet OTC

ra vitamin b-1 oral tablet OTC

ra vitamin b-6 oral tablet OTC

sm niacin cr oral tablet extended release Endur-Acin OTC

sm vitamin b1 oral tablet OTC

sm vitamin b6 oral tablet OTC

sm vitamin b-6 oral tablet OTC

thiamine hcl injection solution

thiamine hcl oral tablet OTC

thiamine mononitrate oral tablet OTC

vitamin b-1 oral tablet OTC

vitamin b-2 oral tablet OTC

vitamin b6 oral tablet OTC

vitamin b-6 oral tablet OTC

yl vitamin b-6 oral tablet OTC

VITAMINA C

ACEROLA C 500 ORAL WAFER OTC

acerola c-500 oral tablet chewable Sunkist Vitamin C OTC; QL

ascorbic acid oral liquid BProtected Vitamin C OTC

ascorbic acid oral tablet 1000 mg OTC

ascorbic acid oral tablet 250 mg OTC; QL

ascorbic acid oral tablet 500 mg PureWay-C OTC; QL

ascorbic acid oral tablet chewable OTC

BPROTECTED VITAMIN C ORAL LIQUID OTC

c 1000 oral tablet OTC

c 250 oral tablet OTC; QL

c 250 oral tablet chewable OTC

c 500 oral tablet PureWay-C OTC; QL

c 500 oral tablet chewable Sunkist Vitamin C OTC; QL

c 500/rose hips oral tablet PureWay-C OTC; QL

c-1000 oral tablet OTC

c-1000 oral tablet extended release Endur-C OTC

c-1000 sr oral tablet extended release Endur-C OTC

c-1000/rose hips oral tablet OTC

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c-1000/rose hips sr oral tablet extended release

Endur-C OTC

c-1500/rose hips sr oral tablet extended release

OTC

c-250 oral tablet OTC; QL

c-250 oral tablet chewable OTC

c-500 non-acid oral tablet OTC; QL

c-500 oral tablet PureWay-C OTC; QL

c-500 oral tablet chewable Sunkist Vitamin C OTC; QL

c-500 oral tablet extended release Endur-C OTC

c-500 sr oral capsule extended release OTC

c-500 sr oral tablet extended release Endur-C OTC

c-500/rose hips oral tablet PureWay-C OTC; QL

calcium ascorbate oral tablet OTC; QL

c-chewable oral tablet chewable Sunkist Vitamin C OTC; QL

CRUSH VITAMIN C DROPS MOUTH/THROAT LOZENGE

OTC

cvs chewable c with rose hips oral tablet chewable

Sunkist Vitamin C OTC; QL

cvs vitamin c oral tablet 1000 mg OTC

cvs vitamin c oral tablet 250 mg OTC; QL

cvs vitamin c oral tablet 500 mg PureWay-C OTC; QL

cvs vitamin c-rose hips oral tablet 1000 mg OTC

cvs vitamin c-rose hips oral tablet 500 mg PureWay-C OTC; QL

ENDUR-C ORAL TABLET EXTENDED RELEASE

OTC

eql vitamin c oral tablet 1000 mg OTC

eql vitamin c oral tablet 500 mg PureWay-C OTC; QL

eql vitamin c/rose hips oral tablet 1000 mg OTC

eql vitamin c/rose hips oral tablet 500 mg PureWay-C OTC; QL

fruit c 500 oral tablet chewable Sunkist Vitamin C OTC; QL

fruit c oral tablet chewable OTC

fruity c oral tablet chewable OTC

gnp vitamin c drops mouth/throat lozenge Crush Vitamin C Drops OTC

gnp vitamin c oral tablet 1000 mg OTC

gnp vitamin c oral tablet 250 mg OTC; QL

gnp vitamin c oral tablet 500 mg PureWay-C OTC; QL

gnp vitamin c oral tablet chewable Sunkist Vitamin C OTC; QL

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gnp vitamin c oral tablet extended release Endur-C OTC

