2011 Formulary List of Covered Drugs Elite HMO by wuxiangyu

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									                                  2011 Formulary
                              List of Covered Drugs
                                          Elite
                                          HMO

                PLEASE READ: THIS DOCUMENT CONTAINS
          INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN

Note to existing members: This formulary has changed since last year. Please review this
document to make sure that it still contains the drugs you take.
Members must use network pharmacies to access their prescription drug benefit. Benefits,
formulary, pharmacy network, premiums and/or copayments/coinsurance may change on
January 1, 2011.
MMM Healthcare, Inc. is a health plan with a Medicare contract.
This information is available in different formats, including Braille, Spanish language, large
print, and audio format. Please call our Member Services Department at the numbers listed above
if you need plan information in another format or language.

Esta información está disponible en diferentes formatos incluyendo Braille, idioma español,
letra grande y formato auditivo. Si usted necesita información del plan en alguno de estos
formatos, comuníquese con nuestro Departamento de Servicios al Afiliado a los números
antes mencionados.

Last Update: 07/29/10


H4003 – MMM Healthcare, Inc.
Y0049_2011 5003 0005 1
File & Use 09082010
What is the Medicare y Mucho Más (MMM) Formulary?
A formulary is a list of covered drugs selected by MMM in consultation with a team of
healthcare providers, which represents the prescription therapies believed to be a necessary part
of a quality treatment program. MMM will generally cover the drugs listed in our formulary as
long as the drug is medically necessary, the prescription is filled at a MMM network pharmacy,
and other plan rules are followed. For more information on how to fill your prescriptions, please
review your Evidence of Coverage.

Can the Formulary change?

Generally, if you are taking a drug from our 2010 formulary that was covered at the beginning of
the year, we will not discontinue or reduce coverage of the drug during the 2011 coverage year
except when a new, less expensive generic drug becomes available or when new adverse
information about the safety or effectiveness of a drug is released. Other types of formulary
changes, such as removing a drug from our formulary, will not affect members who are currently
taking the drug. It will remain available at the same cost-sharing for those members taking it for
the remainder of the coverage year. We feel it is important that you have continued access for the
remainder of the coverage year to the formulary drugs that were available when you chose our
plan, except for cases in which you can save additional money or we can ensure your safety.


If we remove drugs from our formulary, or add prior authorization, quantity limits or step
therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify
affected members of the change at least 60 days before the change becomes effective, or at the
time the member requests a refill of the drug, at which time the member will receive a 60-day
supply of the drug. If the Food and Drug Administration deems a drug in our formulary to be
unsafe or the drug’s manufacturer removes the drug from the market, we will immediately
remove the drug from our formulary and provide notice to members who take the drug. The
enclosed formulary is current as of January 1, 2011. To get updated information about the drugs
covered by MMM, please visit our website at www.mmm-pr.com or call Member Services at
787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through Sunday, from 7:30
a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469. Please also
note mid-year formulary changes are posted through our website at www.mmm-pr.com.




                                                2
    How do I use the Formulary?

    There are two ways to find your drug within the formulary:


    Medical Condition
    The formulary begins on page 8. The drugs in this formulary are grouped into categories
    depending on the type of medical conditions that they are used to treat. For example, drugs used
    to treat a heart condition are listed under the category, “Cardiovascular Medications”. If you
    know what your drug is used for, look for the category name in the list that begins on page
    number 8. Then look under the category name for your drug.

    Alphabetical Listing
    If you are not sure what category to look under, you should look for your drug in the Index that
    begins on page 66. The Index provides an alphabetical list of all of the drugs included in this
    document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index
    and find your drug. Next to your drug, you will see the page number where you can find
    coverage information. Turn to the page listed in the Index and find the name of your drug in the
    first column of the list.

    What are generic drugs?
    MMM covers both brand name drugs and generic drugs. A generic drug is approved by the FDA
    as having the same active ingredient as the brand name drug. Generally, generic drugs cost less
    than brand name drugs.


    Are there any restrictions on my coverage?
    Some covered drugs may have additional requirements or limits on coverage. These
    requirements and limits may include:

•           Prior Authorization: MMM requires you or your doctor to get prior authorization for
    certain drugs. This means that you will need to get approval from MMM before you fill your
    prescriptions. If you don’t get approval, MMM may not cover the drug.

•           Quantity Limits: For certain drugs, MMM limits the amount of the drug that MMM will
    cover. For example, MMM provides 4 tablets per prescription for Alendronate 70mg. This may
    be in addition to a standard one (1) month or three (3) month supply.

•            Step Therapy: In some cases, MMM requires you to first try certain drugs to treat your
    medical condition before we will cover another drug for that condition. For example, if Drug A
    and Drug B both treat your medical condition, MMM may not cover Drug B unless you try Drug
    A first. If Drug A does not work for you, MMM will then cover Drug B.



                                                   3
    You can find out if your drug has any additional requirements or limits by looking in the
    formulary that begins on page 8. You can also get more information about the restrictions
    applied to specific covered drugs by visiting our website at www.mmm-pr.com.

    You can ask MMM to make an exception to these restrictions or limits. See the section, “How do
    I request an exception to the MMM formulary?” on page 4 for information about how to request
    an exception.

    What if my drug is not in the Formulary?

    If your drug is not included in this formulary, you should first contact Member Services and
    confirm that your drug is not covered. If you learn that MMM does not cover your drug, you
    have two options:

•             You can ask Member Services for a list of similar drugs that are covered by MMM.
    When you receive the list, show it to your doctor and ask them to prescribe a similar drug that is
    covered by MMM.

•              You can ask MMM to make an exception and cover your drug. See below for
    information about how to request an exception.


    How do I request an exception to the MMM Formulary?
    You can ask MMM to make an exception to our coverage rules. There are several types of
    exceptions that you can ask us to make:

•              You can ask us to cover your drug even if it is not in our formulary.

•               You can ask us to waive coverage restrictions or limits on your drug. For example,
    for certain drugs, MMM limits the amount of the drug that we will cover. If your drug has a
    quantity limit, you can ask us to waive the limit and cover more.

•               You can ask us to provide a higher level of coverage for your drug. If your drug is
    contained in our highest tier subject to the tiering exceptions process tier, you can ask us to cover
    it at the cost-sharing amount that applies to drugs in the lowest tier subject to the tiering
    exceptions process tier, instead. This would lower the amount you must pay for your drug. Please
    note, if we grant your request to cover a drug that is not in our formulary, you may not ask us to
    provide a higher level of coverage for the drug. Also, you may not ask us to provide a higher
    level of coverage for drugs that are in the SP (specialty drug) tier.

    Generally, MMM will only approve your request for an exception if the alternative drugs
    included in the plan’s formulary, the lower-tiered drug or additional utilization restrictions would
    not be as effective in treating your condition or would cause you to have adverse medical effects.



                                                     4
You should contact us to ask us for an initial coverage decision for a formulary, or utilization
restriction exception. When you are requesting a formulary, or utilization restriction
exception you should submit a statement from your doctor supporting your request.
Generally, we must make our decision within 72 hours of getting your prescribing doctor’s
supporting statement. You can request an expedited (fast) exception if you or your doctor believe
that your health could be seriously harmed by waiting up to 72 hours for a decision. If your
request to expedite is granted, we must give you a decision no later than 24 hours after we get
your prescribing doctor’s supporting statement.

What do I do before I can talk to my doctor about changing my drugs or
requesting an exception?
As a new or continuing member in our plan, you may be taking drugs that are not in our
formulary. Or, you may be taking a drug that is in our formulary but your ability to get it is
limited. For example, you may need a prior authorization from us before you can fill your
prescription. You should talk to your doctor to decide if you should switch to an appropriate drug
that we cover or request a formulary exception so that we cover the drug you take. While you
talk to your doctor to determine the right course of action for you, we may cover your drug in
certain cases during the first 90 days you are a member of our plan.

For each of your drugs that is not in our formulary or if your ability to get your drugs is limited,
we will cover a temporary 30-day supply (unless you have a prescription written for fewer days)
when you go to a network pharmacy. After your first 30-day supply, we will not pay for these
drugs, even if you have been a member of the plan less than 90 days.

If you are a resident of a long-term care facility, we will cover a temporary 31-day transition
supply (unless you have a prescription written for fewer days). We will cover more than one
refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is
not in our formulary or if your ability to get your drugs is limited; but you are past the first 90
days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless
you have a prescription for fewer days) while you pursue a formulary exception.

For those members that are released from a hospital, or other care facility to their home, or if
your ability to get your drugs is limited, MMM will cover a temporary 30-day supply for the
drugs that are not in our formulary, while you ask your doctor to prescribe a similar drug that is
covered by MMM.




                                                 5
For more information

For more detailed information about your MMM prescription drug coverage, please review your
Evidence of Coverage and other plan materials.

If you have questions about MMM, please call Member Services at 787-620-2397 (Metro Area),
1-866-333-5470 (toll free), Monday through Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD
users (hearing impaired) should call 1-866-333-5469. Or, visit www.mmm-pr.com.

If you have general questions about Medicare prescription drug coverage, please call Medicare at
1-800-MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY/TDD (hearing
impaired) users should call 1-877-486-2048. Or, visit www.medicare.gov.


MMM Formulary

The formulary that begins on the next page provides coverage information about some of the
drugs covered by MMM. If you have trouble finding your drug on the list, turn to the Index that
begins on page 66.

The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g.,
PROCRIT) and generic drugs are listed in lower-case italics (e.g., penicillin).

The information in the Notes column tells you if MMM has any special requirements for
coverage of your drug.




                                               6
Tier Level Structure
$0 Deductible

Before the total yearly drug costs (paid by both you and MMM) reach $2,840, you pay the
following for prescription drugs:
                                              Retail              Retail           Mail   Order
                Tier Level   Drugs
                                              Copayment           90 days          Copayment
                             Preferred        $5                  $15              $10
                1
                             Generics
                             Preferred        $29                 $87              $58
                2
Elite                        Brands
                             Non-Preferred    $50                 $150             $100
                3
                             Brands
                4            Specialty        25%                 25%              25%


After your total yearly drug costs reach $2,840, the plan covers some generic drugs through the
coverage gap, please refer to the generic copays. You will also receive a discount on brand name
drugs and generally pay no more than 93% of the plan’s costs for all generic drugs, until your
yearly out-of-pocket drug costs reach $4,550.

After your yearly out-of-pocket drug costs reach $4,550, you pay the greater of:

•       $2.50 for generic (including brand drugs treated as generic) and $6.30 for all other drugs,
•       5% coinsurance

For more information on how the tier level is applied, please review your Evidence of Coverage
(EOC).

Symbols and abbreviations used in the Formulary
PA - drugs that need prior authorization
QL - drugs with quantity limit
ST - step therapy
LA - drugs with limited access (ex. Specialty Drugs)
MT - maintenance drugs (ex. Mail Order, 90 days supply)
CG - drugs covered during your Coverage Gap




                                                 7
General Drug Table

                       Drug                        Brand/Generic Reference            Tier   Restrictions

ANESTHETICS
   LOCAL ANESTHETICS

      lidocaine hcl 0.5% vial, -1% vial        XYLOCAINE                              1

   TOPICAL ANESTHETICS

      lidocaine hcl dental/mucous                                                     1
      membrn products, -gel, -oint
      lidocaine hcl viscous                    XYLOCAINE VISCOUS                      1
      lidocaine-prilocaine                     XYLOCAINE                              1
      LIDODERM                                 lidocaine                              2      [PA]

ANTIINFECTIVES
   AMEBICIDES

      paromomycin sulfate                      HUMATIN                                1

   AMINOGLYCOSIDES

      gentamicin 10 mg/ml vial, -40                                                   1
      mg/ml vial
      neomycin sulfate tablet                                                         1
      tobramycin 10 mg/ml vial, -40                                                   1      [PA]
      mg/ml vial

   ANTHELMINTICS

      ALBENZA                                  albendazole                            2
      mebendazole chew tab                                                            1
      STROMECTOL                               ivermectin                             2

   ANTIINFECTIVES SPECIALIZED INDICATIONS

      DAPSONE                                  dapsone                                2      [MT]
      metronidazole cap, -injection, -                                                1
      tablet
                                                      8
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions

   ANTIRETROVIRALS AND PROTEASE INH

      APTIVUS                                  tipranavir/vitamin e tpgs              4      [MT]
      ATRIPLA                                  emtricitabine/tenofovir/efavir         4      [MT]
      COMBIVIR                                 lamivudine/zidovudine                  4      [MT]
      CRIXIVAN                                 indinavir                              2      [MT]
      didanosine                               VIDEX EC                               1      [MT]
      EMTRIVA                                  emtricitabine                          2      [MT]
      EPIVIR                                   lamivudine                             2      [MT]
      EPZICOM                                  abacavir sulfate/lamivudine            4      [MT]
      FUZEON                                   enfuvirtide                            4      [MT]
      INTELENCE                                etravirine                             4      [MT]
      INVIRASE                                 saquinavir mesylate                    4      [MT]
      ISENTRESS                                raltegravir potassium                  4      [MT]
      KALETRA 100-25 MG TABLET                 ritonavir/lopinavir                    2      [MT]
      KALETRA 200-50 MG TABLET, -              ritonavir/lopinavir                    4      [MT]
      SOLUTION
      LEXIVA ORAL SUSP                         fosamprenavir calcium                  2      [MT]
      LEXIVA TABLET                            fosamprenavir calcium                  4      [MT]
      NORVIR CAP, -TABLET                      ritonavir                              2      [MT]
      NORVIR SOLUTION                          ritonavir                              4      [MT]
      PREZISTA 150 MG TABLET, -300             darunavir ethanolate                   4      [MT]
      MG TABLET, -400 MG TABLET, -600
      MG TABLET
      PREZISTA 75 MG TABLET                    darunavir ethanolate                   2      [MT]
      RESCRIPTOR                               delavirdine mesylate                   2      [MT]
      RETROVIR INJECTION                       zidovudine                             2
      REYATAZ                                  atazanavir sulfate                     4      [MT]
      SELZENTRY                                maraviroc                              4      [MT]
      stavudine                                ZERIT                                  1      [MT]
      SUSTIVA 200 MG CAPSULE, -50 MG           efavirenz                              2      [MT]
      CAPSULE, -TABLET
      TRIZIVIR                                 zidovudine/lamivudine/abacavir         4      [MT]
      TRUVADA                                  emtricitabine/tenofovir                4      [MT]
      VIDEX 2 GM PEDIATRIC SOLN                didanosine                             2      [MT]
      VIRACEPT                                 nelfinavir mesylate                    2      [MT]
      VIRAMUNE                                 nevirapine                             2      [MT]
      VIREAD                                   tenofovir disproxil fumarate           2      [MT]
      ZIAGEN                                   abacavir sulfate                       2      [MT]