gnp vitamin c w/rose hips oral tablet PureWay-C OTC; QL

gnp vitamin c/rose hips oral tablet OTC

hm vitamin c oral tablet 1000 mg OTC

hm vitamin c oral tablet 500 mg PureWay-C OTC; QL

hm vitamin c oral tablet chewable Sunkist Vitamin C OTC; QL

hm vitamin c tr oral tablet extended release Endur-C OTC

meijer c oral tablet PureWay-C OTC; QL

natural c/rose hips oral tablet 1000 mg OTC

natural c/rose hips oral tablet 500 mg PureWay-C OTC; QL

PUREWAY-C ORAL TABLET OTC; QL

px vitamin c oral tablet PureWay-C OTC; QL

qc vitamin c oral tablet 1000 mg OTC

qc vitamin c oral tablet 500 mg PureWay-C OTC; QL

qc vitamin c oral tablet chewable Sunkist Vitamin C OTC; QL

qc vitamin c with rose hips oral tablet PureWay-C OTC; QL

ra vitamin c cr oral tablet extended release Endur-C OTC

ra vitamin c oral tablet OTC; QL

ra vitamin c oral tablet chewable 250 mg OTC

ra vitamin c oral tablet chewable 500 mg Sunkist Vitamin C OTC; QL

ra vitamin c/acerola oral tablet chewable Sunkist Vitamin C OTC; QL

ra vitamin c/rose hips oral tablet 1000 mg OTC

ra vitamin c/rose hips oral tablet 500 mg PureWay-C OTC; QL

sb vitamin c oral tablet PureWay-C OTC; QL

sm chewable c oral tablet chewable Sunkist Vitamin C OTC; QL

sm chewable vitamin c oral tablet chewable Sunkist Vitamin C OTC; QL

sm vit c/rose hips oral tablet OTC

sm vitamin c cr oral tablet extended release Endur-C OTC

sm vitamin c oral tablet 1000 mg OTC

sm vitamin c oral tablet 250 mg OTC; QL

sm vitamin c oral tablet 500 mg PureWay-C OTC; QL

sm vitamin c oral tablet chewable Sunkist Vitamin C OTC; QL

sm vitamin c/rose hips oral tablet PureWay-C OTC; QL

SUNKIST VITAMIN C ORAL TABLET CHEWABLE

OTC; QL

vita-c oral crystals OTC

vitamin c drops mouth/throat lozenge Crush Vitamin C Drops OTC

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vitamin c er oral capsule extended release OTC

vitamin c er oral tablet extended release Endur-C OTC

vitamin c immune health oral tablet chewable

Sunkist Vitamin C OTC; QL

vitamin c oral liquid BProtected Vitamin C OTC

vitamin c oral tablet 100 mg, 1000 mg OTC

vitamin c oral tablet 250 mg OTC; QL

vitamin c oral tablet chewable 100 mg, 250 mg

OTC

vitamin c oral tablet chewable 500 mg Sunkist Vitamin C OTC; QL

vitamin c plus wild rose hips oral tablet chewable

Sunkist Vitamin C OTC; QL

vitamin c/bioflavonoids/rosehp oral tablet PureWay-C OTC; QL

vitamin c/natural rose hips oral tablet OTC

vitamin c/rose hips oral tablet PureWay-C OTC; QL

vitamin c/rose hips tr oral tablet extended release

Endur-C OTC

vitamin c-acerola oral tablet PureWay-C OTC; QL

vitamin c-acerola oral tablet chewable Sunkist Vitamin C OTC; QL

vitamin c-rose hips er oral tablet extended release

Endur-C OTC

vitamin c-rose hips oral tablet 1000 mg OTC

vitamin c-rose hips oral tablet 500 mg PureWay-C OTC; QL

vitamin c-rose hips oral tablet chewable Sunkist Vitamin C OTC; QL

vitamin c-rose hips tr oral tablet extended release

Endur-C OTC

yl vitamin c oral tablet 1000 mg OTC

yl vitamin c oral tablet 500 mg PureWay-C OTC; QL

yl vitamin c-rose hips oral tablet 1000 mg OTC

yl vitamin c-rose hips oral tablet 500 mg PureWay-C OTC; QL

VITAMINA D

aqueous vitamin d oral liquid BProtected Pedia D-Vite OTC; QL

BPROTECTED PEDIA D-VITE ORAL LIQUID

OTC; QL

CALCIDOL ORAL SOLUTION OTC

cvs d3 oral capsule 10 mcg (400 unit) OTC

cvs d3 oral capsule 125 mcg (5000 ut) Dialyvite Vitamin D 5000 OTC; QL

cvs d3 oral capsule 25 mcg (1000 ut) Pronutrients Vitamin D3 OTC

cvs d3 oral capsule 50 mcg (2000 ut) OTC; QL

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cvs vitamin d3 oral capsule Decara OTC

cvs vitamin d3 oral tablet chewableKids First Vitamin D3 Gummies

OTC

d 1000 oral capsule Pronutrients Vitamin D3 OTC

d 1000 oral tablet Vitamin D-1000 Max St OTC

d 1000 oral tablet chewableKids First Vitamin D3 Gummies

OTC

d 10000 oral capsule Decara OTC

d 400 oral tablet OTC; QL

d 400 oral tablet chewable Healthy Kids Vitamin D3 OTC

d 5000 oral capsule Dialyvite Vitamin D 5000 OTC; QL

d 5000 oral tabletRadiance Platinum Vitamin D3

OTC

d-1000 extra strength oral tablet Vitamin D-1000 Max St OTC

d-1000 oral tablet Vitamin D-1000 Max St OTC

d2000 ultra strength oral capsule OTC; QL

d3 adult oral tablet chewableKids First Vitamin D3 Gummies

OTC

d3 high potency oral capsule 125 mcg (5000 ut)

Dialyvite Vitamin D 5000 OTC; QL

d3 high potency oral capsule 25 mcg (1000 ut)

Pronutrients Vitamin D3 OTC

d3 high potency oral capsule 50 mcg (2000 ut)

OTC; QL

d3 high potency oral tablet OTC; QL

d3 kids oral tablet chewable Healthy Kids Vitamin D3 OTC

d3 maximum strength oral capsule Dialyvite Vitamin D 5000 OTC; QL

d3 maximum strength oral liquid OTC

d3 oral tablet Thera-D 2000 OTC

d3 super strength oral capsule OTC; QL

d3-1000 oral capsule Pronutrients Vitamin D3 OTC

d3-1000 oral tablet Vitamin D-1000 Max St OTC

d-3-5 oral capsule Dialyvite Vitamin D 5000 OTC; QL

D3-50 ORAL CAPSULE OTC

d-400 oral tablet OTC; QL

d-5000 oral tabletRadiance Platinum Vitamin D3

OTC

DECARA ORAL CAPSULE OTC

delta d3 oral tablet OTC; QL

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DIALYVITE VITAMIN D 5000 ORAL CAPSULE

OTC; QL

DIALYVITE VITAMIN D3 MAX ORAL TABLET

OTC

d-vite pediatric oral liquid BProtected Pedia D-Vite OTC; QL

eql vitamin d3 gummies oral tablet chewableKids First Vitamin D3 Gummies

OTC

eql vitamin d3 oral capsule 10 mcg (400 unit)

OTC

eql vitamin d3 oral capsule 125 mcg (5000 ut)

Dialyvite Vitamin D 5000 OTC; QL

eql vitamin d3 oral capsule 25 mcg (1000 ut) Pronutrients Vitamin D3 OTC

eql vitamin d3 oral capsule 50 mcg (2000 ut) OTC; QL

ergocalciferol oral capsule Drisdol

ergocalciferol oral solution Calcidol OTC

gnp d 1000 oral capsule Pronutrients Vitamin D3 OTC

gnp d 2000 oral tablet chewableKids First Vitamin D3 Gummies

OTC

gnp vitamin d maximum strength oral tablet Thera-D 2000 OTC

gnp vitamin d oral tablet Vitamin D-1000 Max St OTC

gnp vitamin d oral tablet chewable Healthy Kids Vitamin D3 OTC

gnp vitamin d super strength oral tabletRadiance Platinum Vitamin D3

OTC

gnp vitamin d3 extra strength oral tablet Vitamin D-1000 Max St OTC

gnp vitamin d-400 oral tablet OTC; QL

HEALTHY KIDS VITAMIN D3 ORAL TABLET CHEWABLE

OTC

hm vitamin d oral tablet 10 mcg (400 unit) OTC; QL

hm vitamin d oral tablet 25 mcg (1000 ut) Vitamin D-1000 Max St OTC

hm vitamin d3 oral capsule 100 mcg (4000 ut)