                                                       9
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                       Brand/Generic Reference             Tier Restrictions
      zidovudine                               RETROVIR                               1    [MT]

   ANTITUBERCULOSIS DRUGS

      CAPASTAT SULFATE                         capreomycin                            4
      ethambutol hcl tablet                                                           1      [MT]
      isonarif                                 RIFAMATE                               1
      isoniazid injection                                                             1
      isoniazid syrup, -tablet                                                        1      [MT]
      MYCOBUTIN                                rifabutin                              2
      PASER                                    aminosalicylic acid                    2      [MT]
      PRIFTIN                                  rifapentine                            2
      pyrazinamide                                                                    1      [MT]
      rifampin cap                                                                    1
      rifampin injection                       RIFADIN                                4
      SEROMYCIN                                cycloserine                            2
      STREPTOMYCIN SULFATE                     streptomycin                           2
      INJECTION
      TRECATOR                                 ethionamide                            2

   CEPHALOSPORINS

      cefaclor                                 CECLOR                                 1
      cefaclor er                              CECLOR CD                              1
      cefadroxil                               DURICEF                                1
      cefazolin 1 gm vial                      KEFZOL                                 1
      cefdinir                                 OMNICEF                                1
      cefotaxime sodium 500 mg vial            CLAFORAN                               1      [PA]
      cefoxitin 1 gm vial, -2 gm vial          MEFOXIN                                1      [PA]
      cefpodoxime proxetil                     VANTIN                                 1
      cefprozil                                CEFZIL                                 1
      ceftriaxone 1 gm vial, -2 gm vial, -     ROCEPHIN                               1      [PA]
      250 mg vial, -500 mg vial
      cefuroxime 125 mg/5 ml susp              CEFTIN                                 1
      cefuroxime sod 1.5 gm vial, -sod         CLAFORAN                               1      [PA]
      750 mg vial
      cefuroxime sod 7.5 gm vial               ZINACEF                                1
      cefuroxime tablet                        KEFTAB                                 1
      cephalexin                               KEFLEX                                 1
      MAXIPIME 2 GM ADD-VANTAGE VL             cefepime                               2      [PA]

                                                     10
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                         Brand/Generic Reference           Tier   Restrictions
      SUPRAX                                   cefixime                               2

   CHLORAMPHENICOLS

      chloramphenicol sod succinate            CHLOROMYCETIN                          1      [PA]

   CLINDAMYCINS

      clindamycin 150 mg/ml addvan, -ph CLEOCIN                                       1      [PA]
      300 mg/2 ml vl
      clindamycin hcl cap                                                             1

   ERYTHROMYCINS

      ERY-TAB                                  erythromycin base                      2
      erythrocin stearate                      ERYTHROMYCIN STEARATE                  1
      erythromycin e.c. cap, -tablet                                                  1
      erythromycin ethylsuccinate tablet                                              1

   ORAL ANTIFUNGAL DRUGS

      ANCOBON                                  flucytosine                            4
      clotrimazole loz                                                                1
      fluconazole 100 mg tablet, -200 mg       DIFLUCAN                               1
      tablet, -50 mg tablet, -suspension
      fluconazole 150 mg tablet                DIFLUCAN                               1      [QL, 2/7]
      GRIFULVIN V TABLET                       griseofulvin microsize                 2
      griseofulvin oral susp                                                          1
      GRIS-PEG                                 griseofulvin ultramicrosize            2
      itraconazole cap                                                                1
      ketoconazole tablet                      NIZORAL                                1
      nystatin 500,000 unit oral tab, -oral                                           1
      susp
      terbinafine hcl                          LAMISIL                                1

   OTHER ANTIINFECTIVE DRUGS

      ALINIA                                   nitazoxanide                           2
      baciim                                                                          1
      bacitracin injection                                                            1
                                                     11
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                      Drug                         Brand/Generic Reference            Tier Restrictions
      colistimethate 150 mg vial               COLY-MYCIN M PARENTERAL                4    [PA]
      CUBICIN                                  daptomycin                             4
      INVANZ 1 GM VIAL                         ertapenem sodium                       2
      MEPRON                                   atovaquone                             4
      polymyxin b sulfate injection                                                   1
      PRIMAXIN 250 MG VIAL                     imipenem/cilastatin sodium             2
      PRIMAXIN 500 MG VIAL                     imipenem/cilastatin sodium             4
      PRIMAXIN I.M.                            imipenem/cilastatin sodium             4
      SYNERCID                                 quinupristin/dalfopristin              4
      TYGACIL                                  tigecycline                            4
      vancomycin 1 gm vial                     VANCOCIN HCL                           1
      ZYVOX 600 MG/300 ML IV SOLN, -           linezolid                              4    [PA]
      ORAL SUSP, -TABLET

   OTHER ANTIVIRAL DRUGS

      acyclovir cap, -oral susp, -tablet                                              1      [MT]
      acyclovir sodium 500 mg vial             ZOVIRAX                                1
      amantadine                               SYMMETREL                              1      [MT]
      BARACLUDE SOLUTION                       entecavir                              2      [MT]
      BARACLUDE TABLET                         entecavir                              4      [MT]
      DENAVIR                                  penciclovir                            2
      EPIVIR HBV                               lamivudine                             2      [MT]
      famciclovir 125 mg tablet, -500 mg       FAMVIR                                 1      [QL, 21/7]
      tablet
      famciclovir 250 mg tablet                FAMVIR                                 1      [QL, 60/30]
      foscarnet sodium                         FOSCAVIR                               1
      ganciclovir                              CYTOVENE                               4
      HEPSERA                                  adefovir dipivoxil                     4
      ribapak                                  RIBATAB                                4
      ribasphere 200 mg tablet                 COPEGUS                                1
      ribasphere 400 mg tablet, -600 mg                                               4
      tablet, -cap
      ribavirin 200 mg tablet                  COPEGUS                                1
      ribavirin 400 mg tablet, -600 mg                                                4
      tablet, -cap
      rimantadine hcl                          FLUMADINE                              1
      TAMIFLU 30 MG GELCAP                     oseltamivir phosphate                  2      [QL, 84/180]
      TAMIFLU 45 MG GELCAP                     oseltamivir phosphate                  2      [QL, 42/180]
      TAMIFLU 75 MG GELCAP                     oseltamivir phosphate                  2      [QL, 56/365]

                                                     12
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                  Drug                              Brand/Generic Reference           Tier Restrictions
      TAMIFLU SUSPENSION                       oseltamivir phosphate                  2
      TYZEKA                                   telbivudine                            2    [MT]
      VALCYTE                                  valganciclovir                         4    [MT]
      VIRAZOLE                                 ribavirin                              2

   OTHER MACROLIDES

      azithromycin 100 mg/5 ml susp            ZITHROMAX                              1      [QL,   30 ml/5]
      azithromycin 200 mg/5 ml susp            ZITHROMAX                              1      [QL,   68 ml/5]
      azithromycin 250 mg tablet               ZITHROMAX                              1      [QL,   8/7]
      azithromycin 500 mg tablet               ZITHROMAX                              1      [QL,   4/4]
      azithromycin 600 mg tablet, -i.v.        ZITHROMAX                              1
      500 mg vial
      clarithromycin                           BIAXIN                                 1
      clarithromycin er                        BIAXIN XL                              1

   OTHER TOPICAL ANTIFUNGALS

      ciclopirox cream, -gel, -lotion, -soln,                                         1
      top
      clotrimazole 1% cream, -1%              LOTRIMIN                                1
      solution, -af 1% cream
      econazole nitrate cream                 SPECTAZOLE                              1
      EXELDERM                                sulconazole nitrate                     3
      ketoconazole cream, -                                                           1
      oil,shampoo,cleanser
      nyamyc                                  MYCOSTATIN                              1
      nystatin 100,000 unit/gm powd, -                                                1
      cream, -oint
      nystop                                  MYCOSTATIN                              1
      pedi-dri                                MYCOSTATIN                              1

   PARENTERAL ANTIFUNGALS

      ABELCET                                  amphotericin b lipid complex           4      [PA]
      AMBISOME                                 amphotericin b liposome                4
      AMPHOTEC 50 MG VIAL                      ampho b c-s                            2
      amphotericin b injection                 AMPHOCIN                               1      [PA]
      CANCIDAS                                 caspofungin acetate                    4      [PA]
      fluconazole-dext 400 mg/200 ml           DIFLUCAN IN DEXTROSE                   1      [PA]

                                                     13
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                         Drug                      Brand/Generic Reference            Tier Restrictions
      MYCAMINE                                 micafungin sodium                      4    [PA]

   PENICILLINS

      amoclan                                  AUGMENTIN                              1
      amox tr-potassium clavulanate            AUGMENTIN                              1
      amoxicillin                              AMOXIL                                 1
      amoxicillin-clavulanate er               AUGMENTIN ES                           1
      ampicillin 1 gm vial, -125 mg vial       TOTACILLIN                             1      [PA]
      ampicillin trihydrate                    PRINCIPEN 250                          1
      ampicillin-sulbactam 15 gm vl, -3        UNASYN                                 1      [PA]
      gm vial
      BICILLIN C-R                             pen g procaine/pen g benz              2
      dicloxacillin sodium                     DYNAPEN                                1
      nafcillin 1 gm add-van vial, -1 gm       NALLPEN                                4      [PA]
      vial
      penicillin g k 5 million unit            PFIZERPEN                              1
      penicillin g sodium                      PFIZERPEN                              1
      penicillin v potassium                   PEN-V                                  1
      piperacillin 3 gm vial                   PIPRACIL                               1      [PA]

   PLASMODICIDES

      chloroquine phosphate tablet             ARALEN                                 1      [MT]
      DARAPRIM                                 pyrimethamine                          2
      hydroxychloroquine sulfate tablet        PLAQUENIL                              1      [MT]
      MALARONE                                 atovaquone/proguanil hcl               2
      mefloquine hcl                           LARIAM                                 1      [MT]
      PRIMAQUINE                               primaquine                             2      [MT]

   QUINOLONES

      AVELOX                                   moxifloxacin                           2      [QL, 10/10]
      AVELOX ABC PACK                          moxifloxacin                           2
      ciprofloxacin 10 mg/ml vial, -400        CIPRO I.V.                             1
      mg/40 ml vl
      ciprofloxacin er                         CIPRO XR                               1
      ciprofloxacin hcl tablet                 CIPRO                                  1
      LEVAQUIN TABLET                          levofloxacin                           2
      ofloxacin tablet                         FLOXIN                                 1

                                                     14
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions

   SULFONAMIDES

      erythromycin-sulfisoxazole               PEDIAZOLE                              1
      sulfadiazine tablet                                                             1
      sulfamethoxazole-trimethoprim            BACTRIM                                1
      sulfatrim                                SEPTRA                                 1

   TETRACYCLINES

      demeclocycline hcl                       DECLOMYCIN                             1
      doxycycline hyclate 100 mg tab, -                                               1
      cap, -e.c. cap, -injection
      doxycycline monohydrate                  VIBRAMYCIN                             1
      doxycycline tablet                       VIBRAMYCIN                             1
      minocycline hcl cap, -tab sa, -tablet                                           1
      tetracycline hcl cap                                                            1

   TOPICAL ANTIBACTERIAL DRUGS

      gentamicin 0.1% ointment, -cream         GARAMYCIN                              1
      mupirocin oint                                                                  1
      silver sulfadiazine                      SILVADENE                              1
      ssd                                      SILVADENE                              1
      ssd af                                                                          1
      thermazene                               SILVADENE                              1

   TOPICAL ANTIFUNGAL-CORTICOSTEROID COMB.

      clotrimazole-betamethasone               LOTRISONE                              1
      nystatin-triamcinolone                   MYCOLOG II                             1

   URINARY ANTIINFECTIVES

      FURADANTIN                               nitrofurantoin                         2
      methenamine hippurate                    HIPREX                                 1
      trimethoprim tablet                      PROLOPRIM                              1




                                                     15
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   VAGINAL ANTIFUNGALS

      miconazole 3 200 mg vag supp             METROGEL-VAGINAL                       1      [QL, 3/3]
      terconazole 0.4% cream                   TERAZOL 7                              1      [QL, 45
                                                                                             gm/7]
      terconazole 0.8% cream                   TERAZOL 3                              1      [QL, 20
                                                                                             gm/3]
      terconazole 80 mg suppository            TERAZOL 3                              1      [QL, 3/3]

ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS
   ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS

      AFINITOR                                 everolimus                             4      [MT][PA]
      ALIMTA 500 MG VIAL                       pemetrexed disodium                    4      [PA]
      AMEVIVE [LA]                             alefacept                              4      [PA]
      amifostine                                                                      4      [PA]
      anagrelide hcl                           AGRYLIN                                1      [MT]
      anastrozole tablet                                                              1      [MT]
      ARIMIDEX                                 anastrozole                            2      [MT]
      AROMASIN                                 exemestane                             2      [MT]
      AVASTIN                                  bevacizumab                            2      [PA]
      AZASAN                                   azathioprine                           2      [MT][PA]
      azathioprine tablet                      IMURAN                                 1      [MT][PA]
      bicalutamide                             CASODEX                                1      [MT]
      CAMPATH                                  alemtuzumab                            4      [PA]
      CEENU                                    lomustine                              2
      CELLCEPT ORAL SUSP                       mycophenolate mofetil                  4      [MT][PA]
      cyclophosphamide tablet                  CYTOXAN                                1      [PA]
      cyclosporine cap, -solution                                                     1      [MT][PA]
      cyclosporine modified                    NEORAL                                 1      [MT][PA]
      DEPO-PROVERA 400 MG/ML VIAL              medroxyprogesterone                    2      [MT]
      ELIGARD                                  leuprolide                             2      [PA]
      ELITEK 1.5 MG VIAL                       rasburicase                            4      [PA]
      EMCYT                                    estramustine phosphate sodium          2
      ENBREL                                   etanercept                             4      [MT][PA]
      FARESTON                                 toremifene                             2      [MT]
      FEMARA                                   letrozole                              2      [MT]
      flutamide                                EULEXIN                                1      [MT]
      gengraf                                  NEORAL                                 1      [MT][PA]
      GLEEVEC                                  imatinib mesylate                      4      [MT]
                                                     16
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                         Brand/Generic Reference           Tier Restrictions
      HEXALEN                                  altretamine                            4
      HUMIRA                                   adalimumab                             4    [MT][PA]
      hydroxyurea cap                                                                 1    [MT]
      IRESSA [LA]                              gefitinib                              4
      leflunomide                              ARAVA                                  1    [MT][QL,
                                                                                           30/30]
      leucovorin calcium tablet                                                       1
      LEUKERAN                                 chlorambucil                           2
      LYSODREN                                 mitotane                               4
      MATULANE                                 procarbazine                           4
      megestrol acetate oral susp                                                     1    [MT]
      megestrol acetate tablet                 MEGACE                                 1
      mercaptopurine tablet                    PURINETHOL                             1
      MESNEX TABLET                            mesna                                  4
      methotrexate injection                   RHEUMATREX                             1    [PA]
      methotrexate tablet                      RHEUMATREX                             1    [MT][PA]
      mitoxantrone hcl injection               NOVANTRONE                             4    [MT][PA]
      mycophenolate mofetil cap                                                       1    [MT][PA]
      mycophenolate mofetil tablet             CELLCEPT                               4    [MT][PA]
      MYFORTIC                                 mycophenolate sodium                   2    [MT][PA]
      NEXAVAR [LA]                             sorafenib tosylate                     4
      NILANDRON                                nilutamide                             2    [MT]
      octreotide 1,000 mcg/ml vial, -acet      SANDOSTATIN                            4    [PA]
      500 mcg/ml amp, -acet 500 mcg/ml
      vl
      octreotide acet 100 mcg/ml amp, -        SANDOSTATIN                            4
      acet 200 mcg/ml vl
      octreotide acet 50 mcg/ml amp            SANDOSTATIN                            1
      octreotide acet 50 mcg/ml vial           SANDOSTATIN                            1      [PA]
      ORENCIA                                  abatacept/maltose                      4      [MT][PA]
      PROGRAF 0.5 MG CAPSULE, -1 MG            tacrolimus                             2      [MT][PA]
      CAPSULE
      PROGRAF 5 MG CAPSULE                     tacrolimus                             4      [MT][PA]
      RAPAMUNE                                 sirolimus                              2      [MT][PA]
      REMICADE                                 infliximab                             4      [MT][PA]
      REVLIMID [LA]                            lenalidomide                           4      [MT]
      RITUXAN                                  rituximab                              4      [PA]
      SANDOSTATIN LAR 10 MG KIT, -30           octreotide                             4      [MT][PA][QL,
      MG KIT                                                                                 1/28]
      SANDOSTATIN LAR 20 MG KIT                octreotide                             4      [MT][PA][QL,
                                                                                             2/28]
                                                     17
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier Restrictions
      SPRYCEL                                  dasatinib                              4    [MT]
      SUTENT                                   sunitinib malate                       4
      tacrolimus 0.5 mg capsule, -1 mg         PROGRAF                                1    [MT][PA]
      capsule
      tacrolimus 5 mg capsule                  PROGRAF                                4      [MT][PA]
      tamoxifen citrate tablet                 NOLVADEX                               1      [MT]
      TARCEVA                                  erlotinib hcl                          4      [MT]
      TARGRETIN CAP                            bexarotene                             4      [MT]
      TARGRETIN GEL                            bexarotene                             4
      TASIGNA                                  nilotinib hydrochloride                4      [MT]
      THIOGUANINE                              thioguanine                            2
      TRELSTAR DEPOT [LA]                      triptorelin pamoate                    2
      TRELSTAR LA [LA]                         triptorelin pamoate                    2
      tretinoin cap                                                                   4
      TYKERB                                   lapatinib ditosylate                   4      [MT]
      VELCADE                                  bortezomib                             4      [PA]
      VIDAZA                                   azacitidine                            4      [PA]
      VOTRIENT                                 pazopanib                              4      [PA][QL,
                                                                                             120/30]
      ZOLINZA                                  vorinostat                             4

AUTONOMIC AND CNS MEDICATIONS
   ANALGESICS

      butorphanol 1 mg/ml vial, -2 mg/ml       STADOL                                 1
      vial
      tramadol hcl tablet                      ULTRAM                                 1
      tramadol hcl-acetaminophen               ULTRACET                               1

   ANTIDEMENTIA DRUGS

      ARICEPT 10 MG TABLET, -5 MG              donepezil                              2      [MT][PA]
      TABLET
      ARICEPT ODT                              donepezil                              2      [MT][PA]
      EXELON                                   rivastigmine tartrate                  2      [MT][PA]
      galantamine hbr                          RAZADYNE                               1      [MT][PA]
      galantamine solution                     RAZADYNE                               1      [MT]
      NAMENDA 10 MG TABLET, -5 MG              memantine hcl                          2      [MT][PA]
      TABLET, -SOLUTION
      NAMENDA 5-10 MG TITRATION PK             memantine hcl                          2      [PA]

                                                     18
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier Restrictions
      rivastigmine                                                                    1    [MT]

   ANTIMANIA DRUGS

      lithium                                                                         1      [MT]
      lithium carbonate cap, -tab sa, -                                               1      [MT]
      tablet
      lithium citrate                                                                 1      [MT]

   ANTIPARKINSON ANTICHOLINERGIC DRUGS

      benztropine mesylate tablet              COGENTIN                               1      [MT]
      trihexyphenidyl hcl                      ARTANE                                 1      [MT]

   ANTIPSYCHOTIC DRUGS

      ABILIFY DISCMELT                         aripiprazole                           2      [MT][QL,
                                                                                             60/30][ST]
      ABILIFY INJECTION                        aripiprazole                           2      [ST]
      ABILIFY SOLUTION                         aripiprazole                           2      [MT][ST]
      ABILIFY TABLET                           aripiprazole                           2      [MT][QL,
                                                                                             30/30][ST]
      chlorpromazine hcl injection             THORAZINE                              1
      chlorpromazine hcl tablet                                                       1      [MT]
      clozapine                                CLOZARIL                               1      [MT]
      FANAPT 1 MG TABLET, -10 MG               iloperidone                            2      [MT][QL,
      TABLET, -12 MG TABLET, -2 MG                                                           60/30][ST]
      TABLET, -4 MG TABLET, -6 MG
      TABLET, -8 MG TABLET
      FANAPT TITRATION PACK                    iloperidone                            2      [QL,
                                                                                             1/30][ST]
      FAZACLO 100 MG ODT, -12.5 MG             clozapine                              2      [MT][ST]
      ODT, -25 MG ODT
      fluphenazine decanoate                   PROLIXIN DECANOATE                     1
      fluphenazine hcl elix, -tablet                                                  1      [MT]
      fluphenazine hcl injection, -solution                                           1
      GEODON CAP                               ziprasidone                            2      [MT][QL,
                                                                                             60/30][ST]
      GEODON INJECTION                         ziprasidone                            2      [ST]
      haloperidol decanoate                    HALDOL DECANOATE                       1      [MT]
      haloperidol lactate injection            HALDOL                                 1
                                                   19
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                      Drug                         Brand/Generic Reference            Tier Restrictions
      haloperidol lactate solution             HALDOL                                 1    [MT]
      haloperidol tablet                       HALDOL                                 1    [MT]
      INVEGA ER 1.5 MG TABLET, -ER 3           paliperidone                           2    [MT][QL,
      MG TABLET, -ER 9 MG TABLET                                                           30/30][ST]
      INVEGA ER 6 MG TABLET                    paliperidone                           2    [MT][QL,
                                                                                           60/30][ST]
      INVEGA SUSTENNA 117 MG PREF              paliperidone                           4    [MT][ST]
      SY, -156 MG PREF SY, -234 MG
      PREF SY
      INVEGA SUSTENNA 39 MG PREF               paliperidone                           2      [MT][ST]
      SYR, -78 MG PREF SYR
      loxapine                                 LOXITANE                               1      [MT]
      ORAP                                     pimozide                               2      [MT][ST]
      perphenazine                             TRILAFON                               1      [MT]
      RISPERDAL CONSTA 25 MG SYR               risperidone                            2      [MT][ST]
      RISPERDAL CONSTA 37.5 MG SYR,            risperidone                            4      [MT][ST]
      -50 MG SYR
      risperidone 0.25 mg odt, -1 mg odt       RISPERDAL                              1      [MT][QL,
                                                                                             60/30]
      risperidone 0.5 mg odt, -2 mg odt,       RISPERDAL                              1      [MT]
      -3 mg odt, -4 mg odt
      risperidone m-tab 0.5 mg odt, -2         RISPERDAL M-TAB                        1      [MT]
      mg odt, -3 mg odt, -4 mg odt
      risperidone m-tab 1 mg odt               RISPERDAL M-TAB                        1      [MT][QL,
                                                                                             60/30]
      risperidone solution                     RISPERDAL                              1      [MT][QL, 480
                                                                                             ml/30]
      risperidone tablet                       RISPERDAL                              1      [MT][QL,
                                                                                             60/30]
      SAPHRIS                                  asenapine                              2      [MT][QL,
                                                                                             60/30][ST]
      SEROQUEL 100 MG TABLET, -200             quetiapine fumarate                    2      [MT][QL,
      MG TABLET                                                                              90/30][ST]
      SEROQUEL 25 MG TABLET, -50 MG            quetiapine fumarate                    2      [MT][PA][QL,
      TABLET                                                                                 90/30]
      SEROQUEL 300 MG TABLET, -400             quetiapine fumarate                    2      [MT][QL,
      MG TABLET                                                                              60/30][ST]
      thioridazine hcl                         MELLARIL                               1      [MT][PA]
      thiothixene                              NAVANE                                 1      [MT]
      trifluoperazine hcl                      STELAZINE                              1      [MT]
      ZYPREXA INJECTION                        olanzapine                             2      [ST]

                                                     20
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                  Drug                             Brand/Generic Reference            Tier Restrictions
      ZYPREXA TABLET                           olanzapine                             2    [MT][QL,
                                                                                           30/30][ST]
      ZYPREXA ZYDIS                            olanzapine                             2    [MT][QL,
                                                                                           30/30][ST]

   ANTIVERTIGO AND ANTIEMETIC DRUGS

      compro                                   COMPAZINE                              1
      dronabinol 10 mg capsule, -5 mg          MARINOL                                4      [PA]
      capsule
      dronabinol 2.5 mg capsule                MARINOL                                1      [PA]
      EMEND 125 MG CAPSULE, -40 MG             aprepitant                             2      [PA][QL, 1/1]
      CAPSULE
      EMEND 80 MG CAPSULE                      aprepitant                             2      [PA][QL, 2/2]
      EMEND TRIFOLD PACK                       aprepitant                             2      [PA][QL, 3/3]
      granisetron hcl tablet                   KYTRIL                                 1      [PA][QL, 2/1]
      meclizine 12.5 mg tablet, -25 mg         ANTIVERT                               1
      tablet
      ondansetron hcl 24 mg tablet             ZOFRAN                                 1      [PA][QL, 1/1]
      ondansetron hcl 4 mg tablet, -8 mg       ZOFRAN                                 1      [PA][QL,
      tablet                                                                                 12/5]
      ondansetron hcl 4 mg/2 ml vial, -40      ZOFRAN                                 1
      mg/20 ml vial
      ondansetron hcl solution                 ZOFRAN                                 1      [PA][QL, 150
                                                                                             ml/5]
      ondansetron odt                          ZOFRAN ODT                             1      [PA][QL,
                                                                                             12/5]
      phenadoz                                 PHENERGAN                              1
      prochlorperazine edisylate               COMPAZINE                              1
      prochlorperazine maleate rectal, -                                              1
      tablet

   ANXIOLYTICS

      buspirone hcl tablet                     BUSPAR                                 1      [MT]
      meprobamate                              MILTOWN                                1      [PA]

   CARBAMAZEPINES

      carbamazepine chew tab, -oral                                                   1      [MT]
      susp, -tablet
                                                     21
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                    Drug                           Brand/Generic Reference            Tier    Restrictions
      carbamazepine xr                         TEGRETOL XR                            1      [MT]
      epitol                                   TEGRETOL                               1      [MT]
      oxcarbazepine                            TRILEPTAL                              1      [MT]
      TEGRETOL                                 carbamazepine                          2      [MT]
      TEGRETOL XR                              carbamazepine                          2      [MT]
      TRILEPTAL SUSPENSION                     oxcarbazepine                          2      [MT]

   CLASS II NARCOTICS

      DEMEROL 75 MG/ML SYRINGE                 meperidine                             2
      endocet                                  PERCOCET                               1
      endodan                                  PERCODAN                               1
      fentanyl                                 DURAGESIC                              1      [PA][QL,
                                                                                             10/30]
      fentanyl 0.05 mg/ml syringe              FENTANYL CITRATE                       1
      fentanyl cit otfc 1,200 mcg, -otfc       ACTIQ                                  4      [PA][QL,
      200 mcg, -otfc 400 mcg, -otfc 600                                                      120/30]
      mcg, -otfc 800 mcg
      fentanyl cit otfc 1,600 mcg              ACTIQ                                  4      [PA]
      hydromorphone hcl 10 mg/ml amp,          DILAUDID                               1
      -tablet
      levorphanol tartrate tablet              LEVO-DROMORAN                          1
      methadone hcl 10 mg tablet, -5 mg        DOLOPHINE HCL                          1
      tablet, -injection, -soln., oral conc.
      methadose 10 mg tablet, -5 mg                                                   1
      tablet
      morphine 0.5 mg/ml vial, -1 mg/ml                                               1
      vial, -1 mg/ml vial p-f, -5 mg/ml
      vial, -solution, -tab sa, -tablet
      oxycodone hcl cap, -tablet                                                      1
      oxycodone hcl-acetaminophen              PERCOCET                               1
      oxycodone hcl-ibuprofen                  COMBUNOX                               1
      oxycodone-acetaminophen                  PERCOCET                               1
      oxycodone-aspirin                        PERCODAN                               1
      roxicet tablet                           PERCOCET                               1

   CLASS III NARCOTICS

      acetaminophen-codeine                    TYLENOL-CODEINE                        1
      apap-caffeine-dihydrocodeine             PANLOR SS                              1
      co-gesic                                 LORTAB                                 1
                                                   22
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                    Drug                          Brand/Generic Reference             Tier Restrictions
      hydrocodone bit-ibuprofen                VICOPROFEN                             1
      hydrocodone-acetaminophen                LORCET 10-650                          1
      margesic h                               POLYGESIC                              1
      stagesic                                 POLYGESIC                              1
      SUBOXONE TAB, SL                         buprenorphine/naloxone                 2    [QL, 90/30]

   CNS STIMULANT DRUGS

      dextroamphetamine sulfate cap sa                                                1      [MT]
      metadate er 20 mg tablet                 RITALIN-SR                             1      [MT]
      PROVIGIL                                 modafinil                              2      [MT][PA]