OTC

hm vitamin d3 oral capsule 50 mcg (2000 ut) OTC; QL

hm vitamin d3 oral tablet Vitamin D-1000 Max St OTC

IS-D 10,000 ORAL CAPSULE OTC

KIDS FIRST VITAMIN D3 GUMMIES ORAL TABLET CHEWABLE

OTC

kls d3 oral capsule OTC; QL

kp vitamin d oral capsule Pronutrients Vitamin D3 OTC

kp vitamin d oral tablet chewable Healthy Kids Vitamin D3 OTC

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kp vitamin d3 oral capsule 25 mcg (1000 ut) Pronutrients Vitamin D3 OTC

kp vitamin d3 oral capsule 50 mcg (2000 ut) OTC; QL

nat-rul vitamin d oral tablet Vitamin D-1000 Max St OTC

natural vitamin d-3 oral tabletRadiance Platinum Vitamin D3

OTC

OPTIMAL-D ORAL CAPSULE OTC

pharmacist choice d-vitamin oral liquid BProtected Pedia D-Vite OTC; QL

PRONUTRIENTS VITAMIN D3 ORAL CAPSULE

OTC

qc vitamin d3 oral capsule 25 mcg (1000 ut) Pronutrients Vitamin D3 OTC

qc vitamin d3 oral capsule 50 mcg (2000 ut) OTC; QL

qc vitamin d3 oral tablet 10 mcg (400 unit) OTC; QL

qc vitamin d3 oral tablet 125 mcg (5000 ut)Radiance Platinum Vitamin D3

OTC

qc vitamin d3 oral tablet 25 mcg (1000 ut) Vitamin D-1000 Max St OTC

qc vitamin d3 oral tablet 50 mcg (2000 ut) Thera-D 2000 OTC

ra vitamin d-3 oral capsule OTC; QL

ra vitamin d-3 oral tablet Vitamin D-1000 Max St OTC

RADIANCE PLATINUM VITAMIN D3 ORAL TABLET

OTC

REPLESTA ORAL WAFER OTC

sm vitamin d oral tablet OTC; QL

sm vitamin d3 oral capsule 100 mcg (4000 ut)

OTC

sm vitamin d3 oral capsule 125 mcg (5000 ut)

Dialyvite Vitamin D 5000 OTC; QL

sm vitamin d3 oral capsule 50 mcg, 50 mcg (2000 ut)

OTC; QL

sm vitamin d3 oral tablet Vitamin D-1000 Max St OTC

THERA-D 2000 ORAL TABLET OTC

THERA-D RAPID REPLETION ORAL TABLET

OTC

VITAJOY DAILY D GUMMIES ORAL TABLET CHEWABLE

OTC

vitamin d (cholecalciferol) oral capsule 10 mcg (400 unit)

OTC

vitamin d (cholecalciferol) oral capsule 25 mcg (1000 ut)

Pronutrients Vitamin D3 OTC

vitamin d (cholecalciferol) oral capsule 50 mcg (2000 ut)

OTC; QL

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vitamin d (cholecalciferol) oral tablet 10 mcg (400 unit)

OTC; QL

vitamin d (cholecalciferol) oral tablet 25 mcg (1000 ut)