   DRUGS TO PREVENT AND TREAT HEADACHES

      ascomp with codeine                      FIORINAL WITH CODEINE #3               1
      butalbital compound-codeine              FIORINAL WITH CODEINE                  1
      butalbital-caff-apap-codeine             FIORICET WITH CODEINE                  1
      butorphanol tartrate aerosol                                                    1      [QL, 5 ml/3]
      ergotamine-caffeine                      CAFERGOT                               1      [PA]
      MAXALT                                   rizatriptan benzoate                   2      [QL, 27/28]
      MAXALT MLT                               rizatriptan benzoate                   2      [QL, 27/28]
      sumatriptan 4 mg/0.5 ml kit, -4          IMITREX                                1      [QL, 8/28]
      mg/0.5 ml refill, -4 mg/0.5 ml
      syrng, -6 mg/0.5 ml kit, -6 mg/0.5
      ml refill, -6 mg/0.5 ml syrng
      sumatriptan 4 mg/0.5 ml vial, -6         IMITREX                                1      [QL, 8 ml/28]
      mg/0.5 ml vial
      sumatriptan succinate tablet             IMITREX                                1      [QL, 18/28]

   HYDANTOINS

      DILANTIN 100 MG CAPSULE, -30             phenytoin                              2      [MT]
      MG CAPSULE, -CHEW TAB
      DILANTIN-125                             phenytoin sodium                       2      [MT]
      fosphenytoin 100 mg pe/2 ml vl           CEREBYX                                1      [PA]
      fosphenytoin 500 mg pe/10 ml             CEREBYX                                1
      PEGANONE                                 ethotoin                               2
      phenytoin 50 mg/ml ampul                 PHENYTOIN SODIUM                       1
      phenytoin oral susp                                                             1      [MT]
      phenytoin sod ext 100 mg cap             DILANTIN                               1      [MT]

                                                     23
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions

   MAO INHIBITORS

      EMSAM                                    selegiline                             2
      MARPLAN                                  isocarboxazid                          2      [MT]
      NARDIL                                   phenelzine                             2      [MT]
      tranylcypromine sulfate                  PARNATE                                1      [MT]

   OTHER ANTICONVULSANTS

      BANZEL 200 MG TABLET                     rufinamide                             2      [MT]
      BANZEL 400 MG TABLET                     rufinamide                             4      [MT]
      FELBATOL                                 felbamate                              2      [MT]
      gabapentin cap, -tablet                                                         1      [MT]
      GABITRIL                                 tiagabine                              2      [MT]
      KEPPRA INJECTION                         levetiracetam                          2
      lamotrigine 100 mg tablet, -150 mg       LAMICTAL                               1      [MT]
      tablet, -200 mg tablet, -25 mg
      disper tab, -25 mg tablet, -5 mg
      disper tablet
      lamotrigine tablet starter kit           LAMICTAL                               1
      levetiracetam injection                  KEPPRA                                 1
      levetiracetam solution, -tablet          KEPPRA                                 1      [MT]
      LYRICA                                   pregabalin                             2      [MT][ST]
      NEURONTIN SOLUTION                       gabapentin                             2      [MT]
      primidone                                MYSOLINE                               1      [MT]
      SABRIL PWD [LA]                          vigabatrin                             4      [MT]
      SABRIL TABLET [LA]                       vigabatrin                             4
      topiragen                                TOPAMAX                                1      [MT]
      topiramate sprinkle, -tablet                                                    1      [MT]
      VIMPAT INJECTION                         lacosamide                             2
      VIMPAT SOLUTION, -TABLET                 lacosamide                             2      [MT]
      zonisamide                               ZONEGRAN                               1      [MT]

   OTHER ANTIDEPRESSANTS

      amitriptyline-chlordiazepoxide           LIMBITROL                              1      [MT]
      budeprion sr                             WELLBUTRIN SR                          1      [MT][QL,
                                                                                             60/30]


                                                     24
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                       Brand/Generic Reference             Tier Restrictions
      budeprion xl                             WELLBUTRIN XL                          1    [MT][QL,
                                                                                           30/30]
      bupropion hcl                            WELLBUTRIN                             1    [MT]
      bupropion hcl sr                         WELLBUTRIN SR                          1    [MT][QL,
                                                                                           60/30]
      bupropion xl                             WELLBUTRIN XL                          1    [MT][QL,
                                                                                           90/90]
      CYMBALTA 20 MG CAPSULE                   duloxetine                             2    [MT][QL,
                                                                                           60/30][ST]
      CYMBALTA 30 MG CAPSULE, -60              duloxetine                             2    [MT][QL,
      MG CAPSULE                                                                           30/30][ST]
      maprotiline hcl                          LUDIOMIL                               1    [MT]
      mirtazapine                              REMERON                                1    [MT]
      nefazodone hcl                           SERZONE                                1    [MT]
      perphenazine-amitriptyline               TRIAVIL 25-4                           1    [MT]
      PRISTIQ                                  desvenlafaxine succinate               2    [MT][ST]
      SAVELLA 100 MG TABLET, -12.5             milnacipran hcl                        2    [MT][QL,
      MG TABLET, -25 MG TABLET, -50                                                        60/30]
      MG TABLET
      SAVELLA TITRATION PACK                   milnacipran hcl                        2      [QL, 1/30]
      trazodone hcl tablet                     DESYREL                                1      [MT]
      venlafaxine hcl                          EFFEXOR                                1      [MT]

   OTHER ANTIPARKINSON DRUGS

      APOKYN [LA]                              apomorphine hcl                        4      [MT]
      bromocriptine mesylate cap, -tablet                                             1      [MT]
      carbidopa-levodopa                       PARCOPA                                1      [MT]
      COMTAN                                   entacapone                             2      [MT]
      MIRAPEX ER                               pramipexole                            3      [MT]
      pramipexole dihydrochloride              MIRAPEX                                1      [MT]
      ropinirole hcl                           REQUIP                                 1      [MT]
      selegiline hcl cap, -tablet                                                     1      [MT]
      STALEVO 100                              carbidopa/levodopa/entacap             2      [MT]
      STALEVO 125                              carbidopa/levodopa/entacap             2      [MT]
      STALEVO 150                              carbidopa/levodopa/entacap             2      [MT]
      STALEVO 200                              carbidopa/levodopa/entacap             2      [MT]
      STALEVO 50                               carbidopa/levodopa/entacap             2      [MT]
      STALEVO 75                               carbidopa/levodopa/entacap             2      [MT]
      TASMAR 100 MG TABLET                     tolcapone                              2      [MT]

                                                     25
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   OTHER CNS/AUTONOMIC DRUGS

      ANTABUSE                                 disulfiram                             2      [MT]
      depade                                   REVIA                                  1
      guanidine hcl                                                                   1
      INTUNIV                                  guanfacine                             2      [MT]
      MESTINON TAB SA                          pyridostigmine                         2      [MT]
      naloxone 0.4 mg/ml ampul, -0.4           NARCAN                                 1
      mg/ml syringe, -0.4 mg/ml vial, -1
      mg/ml syringe
      naltrexone hcl tablet                    REVIA                                  1
      pyridostigmine bromide                   MESTINON                               1      [MT]
      STRATTERA                                atomoxetine                            2      [MT][PA][QL,
                                                                                             60/30]
      XENAZINE [LA]                            tetrabenazine                          4      [MT][PA]
      XYREM [LA]                               sodium oxybate                         4

   SECONDARY AMINES

      amoxapine                                AMOXAPINE                              1      [MT]
      desipramine hcl                          NORPRAMIN                              1      [MT]
      nortriptyline hcl cap, -solution                                                1      [MT]
      protriptyline hcl                        VIVACTIL                               1      [MT]

   SEDATIVE/HYPNOTIC DRUGS

      ROZEREM                                  ramelteon                              2      [QL,
                                                                                             21/30][ST]
      zaleplon                                 SONATA                                 1      [QL, 21/30]
      zolpidem tartrate                        AMBIEN                                 1      [QL, 21/30]

   SELECTIVE SEROTONIN REUPTAKE INHIBITORS

      Citalopram solution                      CELEXA                                 1      [MT]
      citalopram hbr                           CELEXA                                 1      [MT][QL,
                                                                                             30/30]
      fluoxetine dr                            PROZAC                                 1      [MT][QL,
                                                                                             4/30]
      fluoxetine hcl 10 mg capsule, -10        PROZAC                                 1      [MT][QL,
      mg tablet                                                                              30/30]

                                                     26
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                      Drug                        Brand/Generic Reference             Tier Restrictions
      fluoxetine hcl 20 mg capsule, -20        PROZAC                                 1    [MT]
      mg tablet, -solution
      fluoxetine hcl 40 mg capsule             PROZAC                                 1      [MT][QL,
                                                                                             60/30]
      fluvoxamine maleate 100 mg tab           LUVOX                                  1      [MT][QL,
                                                                                             90/30]
      fluvoxamine maleate 25 mg tab            LUVOX                                  1      [MT][QL,
                                                                                             30/30]
      fluvoxamine maleate 50 mg tab            LUVOX                                  1      [MT][QL,
                                                                                             60/30]
      paroxetine cr 12.5 mg tablet             PAXIL CR                               1      [MT][QL,
                                                                                             180/30]
      paroxetine cr 25 mg tablet               PAXIL CR                               1      [MT][QL,
                                                                                             90/30]
      paroxetine hcl 10 mg tablet, -40 mg      PAXIL                                  1      [MT][QL,
      tablet                                                                                 30/30]
      paroxetine hcl 20 mg tablet, -30 mg      PAXIL                                  1      [MT][QL,
      tablet                                                                                 60/30]
      paroxetine hcl oral susp                                                        1      [MT]
      sertraline hcl 100 mg tablet, -50 mg     ZOLOFT                                 1      [MT][QL,
      tablet                                                                                 60/30]
      sertraline hcl 25 mg tablet              ZOLOFT                                 1      [MT][QL,
                                                                                             30/30]
      sertraline hcl solution                  ZOLOFT                                 1      [MT]

   SMOKING CESSATION PRODUCTS

      buproban                                 ZYBAN                                  1
      CHANTIX                                  varenicline tartrate                   2      [PA]
      NICOTROL                                 nicotine inhaler                       2
      NICOTROL NS                              nicotine ns                            2

   SUCCINIMIDES

      CELONTIN                                 methsuximide                           2      [MT]
      ethosuximide                             ZARONTIN                               1      [MT]

   TERTIARY AMINES

      amitriptyline hcl tablet                 ELAVIL                                 1      [MT]
      clomipramine hcl cap                                                            1      [MT]
                                                     27
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                     Drug                         Brand/Generic Reference             Tier Restrictions
      doxepin 10 mg capsule, -100 mg           SINEQUAN                               1    [MT]
      capsule, -25 mg capsule, -50 mg
      capsule, -75 mg capsule, -solution
      imipramine hcl tablet                    TOFRANIL                               1      [MT]
      imipramine pamoate                       TOFRANIL-PM                            1      [MT]
      SURMONTIL                                trimipramine                           2      [MT]

   VALPROIC ACID AND DERIVATIVES

      DEPAKENE                                 valproic acid                          2      [MT]
      divalproex sodium                        DEPAKOTE                               1      [MT]
      divalproex sodium er                     DEPAKOTE ER                            1      [MT]
      valproate sodium injection                                                      1
      valproic acid cap, -syrup                                                       1      [MT]

CARDIOVASCULAR MEDICATIONS
   AMIODARONES

      amiodarone hcl tablet                    CORDARONE                              1      [CG][MT]
      pacerone 200 mg tablet                   CORDARONE                              1      [CG][MT]

   ANGIOTENSIN CONVERTING ENZYME INHIBITORS

      ACEON                                    perindopril erbumine                   3      [MT]
      benazepril hcl                           LOTENSIN                               1      [CG][MT]
      captopril tablet                         CAPOTEN                                1      [CG][MT]
      enalapril maleate tablet                 VASOTEC                                1      [CG][MT]
      fosinopril sodium                        MONOPRIL                               1      [CG][MT]
      lisinopril tablet                        PRINIVIL                               1      [CG][MT]
      moexipril hcl                            UNIVASC                                1      [CG][MT]
      perindopril erbumine                     ACEON                                  1      [CG][MT]
      quinapril hcl                            ACCUPRIL                               1      [CG][MT]
      ramipril                                 ALTACE                                 1      [CG][MT]
      trandolapril                             MAVIK                                  1      [CG][MT]

   ANGIOTENSIN II RECEPTOR ANTAGONISTS

      ATACAND                                  candesartan cilexetil                  3      [MT][QL,
                                                                                             30/30][ST]


                                                     28
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier Restrictions
      AVAPRO                                   irbesartan                             2    [MT][QL,
                                                                                           30/30][ST]
      BENICAR                                  olmesartan medoxomil                   3    [MT][QL,
                                                                                           30/30][ST]
      COZAAR                                   losartan                               3    [MT][QL,
                                                                                           30/30][ST]
      DIOVAN                                   valsartan                              3    [MT][QL,
                                                                                           30/30][ST]
      losartan potassium                       COZAAR                                 1    [MT][QL,
                                                                                           30/30]
      MICARDIS                                 telmisartan                            3    [MT][QL,
                                                                                           30/30][ST]
      TEVETEN                                  eprosartan mesylate                    3    [MT][QL,
                                                                                           30/30][ST]

   ANTIDYSRHYTHMIC DRUGS

      flecainide acetate                       TAMBOCOR                               1      [CG][MT]
      mexiletine hcl cap                                                              1      [CG][MT]
      procainamide 500 mg/ml vial                                                     1      [CG]
      propafenone hcl                          RYTHMOL                                1      [CG][MT]
      quinidine gluconate tab sa                                                      1      [CG][MT]
      quinidine sulfate tab sa, -tablet                                               1      [CG][MT]

   BETA-ADRENERGIC ANTAGONIST DRUGS

      acebutolol hcl cap                                                              1      [CG][MT]
      atenolol tablet                          TENORMIN                               1      [CG][MT]
      betaxolol hcl tablet                     KERLONE                                1      [CG][MT]
      bisoprolol fumarate                      ZEBETA                                 1      [CG][MT]
      carvedilol                               COREG                                  1      [CG][MT]
      INNOPRAN XL                              propranolol                            3      [MT]
      labetalol hcl 5 mg/ml vial               TRANDATE                               1      [CG]
      labetalol hcl tablet                     TRANDATE                               1      [CG][MT]
      metoprolol succinate                     TOPROL XL                              1      [CG][MT]
      metoprolol tart 1 mg/ml vial, -tart 5    LOPRESSOR                              1      [CG]
      mg/5 ml vial
      metoprolol tartrate tablet               LOPRESSOR                              1      [CG][MT]
      nadolol tablet                           CORGARD                                1      [CG][MT]
      pindolol                                 VISKEN                                 1      [CG][MT]
      propranolol 1 mg/ml vial                 INDERAL                                1      [CG]
                                                    29
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                      Drug                        Brand/Generic Reference             Tier Restrictions
      propranolol hcl cap sa, -solution, -     INDERAL                                1    [CG][MT]
      tablet
      timolol maleate tablet                   BLOCADREN                              1      [CG][MT]
      TOPROL XL                                metoprolol succinate                   3      [MT]

   CALCIUM ANTAGONISTS

      afeditab cr                              ADALAT CC                              1      [CG][MT]
      amlodipine besylate                      NORVASC                                1      [CG][MT]
      cartia xt                                CARDIZEM CD                            1      [CG][MT]
      dilt-cd                                  CARDIZEM CD                            1      [CG][MT]
      diltia xt                                                                       1      [CG][MT]
      diltiazem 125 mg/25 ml vial, -25                                                1      [CG]
      mg/5 ml vial, -5 mg/ml vial, -50
      mg/10 ml vial
      diltiazem 24hr er cap sa                                                        1      [CG][MT]
      diltiazem 24hr er tab sa                                                        1      [CG][MT]
      diltiazem er                             CARDIZEM CD                            1      [CG][MT]
      diltiazem hcl tablet                     CARDIZEM                               1      [CG][MT]
      dilt-xr                                  DILACOR XR                             1      [CG][MT]
      diltzac er                               TIAZAC                                 1      [CG][MT]
      felodipine er                            PLENDIL                                1      [CG][MT]
      isradipine                               DYNACIRC                               1      [CG][MT]
      nicardipine hcl cap                                                             1      [CG][MT]
      nifediac cc                              ADALAT CC                              1      [CG][MT]
      nifedical xl                             PROCARDIA XL                           1      [CG][MT]
      nifedipine er                            PROCARDIA XL                           1      [CG][MT]
      nimodipine                               NIMOTOP                                4
      nisoldipine er 20 mg tablet, -er 30                                             1      [CG][MT]
      mg tablet, -er 40 mg tablet
      taztia xt                                TIAZAC                                 1      [CG][MT]
      verapamil er                             VERELAN PM                             1      [CG][MT]
      verapamil hcl cap sa, -tab sa, -                                                1      [CG][MT]
      tablet

   CARDIAC GLYCOSIDES

      digoxin 0.25 mg/ml ampul                 LANOXIN                                1      [CG]
      digoxin solution, -tablet                LANOXIN                                1      [CG][MT]
      LANOXIN TABLET                           digoxin                                2      [MT]

                                                     30
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions

   CENTRALLY ACTING ANTIHYPERTENSIVES

      clonidine hcl tablet                                                            1      [CG][MT]
      guanabenz acetate                                                               1      [CG][MT]
      guanfacine hcl                           TENEX                                  1      [CG][MT]
      methyldopa                               ALDOMET                                1      [CG][MT]
      methyldopate hcl                         ALDOMET                                1      [CG]

   DRUGS FOR PHEOCHROMOCYTOMA

      DEMSER                                   metyrosine                             2
      DIBENZYLINE                              phenoxybenzamine                       2

   ENDOTHELIN RECPTR ANTAGONIST

      LETAIRIS [LA]                            ambrisentan                            4      [MT][PA]
      TRACLEER [LA]                            bosentan                               4      [MT][PA]

   HMG-COA REDUCTASE INHIBITORS

      CRESTOR                                  rosuvastatin calcium                   2      [MT][QL,
                                                                                             30/30][ST]
      LIPITOR                                  atorvastatin calcium                   3      [MT][QL,
                                                                                             30/30][ST]
      lovastatin 10 mg tablet                  MEVACOR                                1      [CG][MT][QL,
                                                                                             30/30]
      lovastatin 20 mg tablet, -40 mg          MEVACOR                                1      [CG][MT][QL,
      tablet                                                                                 60/30]
      pravastatin sodium                       PRAVACHOL                              1      [CG][MT][QL,
                                                                                             30/30]
      simvastatin tablet                                                              1      [CG][MT][QL,
                                                                                             30/30]
      VYTORIN                                  ezetimibe/simvastatin                  2      [MT][QL,
                                                                                             30/30][ST]

   HYPOLIPOPROTEINEMICS

      cholestyramine                           QUESTRAN                               1      [CG][MT]
      cholestyramine light                     QUESTRAN LIGHT                         1      [CG][MT]

                                                     31
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier    Restrictions
      colestipol hcl                           COLESTID                               1      [CG][MT]
      fenofibrate                              LOFIBRA                                1      [CG][MT]
      gemfibrozil                              LOPID                                  1      [CG][MT]
      NIASPAN                                  niacin                                 2      [MT]
      prevalite                                QUESTRAN LIGHT                         1      [CG][MT]
      TRICOR                                   fenofibrate                            2      [MT][ST]
      TRILIPIX                                 fenofibric acid                        2      [MT][ST]
      ZETIA                                    ezetimibe                              2      [MT][ST]

   LOOP DIURETICS

      bumetanide injection                     BUMEX                                  1      [CG]
      bumetanide tablet                        BUMEX                                  1      [CG][MT]
      furosemide 10 mg/ml vial                 FUROSEMIDE                             1      [CG]
      furosemide solution, -tablet             LASIX                                  1      [CG][MT]
      torsemide tablet                         DEMADEX                                1      [CG][MT]

   NITRATES

      isosorbide dinitrate                     ISOCHRON                               1      [CG][MT]
      isosorbide mononitrate                   MONOKET                                1      [CG][MT]
      nitro-bid                                NITROGLYCERIN                          1      [CG][MT]
      nitroglycerin patch                      MINITRAN                               1      [CG][MT]
      nitroglycerin tab, sl                                                           1      [CG][MT]
      nitroquick                                                                      1      [CG][MT]
      NITROSTAT                                nitroglycerin                          2      [MT]

   OTHER ANTIARRHYTHMICS

      sorine                                   BETAPACE                               1      [CG][MT]
      sotalol                                  BETAPACE                               1      [CG][MT]
      TIKOSYN                                  dofetilide                             2      [MT]

   OTHER ANTIHYPERTENSIVES

      amlodipine besylate-benazepril           LOTREL                                 1      [CG][MT]
      ATACAND HCT                              candesartan cilexetil/hctz             3      [MT][QL,
                                                                                             30/30][ST]
      atenolol-chlorthalidone                  TENORETIC                              1      [CG][MT]

                                                     32
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier Restrictions
      AVALIDE                                  irbesartan/hctz                        2    [MT][QL,
                                                                                           30/30][ST]
      benazepril-hydrochlorothiazide           LOTENSIN HCT                           1    [CG][MT]
      BENICAR HCT                              olmesartan medoxomil/hctz              3    [MT][QL,
                                                                                           30/30][ST]
      bisoprolol-hydrochlorothiazide           ZIAC                                   1    [CG][MT]
      captopril-hydrochlorothiazide            CAPOZIDE                               1    [CG][MT]
      DIOVAN HCT                               hctz/valsartan                         3    [MT][QL,
                                                                                           30/30][ST]
      enalapril-hydrochlorothiazide            VASERETIC                              1    [CG][MT]
      fosinopril-hydrochlorothiazide           MONOPRIL HCT                           1    [CG][MT]
      hydra-zide                                                                      1    [CG][MT]
      HYZAAR                                   losartan /hctz                         3    [MT][QL,
                                                                                           30/30][ST]
      lisinopril-hydrochlorothiazide           PRINZIDE                               1    [CG][MT]
      losartan-hydrochlorothiazide             HYZAAR                                 1    [MT][QL,
                                                                                           30/30]
      methyldopa-hydrochlorothiazide           ALDORIL                                1    [CG][MT]
      metoprolol-hydrochlorothiazide           LOPRESSOR HCT                          1    [CG][MT]
      MICARDIS HCT                             telmisartan/hctz                       3    [MT][QL,
                                                                                           30/30][ST]
      moexipril-hydrochlorothiazide            UNIRETIC                               1    [CG][MT]
      nadolol-bendroflumethiazide              CORZIDE                                1    [CG][MT]
      propranolol-hydrochlorothiazid           INDERIDE-80/25                         1    [CG][MT]
      quinapril-hydrochlorothiazide            ACCURETIC                              1    [CG][MT]
      reserpine                                                                       1    [CG][MT]
      TEVETEN HCT                              eprosartan mesylate/hctz               3    [MT][QL,
                                                                                           30/30][ST]
      trandolapr-verapam er 2-180 mg, -        TARKA                                  1    [MT]
      er 2-240 mg, -er 4-240 mg

   OTHER CARDIOVASCULAR DRUGS

      midodrine hcl                            PROAMATINE                             1      [CG]
      pentopak                                 TRENTAL                                1      [CG][MT]
      pentoxifylline tab sa                                                           1      [CG][MT]
      RANEXA                                   ranolazine                             2      [MT][PA]




                                                     33
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   OTHER VASODILATING DRUGS

      ADCIRCA                                  adcirca (tadalafil)                    4      [MT][PA][QL,
                                                                                             60/30]
      REVATIO TABLET                           revatio (sildenafil citrate)           4      [PA][QL,
                                                                                             90/30]

   POTASSIUM SPARING DIURETICS

      amiloride hcl tablet                     MIDAMOR                                1      [CG][MT]
      amiloride-hydrochlorothiazide            MODURETIC                              1      [CG][MT]
      eplerenone                               INSPRA                                 1      [CG][MT]
      spironolactone tablet                    ALDACTONE                              1      [CG][MT]
      spironolactone-hctz                      ALDACTAZIDE                            1      [CG][MT]
      triamterene-hctz                         MAXZIDE                                1      [CG][MT]

   THIAZIDE AND RELATED DRUGS

      chlorothiazide                           DIURIL                                 1      [CG][MT]
      chlorthalidone                                                                  1      [CG][MT]
      hydrochlorothiazide cap, -tablet                                                1      [CG][MT]
      indapamide                               LOZOL                                  1      [CG][MT]
      methyclothiazide tablet                  ENDURON                                1      [CG][MT]
      metolazone                               ZAROXOLYN                              1      [CG][MT]

   VASODILATOR ANTIHYPERTENSIVES

      CARDURA XL                               doxazosin                              3      [MT][QL,
                                                                                             30/30]
      doxazosin mesylate 1 mg tab, -2          CARDURA                                1      [CG][MT][QL,
      mg tab, -4 mg tab                                                                      30/30]
      doxazosin mesylate 8 mg tab              CARDURA                                1      [CG][MT][QL,
                                                                                             60/30]
      hydralazine hcl injection                APRESOLINE                             1      [CG]
      hydralazine hcl tablet                   APRESOLINE                             1      [CG][MT]
      minoxidil tablet                         LONITEN                                1      [CG][MT]
      prazosin hcl                             MINIPRESS                              1      [CG][MT]
      terazosin 1 mg capsule, -2 mg            HYTRIN                                 1      [CG][MT][QL,
      capsule, -5 mg capsule                                                                 30/30]


                                                     34
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                     Drug                         Brand/Generic Reference             Tier Restrictions
      terazosin 10 mg capsule                  HYTRIN                                 1    [CG][MT][QL,
                                                                                           60/30]

DERMATOLOGICAL MEDICATIONS
   ANTIACNE DRUGS

      clinda-derm                              CLEOCIN                                1
      clindamycin phosphate foam (non-                                                1
      contraceptive), -gel, -lotion, -soln,
      top, -swabs, applicators
      ery                                      ERYCETTE                               1
      erythromycin gel, -soln, top                                                    1
      erythromycin-benzoyl peroxide            BENZAMYCIN                             1
      metronidazole cream, -gel, -lotion       METROCREAM, METROGEL,                  1
                                               METROLOTION
      sodium sulfacetamide-sulfur foam                                                1
      (non-contraceptive)
      tretinoin 0.025% cream, -0.05%           AVITA, RETIN-A                         1      [PA]
      cream, -0.1% cream, -gel
      vitazol                                                                         1

   ANTIPRURITIC DRUGS

      hydroxyzine hcl injection, -tablet       VISTARIL                               1

   ANTIPSORIASIS AND ANTIECZEMA DRUGS

      calcipotriene                            DOVONEX                                1
      DOVONEX CREAM                            calcipotriene                          2
      selenium sulfide 2.5% lotion, -sulf                                             1
      2.5% shampoo
      sulfacetamide sod 10% top susp, -                                               1
      sulfacetamide 10% lot
      TAZORAC                                  tazarotene                             2      [PA]
      VECTICAL                                 calcitriol                             2

   KERATOLYTIC DRUGS

      CONDYLOX GEL                             podofilox                              2
      podofilox                                CONDYLOX                               1

                                                     35
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   ORAL DERMATOLOGICAL DRUGS

      8-MOP                                    methoxsalen                            4
      amnesteem                                ACCUTANE                               1
      claravis                                 ACCUTANE                               1
      OXSORALEN-ULTRA                          methoxsalen                            4
      sotret                                   ACCUTANE                               1

   SCABICIDES

      acticin                                  ELIMITE                                1
      EURAX                                    crotamiton                             2
      permethrin cream                         ELIMITE                                1

   TOPICAL CORTICOSTEROID DRUGS

      alclometasone dipropionate               ACLOVATE                               1
      amcinonide                               CYCLOCORT                              1
      betamethasone dipropionate cream,                                               1
      -dp aug 0.05% lot, -gel, -oint
      betamethasone valerate cream, -                                                 1
      lotion, -oint
      beta-val                                                                        1
      clobetasol emollient                     TEMOVATE EMOLLIENT                     1
      clobetasol propionate cream, -foam                                              1
      (non-contraceptive), -gel, -oint, -
      soln, top
      cormax oint, -soln, top                                                         1
      desonide cream, -lotion, -oint                                                  1
      desoximetasone cream, -gel, -oint                                               1
      diflorasone diacetate                    PSORCON                                1
      fluocinolone acetonide cream, -oint,                                            1
      -soln, top
      fluocinonide cream, -gel, -oint, -                                              1
      soln, top
      fluocinonide emollient                   LIDEX-E                                1
      fluocinonide-e                           LIDEX-E                                1
      fluticasone propionate cream, -oint                                             1
      halobetasol propionate                   ULTRAVATE                              1