Vitamin D-1000 Max St OTC

vitamin d (cholecalciferol) oral tablet chewable

Healthy Kids Vitamin D3 OTC

vitamin d (ergocalciferol) oral capsule Drisdol

vitamin d high potency oral capsule Pronutrients Vitamin D3 OTC

vitamin d infant oral liquid BProtected Pedia D-Vite OTC; QL

vitamin d oral capsule OTC; QL

vitamin d oral liquid BProtected Pedia D-Vite OTC; QL

vitamin d oral tablet Vitamin D-1000 Max St OTC

VITAMIN D-1000 MAX ST ORAL TABLET OTC

vitamin d2 oral tablet OTC

vitamin d3 adult gummies oral tablet chewable

Kids First Vitamin D3 Gummies

OTC

vitamin d3 extra strength oral tablet chewable

Kids First Vitamin D3 Gummies

OTC

vitamin d3 gummies adult oral tablet chewable

Kids First Vitamin D3 Gummies

OTC

vitamin d3 gummies oral tablet chewableKids First Vitamin D3 Gummies

OTC

vitamin d3 maximum strength oral capsule Dialyvite Vitamin D 5000 OTC; QL

vitamin d-3 oral capsule Pronutrients Vitamin D3 OTC

vitamin d3 oral capsule 1.25 mg (50000 ut) D3-50 OTC

vitamin d3 oral capsule 10 mcg (400 unit) OTC

vitamin d3 oral capsule 125 mcg (5000 ut) Dialyvite Vitamin D 5000 OTC; QL

vitamin d3 oral capsule 25 mcg (1000 ut) Pronutrients Vitamin D3 OTC

vitamin d3 oral capsule 250 mcg (10000 ut) Decara OTC

vitamin d3 oral capsule 50 mcg (2000 ut) OTC; QL

vitamin d3 oral liquid 10 mcg/ml BProtected Pedia D-Vite OTC; QL

vitamin d3 oral liquid 125 mcg/ml OTC

vitamin d-3 oral tabletRadiance Platinum Vitamin D3

OTC

vitamin d3 oral tablet 10 mcg (400 unit) OTC; QL

vitamin d3 oral tablet 125 mcg (5000 ut)Radiance Platinum Vitamin D3

OTC

vitamin d3 oral tablet 25 mcg, 25 mcg (1000 ut)

Vitamin D-1000 Max St OTC

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vitamin d3 oral tablet 50 mcg (2000 ut) Thera-D 2000 OTC

vitamin d3 oral tablet chewable Healthy Kids Vitamin D3 OTC

vitamin d3 super strength oral capsule OTC

vitamin d3 super strength oral tablet Thera-D 2000 OTC

vitamin d3 ultra potency oral tablet Dialyvite Vitamin D3 Max OTC

vitamin d3 ultra strength oral capsule Dialyvite Vitamin D 5000 OTC

vitamin d-400 oral tablet OTC; QL

WEEKLY-D ORAL CAPSULE OTC

VITAMINA E

aqueous vitamin e oral solution SoluVita E OTC

cvs e oral capsule OTC

cvs vitamin e oral capsule OTC

e 1000 oral capsule OTC

e1000 oral capsule OTC

e-1000 oral capsule OTC

e200 oral capsule OTC

e-200 oral capsule OTC

e400 oral capsule OTC

e-400 oral capsule OTC

e-400-clear oral capsule OTC

e600 oral capsule OTC

eql vitamin e oral capsule OTC

gnp vitamin e oral capsule OTC

hm e vitamin oral capsule OTC

hm vitamin e oral capsule OTC

kp vitamin e oral capsule OTC

natural vitamin e oral capsule OTC

px vitamin e oral capsule OTC

qc vitamin e oral capsule OTC

ra natural vitamin e oral capsule OTC

ra vitamin e natural oral capsule OTC

ra vitamin e oral capsule OTC

sm vitamin e oral capsule OTC

SOLUVITA E ORAL SOLUTION OTC

vitamin e blend oral capsule OTC

vitamin e high potency oral capsule OTC

vitamin e oral capsule OTC

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Nombre del medicamento Referencia Notas

vitamin e oral solution SoluVita E OTC

vitamin e water soluble oral capsule OTC

vitamin e/d-alpha natural oral capsule OTC

vitamin e/d-alpha oral capsule OTC

vitamin supplement e-1000 oral capsule OTC

vitamin supplement e-400 oral capsule OTC

VITAMINA K

k 100 oral tablet OTC

phytonadione injection solution

phytonadione oral tablet Mephyton

vitamin k (phytonadione) oral tablet OTC

vitamin k oral tablet OTC

vitamin k1 injection solution

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