                                                     36
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                      Drug                         Brand/Generic Reference            Tier   Restrictions
      hydrocortisone 1% absorbase, -1%                                                1
      cream, -1% lotion, -1% oin, -1%
      oint, -1% ointment, -2.5% cream, -
      2.5% lotion, -2.5% ointment, -aloe
      1% cream, -plus 1% cream
      hydrocortisone butyrate                  LOCOID                                 1
      hydrocortisone valerate                  WESTCORT                               1
      mometasone furoate                       ELOCON                                 1
      prednicarbate                            DERMATOP                               1
      triamcinolone acetonide cream, -                                                1
      lotion, -oint
      triderm                                  KENALOG                                1

   TOPICAL DERMATOLOGICAL DRUGS

      ammonium lactate 12% cream, -            LAC-HYDRIN                             1
      12% lotion
      ELIDEL                                   pimecrolimus                           2      [ST]
      FLUOROPLEX                               fluorouracil                           2
      fluorouracil cream, -soln, top                                                  1
      imiquimod                                ALDARA                                 1
      keratol 40 gel                                                                  1
      PANRETIN                                 alitretinoin                           4
      PROTOPIC                                 tacrolimus                             2      [ST]
      REGRANEX                                 becaplermin                            2      [PA][QL, 30
                                                                                             gm/30]
      SANTYL                                   collagenase                            2
      SOLARAZE                                 diclofenac sodium                      2      [PA]
      urea 35% lotion, -40% cream, -                                                  1
      40% gel, -40% lotion, -45% cream,
      -50% cream, -50% nail gel, -oint
      urealac cream, -lotion                                                          1
      ZONALON                                  doxepin                                2

DIAGNOSTIC AND MISCELLANEOUS MEDICATIONS
   DIAGNOSTIC PRODUCTS

      CHEMET                                   succimer                               2
      EXJADE [LA]                              deferasirox                            4      [MT]
      THIOLA                                   tiopronin                              2

                                                     37
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   MISCELLANEOUS DRUGS

      ADAGEN [LA]                              pegademase bovine                      4
      aminocaproic acid tablet                                                        1
      BUPHENYL                                 sodium phenylbutyrate                  4
      COPAXONE                                 glatiramer acetate                     4      [MT][PA][QL,
                                                                                             30 ml/30]
      CYKLOKAPRON                              tranexamic acid                        2
      ergoloid mesylates tablet                                                       1      [MT][PA]
      fomepizole                               ANTIZOL                                1      [PA]
      ORFADIN [LA]                             nitisinone                             4      [MT]
      THALOMID                                 thalidomide                            4      [MT]

EAR-NOSE-THROAT MEDICATIONS
   DRUGS AFFECTING THE EAR

      a-b otic                                                                        1
      acetasol hc                              VOSOL HC                               1
      acetic acid otic drops                                                          1
      acetic acid-aluminum                     DOMEBORO                               1
      acetic acid-hydrocortisone               VOSOL HC                               1
      antipyrine-benzocaine                                                           1
      aurodex ear drops                                                               1
      auroguard                                                                       1
      borofair                                 DOMEBORO                               1
      CIPRODEX                                 ciprofloxacin/dexameth                 2
      cortomycin otic drops, -                                                        1
      suspensions, (not oral)
      DERMOTIC                                 fluocinolone acetonide                 2
      neomycin-polymyxin-hc otic drops,                                               1
      -solution, -suspensions, (not oral)
      ofloxacin otic drops                                                            1
      oticin hc suspensions, (not oral)                                               1

   DRUGS AFFECTING THE NOSE

      ASTEPRO 0.15% NASAL SPRAY                azelastine hcl                         2      [MT][QL, 60
                                                                                             ml/30]
      azelastine hcl nasal drops/sprays        ASTELIN                                1      [MT][QL, 60
                                                                                             ml/30]

                                                     38
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                      Drug                        Brand/Generic Reference             Tier Restrictions
      flunisolide 0.025% spray                 NASALIDE                               1    [MT][QL, 25
                                                                                           ml/30]
      flunisolide 29 mcg-0.025% spr            NASALIDE                               1    [MT][QL,
                                                                                           75/30]
      fluticasone propionate nasal inhaled FLONASE                                    1    [MT][QL, 16
      steroids                                                                             gm/30]
      ipratropium 0.03% spray              ATROVENT                                   1    [MT][QL, 30
                                                                                           ml/30]
      ipratropium 0.06% spray                  ATROVENT                               1    [MT][QL, 15
                                                                                           ml/30]
      TYZINE                                   tetrahydrozoline                       2

   DRUGS AFFECTING THE THROAT AND MOUTH

      chlorhexidine gluconate                                                         1
      dental/mucous membrn products
      doxycycline hyclate 20 mg tab            PERIOSTAT                              1
      periogard                                PERIDEX                                1
      pilocarpine hcl tablet                   SALAGEN                                1
      triamcinolone acetonide paste            KENALOG IN ORABASE                     1

ENDOCRINE MEDICATIONS
   ANTITHYROID DRUGS

      methimazole tablet                       TAPAZOLE                               1      [MT]
      propylthiouracil                                                                1      [MT]

   GLUCOCORTICOID DRUGS

      cortisone tablet                                                                1
      dexamethasone 4 mg/ml vial               DECADRON PHOSPHATE                     1
      dexamethasone elix, -tablet                                                     1
      dexamethasone intensol                   DECADRON                               1
      hydrocortisone tablet                    CORTEF                                 1      [MT]
      meprolone unipak                                                                1
      methylprednisolone 125 mg vial, -        MEDROL                                 1
      40 mg vial, -ss 1 gm vl
      methylprednisolone acetate               DEPO-MEDROL                            1
      injection
      methylprednisolone tab(in                                                       1
      convenience package), -tablet
                                                     39
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                     Drug                         Brand/Generic Reference             Tier   Restrictions
      prednisolone sodium phosphate            DELTASONE                              1
      solution
      prednisolone syrup                                                              1
      prednisone intensol                      DELTASONE                              1
      prednisone solution, -tab(in                                                    1
      convenience package), -tablet
      veripred 20                              prednisolone                           1

   GLUCOSE ELEVATING DRUGS

      GLUCAGON EMERGENCY KIT                   glucagon, human recombinant            2
      PROGLYCEM                                diazoxide                              2      [MT]

   HYPOGLYCEMIC DRUGS

      BYETTA 10 MCG DOSE PEN INJ               exenatide                              2      [MT][PA][QL,
                                                                                             5 ml/30]
      BYETTA 5 MCG DOSE PEN INJ                exenatide                              2      [MT][PA][QL,
                                                                                             2 ml/30]
      SYMLIN                                   pramlintide acetate                    2      [MT][PA][QL,
                                                                                             35 ml/30]

   INSULIN

      HUMALOG 100 UNITS/ML VIAL                                                       2      [MT][QL,
                                                                                             30/30]
      HUMALOG MIX 50-50 VIAL                                                          2      [MT][QL,
                                                                                             30/30]
      HUMALOG MIX 75-25 VIAL                                                          2      [MT][QL,
                                                                                             30/30]
      HUMULIN 70-30 VIAL                                                              2      [MT][QL,
                                                                                             30/30]
      HUMULIN N 100 UNITS/ML VIAL                                                     2      [MT][QL,
                                                                                             30/30]
      HUMULIN R 100 UNITS/ML VIAL                                                     2      [MT][QL,
                                                                                             30/30]
      HUMULIN R 500 UNITS/ML VIAL                                                     2      [MT][QL,
                                                                                             40/30]
      LANTUS 100 UNITS/ML VIAL                                                        2      [MT][QL,
                                                                                             30/30]


                                                     40
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                   Drug                            Brand/Generic Reference            Tier Restrictions
      LEVEMIR 100 UNITS/ML VIAL                                                       2    [MT][QL,
                                                                                           30/30]
      NOVOLIN 70-30 100 UNIT/ML VIAL,                                                 2    [MT][QL,
      -RELION VIAL                                                                         30/30]
      NOVOLIN N 100 UNITS/ML VIAL, -                                                  2    [MT][QL,
      RELION 100 UNITS/ML                                                                  30/30]
      NOVOLIN R 100 UNITS/ML VIAL, -                                                  2    [MT][QL,
      RELION 100 UNITS/ML                                                                  30/30]
      NOVOLOG 100 UNIT/ML VIAL                                                        2    [MT][QL,
                                                                                           30/30]
      NOVOLOG MIX 70-30 VIAL                                                          2    [MT][QL,
                                                                                           30/30]

   MINERALOCORTICOID DRUGS

      fludrocortisone acetate tablet           FLORINEF                               1      [MT]

   ORAL HYPOGLYCEMICS AND COMBOS

      acarbose                                 PRECOSE                                1      [MT]
      ACTOPLUS MET                             pioglitazone hcl/metformin hc          2      [MT][QL,
                                                                                             90/30][ST]
      ACTOS                                    pioglitazone hcl                       2      [MT][QL,
                                                                                             30/30][ST]
      AVANDAMET                                rosiglitazone/metformin hcl            2      [MT][QL,
                                                                                             60/30][ST]
      AVANDARYL 4 MG-1 MG TABLET, -4 rosiglitazone maleate/glimepir                   2      [MT][QL,
      MG-2 MG TABLET                                                                         60/30][ST]
      AVANDARYL 4 MG-4 MG TABLET, -8 rosiglitazone maleate/glimepir                   2      [MT][QL,
      MG-2 MG TABLET, -8 MG-4 MG                                                             30/30][ST]
      TABLET
      AVANDIA 2 MG TABLET, -4 MG     rosiglitazone maleate                            2      [MT][QL,
      TABLET                                                                                 60/30][ST]
      AVANDIA 8 MG TABLET            rosiglitazone maleate                            2      [MT][QL,
                                                                                             30/30][ST]
      DUETACT                                  pioglitazone/glimepiride               2      [MT][QL,
                                                                                             30/30][ST]
      glimepiride                              AMARYL                                 1      [MT]
      glipizide er                             GLUCOTROL XL                           1      [MT]
      glipizide tablet                                                                1      [MT]
      glipizide xl                             GLUCOTROL XL                           1      [MT]

                                                     41
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                      Drug                         Brand/Generic Reference            Tier    Restrictions
      glipizide-metformin                      METAGLIP                               1      [MT]
      glyburide                                DIABETA                                1      [MT]
      glyburide micronized                     GLYNASE                                1      [MT]
      glyburide-metformin hcl                  GLUCOVANCE                             1      [MT]
      glycron                                  GLYNASE                                1      [MT]
      GLYSET                                   miglitol                               2      [MT]
      JANUMET                                  sitagliptin phos/metformin hcl         2      [MT][QL,
                                                                                             60/30][ST]
      JANUVIA                                  sitagliptin phosphate                  2      [MT][QL,
                                                                                             30/30][ST]
      metformin hcl                            GLUCOPHAGE                             1      [MT]
      metformin hcl er                         GLUCOPHAGE XR                          1      [MT]
      ONGLYZA                                  saxagliptin hydrochloride              2      [MT][QL,
                                                                                             30/30][ST]
      PRANDIN                                  repaglinide                            2      [MT]
      tolazamide                               TOLINASE                               1      [MT]
      tolbutamide                              ORINASE                                1      [MT]

   OTHER ENDOCRINE DRUGS

      ALDURAZYME [LA]                          laronidase                             4
      alendronate sodium 10 mg tab, -40        FOSAMAX                                1      [MT][QL,
      mg tab, -5 mg tablet                                                                   30/30]
      alendronate sodium 35 mg tab, -70        FOSAMAX                                1      [MT][QL,
      mg tab                                                                                 5/35]
      BONIVA 150 MG TABLET                     ibandronate                            2      [MT][QL,
                                                                                             1/30][ST]
      cabergoline                              DOSTINEX                               1      [MT][QL,
                                                                                             20/30]
      calcitonin-salmon                        MIACALCIN                              1      [MT]
      CEREZYME 200 UNITS VIAL [LA]             imiglucerase                           4      [MT][PA]
      desmopressin ac 4 mcg/ml vl              DDAVP                                  1
      desmopressin acetate nasal                                                      1      [MT]
      drops/sprays, -solution, -tablet
      ELAPRASE [LA]                            idursulfase                            4      [MT]
      etidronate disodium                      DIDRONEL                               1      [MT]
      EVISTA                                   raloxifene                             2      [MT]
      FABRAZYME 35 MG VIAL [LA]                agalsidase                             4      [PA]
      FORTEO                                   teriparatide                           2      [MT][PA]
      fortical                                 MIACALCIN                              1      [MT]
      KUVAN [LA]                               sapropterin dihydrochloride            4      [MT]
                                                     42
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                    Drug                           Brand/Generic Reference            Tier Restrictions
      NAGLAZYME [LA]                           galsulfase                             4    [MT]
      pamidronate 30 mg/10 ml vial, -90        AREDIA                                 1
      mg/10 ml vial
      SENSIPAR                                 cinacalcet hcl                         2      [MT]
      SOMAVERT [LA]                            pegvisomant                            4      [MT][PA]
      ZAVESCA [LA]                             miglustat                              4      [MT]
      ZOMETA                                   zoledronic acid                        4

   THYROID SUPPLEMENTS

      levothroid                               SYNTHROID                              1      [MT]
      levothyroxine sodium tablet              SYNTHROID                              1      [MT]
      levoxyl                                  SYNTHROID                              1      [MT]
      liothyronine sodium injection            TRIOSTAT                               1
      liothyronine sodium tablet               CYTOMEL                                1      [MT]
      SYNTHROID                                levothyroxine                          2      [MT]
      THYROLAR-1                               liotrix                                2      [MT]
      THYROLAR-1/4                             liotrix                                2      [MT]
      THYROLAR-2                               liotrix                                2      [MT]
      THYROLAR-3                               liotrix                                2      [MT]
      unithroid                                SYNTHROID                              1      [MT]

GASTROINTESTINAL MEDICATIONS
   ANTIDIARRHEAL DRUGS

      diphenoxylate-atropine                   LOMOTIL                                1      [PA]
      lonox                                    LOMOTIL                                1
      loperamide cap                                                                  1      [MT]

   ANTISPASMODICS/DRUGS AFFECT GI MOTILITY

      BENTYL                                   dicyclomine                            3
      glycopyrrolate injection, -tablet        ROBINUL                                1
      methscopolamine bromide                  PAMINE                                 1
      metoclopramide 5 mg/ml vial, -                                                  1
      syrup, -tablet

   ANTIULCER DRUGS

      cimetidine 200 mg tablet, -solution      TAGAMET                                1      [MT]
                                                     43
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                       Brand/Generic Reference             Tier Restrictions
      cimetidine injection                     TAGAMET                                1    [PA]
      famotidine 20 mg tablet, -40 mg          PEPCID                                 1    [MT]
      tablet
      nizatidine                               AXID                                   1      [MT]
      ranitidine 150 mg tablet, -300 mg                                               1      [MT]
      tablet, -cap, -syrup
      ranitidine hcl injection                 ZANTAC                                 1      [PA]

   IRRITABLE BOWEL DRUGS

      AMITIZA 8 MCG CAPSULE                    lubiprostone                           2      [MT]
      LOTRONEX                                 alosetron                              4      [MT]

   LAXATIVES AND CATHARTICS

      OSMOPREP                                 sodium phosphate/na biphos             2
      polyethylene glycol 3350, -pkt, -                                               1
      powd
      VISICOL                                  sodium phosphate/na biphos             2

   OTHER ANTIULCER DRUGS

      CARAFATE ORAL SUSP                       sucralfate                             2      [MT]
      misoprostol                              CYTOTEC                                1      [MT]
      sucralfate tablet                        CARAFATE                               1      [MT]

   OTHER GI DRUGS

      ASACOL                                   mesalamine                             2      [MT]
      balsalazide disodium                     COLAZAL                                1
      CANASA                                   mesalamine                             2      [MT]
      gavilyte-c                                                                      1
      hydrocortisone rectal                                                           1
      mesalamine rectal                                                               1      [MT]
      peg 3350-electrolyte                     COLYTE                                 1
      PENTASA                                  mesalamine                             2      [MT]
      procto-pak                               ALA-CORT                               1
      proctozone-hc                            ANUSOL-HC                              1
      RELISTOR 12 MG/0.6 ML VIAL               methylnaltrexone bromide               2      [PA]
      SUCRAID                                  sacrosidase                            4      [MT]
                                                      44
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier    Restrictions
      sulfasalazine dr                                                                1      [MT]
      sulfasalazine tablet                     AZULFIDINE                             1      [MT]
      sulfazine                                AZULFIDINE                             1      [MT]
      sulfazine ec                             AZULFIDINE                             1      [MT]
      ursodiol cap, -tablet                                                           1      [MT]

   PROTON PUMP INHIBITORS

      lansoprazole cap sa                                                             1      [MT][QL,
                                                                                             30/30]
      NEXIUM                                   esomeprazole mag trihyd                3      [MT][QL,
                                                                                             30/30][ST]
      omeprazole 20 mg capsule dr, -dr                                                1      [MT][QL,
      10 mg capsule, -dr 20 mg capsule,                                                      30/30]
      -dr 40 mg capsule
      pantoprazole sodium                      PROTONIX                               1      [MT][QL,
                                                                                             30/30][ST]
      PREVACID                                 lansoprazole                           3      [MT][QL,
                                                                                             30/30][ST]
      PROTONIX IV                              pantoprazole                           2      [PA]

IMMUNOLOGICALS AND VACCINES
   GROWTH HORMONES AND RELATED DRUGS

      HUMATROPE                                somatropin                             4      [MT][PA]
      NORDITROPIN                              somatropin                             4      [MT][PA]
      NORDITROPIN FLEXPRO                      somatropin                             4      [MT][PA]
      NORDITROPIN NORDIFLEX 30                 somatropin                             4      [MT][PA]
      MG/3, -5 MG/1.5, -NORDIFLX 15
      MG/1.5

   IMMUNOLOGICALS AND VACCINES

      ACTHIB                                   haemophilus b-tet toxoid               2
      ADACEL VIAL                              diphther,pertuss,tetanus vac           2
      ATGAM                                    lymphocyte immune globulin             4      [PA]
      ATTENUVAX VACCINE WITH                   measles vaccine,atten                  2
      DILUENT
      BOOSTRIX VACCINE SYRINGE                 diphther,pertuss,tetanus vac           2
      CERVARIX                                 human papillomav vacc bival/pf         2
      COMVAX                                   hepatitis b/haemophilus b vacc         2
                                                     45
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                Brand/Generic Reference                    Tier   Restrictions
      DAPTACEL                        diphther,pertuss,tetanus vac                    2
      DIPHTHERIA-TETANUS TOXOID       tetanus,diphtheria toxoid                       2
      ENGERIX-B 10 MCG/0.5 ML PED VL, hepatitis b virus vaccine                       2
      -10 MCG/0.5 ML SYRN, -20 MCG/ML
      SYRINGE, -20 MCG/ML VIAL
      FLEBOGAMMA                      immune globulin - iv                            4      [PA]
      GAMUNEX                         immune globulin - iv                            4      [PA]
      GARDASIL VIAL                   human papillomavirus vacc                       2
      HAVRIX 1,440 UNITS/ML SYRINGE, hepatatis a virus vaccine                        2
      -1,440 UNITS/ML VIAL, -720
      UNIT/0.5 ML SYRINGE
      IMOVAX RABIES VACCINE           rabies vaccine,human diploid                    2
      INFANRIX                        diphther,pertuss,tetanus vac                    2
      IPOL VIAL                       poliomyelitis vac,killed                        2
      IXIARO                          japanese encephalitis vaccine                   2
      JE-VAX                          japanese encephalitis vaccine                   2
      KEPIVANCE [LA]                  palifermin                                      4
      MENACTRA 4 MCG/0.5 ML SYRINGE meningococcal vac a,c,y,w-135                     2
      MENOMUNE-A-C-Y-W-135            meningococcal vac a,c,y,w-135                   2
      MERUVAX II VACCINE W-DILUENT    rubella vaccine                                 2
      M-M-R II VACCINE                measles,mumps&rubella vaccine                   2
      PEDIARIX 0.5 ML VIAL            hep b vaccine/dp (a) t-polio                    2
      PEDVAXHIB                       haemophilus b vaccine                           2
      PROCRIT 10,000 UNITS/ML VIAL, - epoetin alfa                                    2      [MT][PA]
      2,000 UNITS/ML VIAL, -3,000
      UNITS/ML VIAL, -4,000 UNITS/ML
      VIAL
      PROCRIT 20,000 UNITS/ML VIAL, - epoetin alfa                                    4      [MT][PA]
      40,000 UNITS/ML VIAL
      PROQUAD                         measles,mumps,rub,varicella                     2
      RABAVERT                        rabies vac,pf chick-emb cell                    2
      RECOMBIVAX HB 10 MCG/ML VIAL, hepatitis b virus vaccine                         2
      -40 MCG/ML VIAL
      ROTATEQ                         rotavirus vac, live pentav                      2
      TETANUS DIPHTHERIA TOXOIDS      tetanus,diphtheria toxoid                       2
      tetanus toxoid adsorbed                                                         1
      TETANUS-DIPHTERIA-DECAVAC       tetanus,diphtheria toxoid                       2
      TRIHIBIT                        dp (a) ped/hib conj-tet                         2
      TRIPEDIA                        diphther,pertuss,tetanus vac                    2
      TWINRIX VACCINE VIAL            hep b vir recomb/hep a vir                      2
      TYPHIM VI 25 MCG/0.5 ML VIAL    typhoid vaccine                                 2
                                                     46
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                   Drug                             Brand/Generic Reference           Tier   Restrictions
      VAQTA 25 UNITS/0.5 ML VIAL               hepatatis a virus vaccine              2
      VARIVAX VACCINE                          varicella virus vaccine live           2
      VIVOTIF BERNA                            typhoid vaccine                        2
      YF-VAX                                   yellow fever vaccine                   2
      ZOSTAVAX                                 varicella vacc/pf                      2

   INSULIN LIKE GROWTH FACTORS-1

      INCRELEX [LA]                            mecasermin                             4      [PA]

   INTERFERONS

      ACTIMMUNE [LA]                           interferon gamma-1b,recomb.            4
      ALFERON N                                interferon alfa-n3                     4
      AVONEX                                   interferon beta-1a                     4      [MT][PA][QL,
                                                                                             4 kits/28]
      AVONEX ADMINISTRATION PACK               interferon beta-1a                     4      [MT][PA][QL,
                                                                                             4 kits/28]
      BETASERON                                interferon beta-1b                     4      [MT][PA][QL,
                                                                                             15/30]
      INFERGEN 9 MCG/0.3 ML VIAL               interferon alfacon-1                   4      [PA]
      INTRON A 10 MILLION UNIT PEN, -          interferon alfa-2b , recomb.           4      [MT]
      5 MILLION UNIT/ML PEN
      INTRON A 10 MILLION UNIT/ML, -6          interferon alfa-2b , recomb.           4
      MILLION UNIT/ML VL
      INTRON A 10 MILLION UNITS VIAL           interferon alfa-2b , recomb.           2
      INTRON A 3 MILLION UNIT/ML PEN           interferon alfa-2b , recomb.           2      [MT]
      PEGASYS 180 MCG/0.5 ML                   peginterferon alfa-2a                  4      [PA][QL, 4
      CONV.PK                                                                                syringes/28]
      PEGASYS 180 MCG/ML VIAL                  peginterferon alfa-2a                  4      [PA][QL,
                                                                                             4/28]
      REBIF 22 MCG/0.5 ML SYRINGE, -           interferon beta-1a/albumin             4      [MT][PA][QL,
      44 MCG/0.5 ML SYRINGE                                                                  8
                                                                                             syringes/30]
      REBIF TITRATION PACK                     interferon beta-1a/albumin             4      [MT][PA][QL,
                                                                                             12
                                                                                             syringes/28]

   INTERLEUKIN RECPTR ANTAGONIST

      ACTEMRA 200 MG/10 ML VIAL                tocilizumab                            4      [MT][PA]
                                                     47
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                         Brand/Generic Reference           Tier Restrictions
      ARCALYST [LA]                            rilonacept                             4    [MT][PA]

   INTERLEUKINS

      NEUMEGA                                  oprelvekin                             4      [QL, 21
                                                                                             vials/21]
      PROLEUKIN                                aldesleukin                            4

   MYELOID STIMULANTS

      LEUKINE                                  sargramostim                           4
      NEULASTA                                 pegfilgrastim                          4      [PA]
      NEUPOGEN                                 filgrastim                             4      [PA]

   THROMBOPOIETIC AGENTS

      PROMACTA [LA]                            eltrombopag olamine                    4      [MT]

MEDICAL (MISCELLANEOUS) SUPPLIES
   DIABETIC SUPPLIES

      ACCUSURE                                                                        2      [MT][QL,
                                                                                             100/30]
      AIMSCO ULTRA THIN II                                                            2      [MT][QL,
                                                                                             100/30]
      ALCOHOL PREP PADS                                                               2      [QL, 100/30]
      ALCOHOL PREP SWABS                                                              2      [QL, 100/30]
      ALCOHOL SWABS                            alcohol swabs                          2      [QL, 100/30]
      ALCOHOL WIPES                                                                   2      [QL, 100/30]
      ANTI-STICK INSULIN                                                              2      [MT][QL,
                                                                                             100/30]
      AUTOPEN                                                                         2      [MT][QL,
                                                                                             100/30]
      CURAD GAUZE PADS                         misc supp (dress,tape,gauze)           2
      CURITY ALCOHOL PREPS                                                            2      [QL, 100/30]
      EASY COMFORT INSULIN SYRINGE                                                    2      [MT][QL,
                                                                                             100/30]
      EASY TOUCH INSULIN NEEDLES -                                                    2      [MT][QL,
      DISPOSABLE, -INSULIN SYRINGES                                                          100/30]
      - DISPOSABLE

                                                     48
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                   Drug                            Brand/Generic Reference            Tier Restrictions
      EXEL INSULIN SYRINGE                                                            2    [MT][QL,
                                                                                           100/30]
      GLUCOPRO INSULIN SYRINGES -                                                     2    [MT][QL,
      DISPOSABLE                                                                           100/30]
      INSULIN PEN NEEDLE                                                              2    [MT][QL,
                                                                                           100/30]
      INSULIN SYRINGE 0.3 ML, -0.3 ML                                                 2    [MT][QL,
      29GX1/2, -0.3 ML 30GX5/16, -0.3                                                      100/30]
      ML 31GX5/16, -0.3 ML SYRINGE, -
      0.3M, -0.5 ML, -0.5 ML 28GX1/2, -
      0.5 ML 29GX1/2, -0.5 ML
      30GX5/16, -0.5 ML 31GX5/16, -0.5
      ML SYRINGE, -1 ML, -1 ML
      28GX1/2, -1 ML 29GX1/2, -1 ML
      30GX1/2, -1 ML
      INSULIN SYRINGE U100 1ML                                                        2      [QL, 100/30]
      INSUMED SYR 0.3 ML 31GX5/16, -                                                  2      [MT][QL,
      SYR 0.5 ML 31GX5/16, -SYRINGE 1                                                        100/30]
      ML 30GX5/16
      INSUPEN                                                                         2      [MT][QL,
                                                                                             100/30]
      INTEGRA SYRINGE INSULIN                                                         2      [MT][QL,
      SYRINGES - DISPOSABLE                                                                  100/30]
      LITE TOUCH INSULIN PEN                                                          2      [MT][QL,
      NEEDLES                                                                                100/30]
      LITE TOUCH INSULIN SYRINGES -                                                   2      [MT][QL,
      DISPOSABLE                                                                             100/30]
      LUER-LOK SYRINGE INSULIN                                                        2      [MT][QL,
      SYRINGES - DISPOSABLE                                                                  100/30]
      MONOJECT 1 ML SYRN 25X5/8, -1                                                   2      [MT][QL,
      ML SYRN 27X1/2, -1 ML SYRN                                                             100/30]
      28GX1/2, -INSUL SYR U100, -INSUL
      SYR U100 0.5 ML, -INSUL SYR
      U100 1 ML, -INSULIN SYR 0.3 ML, -
      INSULIN SYR 0.5 ML, -INSULIN SYR
      1 ML, -INSULIN SYR U-100, -
      INSULIN SYRN 3/10 ML, -SYR 1/2
      ML BULK PACK,
      MONOJECT INSULIN SAFETY                                                         2      [MT][QL,
      SYRNG                                                                                  100/30]
      NOVOFINE 32                                                                     2      [MT][QL,
                                                                                             100/30]

                                                     49
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                  Drug                             Brand/Generic Reference            Tier Restrictions
      NOVOFINE AUTOCOVER                                                              2    [MT][QL,
                                                                                           100/30]
      NOVOPEN 3                                                                       2    [MT][QL,
                                                                                           100/30]
      NOVOPEN JR                                                                      2    [MT][QL,
                                                                                           100/30]
      ORSINI INSULIN SYRINGE                                                          2    [MT][QL,
                                                                                           100/30]
      PEN 12MM 29G NEEDLES, -                                                         2    [MT][QL,
      31GX3/16, -31GX5/16, -6MM 31G, -                                                     100/30]
      8MM 31G NEEDLES, -AURORA 6MM
      31G, -AURORA S 12MM 29G, -
      AURORA S 8MM 31G, -BD 29GX1/2,
      -BD 29GX3/16, -BD 29GX5/16, -BD
      MINI 31GX3/16, -BD ORIG
      29GX1/2, -BD SHORT 31GX5/16, -
      LIVE BETTER 6MM 31G, -LIVE B
      PEN NEEDLES                                                                     2      [MT][QL,
                                                                                             100/30]
      PRECISION INSULIN SYRINGES -                                                    2      [MT][QL,
      DISPOSABLE                                                                             100/30]
      PRODIGY INSULIN SYRINGE                                                         2      [MT][QL,
                                                                                             100/30]
      PRODIGY PEN NEEDLE                                                              2      [MT][QL,
                                                                                             100/30]
      SAFESNAP INSULIN SYRINGE                                                        2      [MT][QL,
                                                                                             100/30]
      SAFETYGLIDE INSULIN SYRINGE                                                     2      [MT][QL,
                                                                                             100/30]
      SAFETYGLIDE SYRINGE INSULIN                                                     2      [MT][QL,
      SYRINGES - DISPOSABLE                                                                  100/30]
      SINGLE USE SWAB                                                                 2      [QL, 100/30]
      SURE COMFORT                                                                    2      [MT][QL,
                                                                                             100/30]
      SURE COMFORT ALCOHOL                                                            2      [QL, 100/30]
      SURE-FINE PEN NEEDLES                                                           2      [MT][QL,
                                                                                             100/30]
      SURE-JECT INSULIN SYRINGE                                                       2      [MT][QL,
                                                                                             100/30]
      SURE-PREP ALCOHOL PREP PADS                                                     2      [QL, 100/30]
      TERUMO INSULIN SYRINGE                                                          2      [MT][QL,
                                                                                             100/30]

                                                     50
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                 Drug                              Brand/Generic Reference            Tier Restrictions
      TERUMO SURGUARD                                                                 2    [MT][QL,
                                                                                           100/30]
      THINPRO INSULIN SYRINGE                                                         2    [MT][QL,
                                                                                           100/30]
      TOPCARE CLICKFINE                                                               2    [MT][QL,
                                                                                           100/30]
      TOPCARE ULTRA COMFORT                                                           2    [MT][QL,
                                                                                           100/30]
      ULTICARE INSULIN NEEDLES -                                                      2    [MT][QL,
      DISPOSABLE, -INSULIN SYRINGES                                                        100/30]
      - DISPOSABLE
      ULTIGUARD 30GX0.3 ML SYRINGE,                                                   2      [MT][QL,
      -31GX0.3 ML SYRINGE                                                                    100/30]
      ULTILET ALCOHOL SWAB                                                            2      [QL, 100/30]
      ULTILET INSULIN SYRINGE                                                         2      [MT][QL,
                                                                                             100/30]
      ULTILET PEN NEEDLE                                                              2      [MT][QL,
                                                                                             100/30]
      ULTRA COMFORT 0.3 ML 29GX1/2,                                                   2      [MT][QL,
      -0.3 ML 30GX5/16, -0.3 ML                                                              100/30]
      31GX5/16, -0.3 ML SYRINGE, -0.5
      ML 28GX1/2, -0.5 ML 29GX1/2, -0.5
      ML 30GX5/16, -0.5 ML SYR, -0.5 ML
      SYRINGE, -1 ML 28GX1/2, -1 ML
      29GX1/2, -1 ML 30GX5/16, -1 ML
      SYRINGE, -3/10 ML SYR, -DRUG
      MART SYR
      ULTRACOMFORT INSUL SYR 0.5                                                      2      [MT][QL,
      ML, -INSULIN NEEDLES -                                                                 100/30]
      DISPOSABLE, -INSULIN SYR 1 ML
      UNIFINE PENTIPS                                                                 2      [MT][QL,
                                                                                             100/30]
      WEBCOL                                                                          2      [QL, 100/30]

MUSCULOSKELETAL MEDICATIONS
   CNS MUSCLE RELAXANTS

      carisoprodol 350mg tablet                SOMA                                   1      [PA]
      chlorzoxazone 500 mg tablet              PARAFON FORTE DSC                      1      [PA]
      RILUTEK                                  riluzole                               4      [MT]
      SOMA 350mg tablet                        carisoprodol                           3

                                                     51
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   DIRECT MUSCLE RELAXANTS

      baclofen tablet                                                                 1      [MT]
      dantrolene sodium                        DANTRIUM                               1      [MT]
      tizanidine hcl                           ZANAFLEX                               1      [MT]

   DRUGS TO PREVENT AND TREAT GOUT

      allopurinol tablet                       ZYLOPRIM                               1      [MT]
      COLCRYS                                  colchicine                             2      [MT]
      probenecid                                                                      1      [MT]
      probenecid-colchicine                                                           1

   NON-STEROIDAL ANTIINFLAMMATORY AGENTS

      CELEBREX                                 celecoxib                              2      [MT][QL,
                                                                                             60/30][ST]
      diclofenac potassium                     CATAFLAM                               1
      diclofenac sodium e.c. tab, -tab sa                                             1      [MT]
      etodolac                                 LODINE                                 1      [MT]
      fenoprofen calcium                                                              1      [MT]
      flurbiprofen tablet                      ANSAID                                 1      [MT]
      ibuprofen 100 mg/5 ml, -100 mg/5         MOTRIN                                 1      [MT]
      ml sus, -100 mg/5 ml susp, -400
      mg tablet, -600 mg tablet, -800 mg
      tablet
      indomethacin cap, -cap sa                                                       1
      ketoprofen cap, -cap sa                                                         1      [MT]
      meclofenamate sodium cap                                                        1      [MT]
      meloxicam oral susp                                                             1      [MT]
      meloxicam tablet                         MOBIC                                  1      [MT][QL,
                                                                                             30/30]
      nabumetone                               RELAFEN                                1      [MT]
      naproxen e.c. tab, -oral susp, -                                                1      [MT]
      tablet
      naproxen sodium 275 mg tab, -550         ANAPROX                                1      [MT]
      mg tab
      oxaprozin                                DAYPRO                                 1      [MT]
      piroxicam cap                                                                   1      [MT]
      sulindac tablet                          CLINORIL                               1      [MT]

                                                     52
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                     Drug                         Brand/Generic Reference             Tier Restrictions
      tolmetin sodium                          TOLECTIN 600                           1    [MT]

   OTHER DRUGS FOR ARTHRITIS

      CUPRIMINE                                penicillamine                          2      [MT]
      RIDAURA                                  auranofin                              2      [MT]
      SYPRINE                                  trientine                              2

   SALICYLATES AND RELATED DRUGS

      diflunisal                               DOLOBID                                1      [MT]
      salsalate tablet                                                                1

NUTRITION,BLOOD MODIFIERS,ELECTROLYTES
   ANTIPLATELET DRUGS

      AGGRENOX                                 aspirin/dipyridamole                   2      [MT]
      cilostazol                               PLETAL                                 1      [MT]
      dipyridamole tablet                      PERSANTINE                             1      [MT]
      PLAVIX 300 MG TABLET                     clopidogrel                            2
      PLAVIX 75 MG TABLET                      clopidogrel                            2      [MT]
      ticlopidine hcl                          TICLID                                 1      [MT]

   BLOOD DETOXICANTS

      constulose                                                                      1      [MT]
      enulose                                                                         1      [MT]
      generlac                                                                        1      [MT]
      lactulose                                                                       1      [MT]
      RENVELA TABLET                           sevelamer carbonate                    2      [MT]

   ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.

      AMINOSYN                                 amino acids                            2      [PA]
      AMINOSYN     II                          amino acids                            2      [PA]
      AMINOSYN     II 3.5% M-DEXTROSE          amino acids                            2      [PA]
      5%
      AMINOSYN     II 3.5%-DEXTROSE            amino acids                            2      [PA]
      25%
      AMINOSYN     II 3.5%-DEXTROSE 5%         amino acids                            2      [PA]
                                                     53
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                       Brand/Generic Reference             Tier Restrictions
      AMINOSYN II 4.25%-DEXTROSE               amino acids                            2    [PA]
      25%
      AMINOSYN II 5% IN 25%                    amino acids                            2      [PA]
      DEXTROSE
      AMINOSYN II IN DEXTROSE                  amino acids                            2      [PA]
      AMINOSYN II WITH LYTES-CA-DW             amino acids                            2      [PA]
      AMINOSYN M                               amino acids                            2      [PA]
      AMINOSYN WITH ELECTROLYTES               amino acids                            2      [PA]
      AMINOSYN-HBC                             amino acids                            2      [PA]
      AMINOSYN-HF                              amino acids                            2      [PA]
      AMINOSYN-PF                              amino acids                            2      [PA]
      AMMONIUM CHLORIDE INJECTION              ammonium chloride                      2
      CYSTAGON [LA]                            cysteamine                             2      [MT]
      d5-1/3ns/kcl 30 meq/l iv sol                                                    1      [PA]
      d5w/kcl 10 meq/l iv solution             DEXTROSE 5%-1/4NS-KCL                  1      [PA]
      dextrose 10%-1/4ns                       DEXTROSE 5%-1/4NS-KCL                  1      [PA]
      dextrose 10%-water iv solution, -                                               1      [PA]
      5%-water iv soln
      dextrose 2.5%-1/2ns iv soln, -5%-                                               1      [PA]
      1/2ns iv soln., -5%-1/2ns iv
      solution, -5%-1/4ns iv soln., -5%-
      1/4ns iv solution, -5%-ns iv solution
      lactated ringers injection                                                      1
      magnesium sulfate 50% syringe                                                   1
      PLASMA-LYTE 56                           electrolyte solutions                  2
      potassium chloride-nacl                                                         1
      sodium bicarbonate 7.5% syring, -                                               1
      bicarb 7.5% abboject
      sodium chloride 0.45% soln, -                                                   1
      0.45% soln-excel con, -0.9% irrig.,
      -0.9% soln, -0.9% soln., -0.9%
      soln-excel cont, -0.9% solution, -cl
      2.5 meq/ml vial, -sterile saline
      0.9% irr
      sodium lactate 5 meq/ml vial                                                    1

   INJECTABLE ANTICOAGULANTS

      ARIXTRA 10 MG SYRINGE, -5 MG             fondaparinux sodium                    4      [PA]
      SYRINGE, -7.5 MG SYRINGE
      ARIXTRA 2.5 MG SYRINGE                   fondaparinux sodium                    2      [PA]
                                                     54
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                       Brand/Generic Reference             Tier Restrictions
      enoxaparin 100 mg/ml syr, -120           LOVENOX                                4    [PA]
      mg/0.8 ml syr, -150 mg/ml syr, -60
      mg/0.6 ml syr, -80 mg/0.8 ml syr
      enoxaparin 30 mg/0.3 ml syr, -40         LOVENOX                                1      [PA]
      mg/0.4 ml syr
      heparin na 1,000 units/ml vial, -na                                             1
      5,000 units/ml vial, -sod 1,000
      unit/ml vial, -sod 10,000 unit/ml vl,
      -sod 2,000 unit/ml vial, -sod 2,500
      unit/ml vial, -sod 20,000 unit/ml vl,
      -sod 5,000 unit/ml vial
      heparin sodium in 0.45% nacl                                                    1
      heparin sodium in 0.9% nacl                                                     1
      heparin-d5w 20,000 unit/500 ml                                                  1
      LOVENOX 100 MG PREFILLED SYR,            enoxaparin                             4      [PA]
      -120 MG PREFILLED SYR, -150 MG
      PREFILLED SYR, -60 MG PREFILLED
      SYRN, -80 MG PREFILLED SYRN
      LOVENOX 30 MG PREFILLED SYRN,            enoxaparin                             2      [PA]
      -40 MG PREFILLED SYRN

   ORAL ANTICOAGULANTS, VITAMIN K

      COUMADIN TABLET                          warfarin sodium                        2      [MT]
      jantoven                                 COUMADIN                               1      [MT]
      warfarin sodium                          COUMADIN                               1      [MT]

   POTASSIUM REMOVING RESINS

      kalexate                                                                        1
      KAYEXALATE                               sodium polystyrene sulfonate           2
      kionex oral susp                                                                1
      sodium polystyrene sulfonate             KAYEXALATE                             1
      sps oral susp                                                                   1

   POTASSIUM SUPPLEMENTS

      cytra-2                                                                         1
      dextrose 5%-lr iv solution                                                      1
      kaon-cl 10                               K-TAB                                  1      [MT]

                                                     55
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                     Drug                          Brand/Generic Reference            Tier   Restrictions
      kcl 20 meq in d5w-lact ringer, -40                                              1
      meq in d5w-lact ringer
      kcl 40 meq in d5w-lact ringer                                                   1
      klor-con 10                              K-TAB                                  1      [MT]
      klor-con 20 meq packet                                                          1      [MT]
      klor-con 8                                                                      1      [MT]
      klor-con m10                                                                    1      [MT]
      klor-con m15                                                                    1      [MT]
      klor-con m20                             K-DUR                                  1      [MT]
      klor-con-ef                                                                     1      [MT]
      potassium chloride cap sa, -cl 10%                                              1      [MT]
      (20 meq/15 ml, -cl 10% (40
      meq/30 ml, -cl 20% (40 meq/15
      ml, -tab sa
      potassium cl 2 meq/ml vial               POTASSIUM CHLORIDE                     1

   THERAPEUTIC VITAMINS AND MINERALS

      calcitriol 1 mcg/ml ampul, -2            CALCIJEX                               1
      mcg/ml vial
      calcitriol cap, -solution                                                       1      [MT]
      calcium acetate                          PHOSLO                                 1      [MT]
      eliphos                                  PHOSLO                                 1      [MT]
      HECTOROL CAP                             doxercalciferol                        2      [MT]
      levocarnitine solution, -tablet          CARNITOR                               1      [MT]

   VITAMINS AND MINERALS AND RELATED PRODUCTS

      INTRALIPID 30% IV FAT EMUL               fat emulsions                          2      [PA]

OBSTETRICAL AND GYNECOLOGICAL MEDICATIONS
   ANDROGEN DRUGS

      ANADROL-50                               oxymetholone                           4      [PA]
      ANDROXY                                  fluoxymesterone                        2      [MT]
      danazol cap                                                                     1
      METHITEST                                methyltestosterone                     2      [MT]
      oxandrolone                              OXANDRIN                               1      [MT][PA]



                                                     56
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   CONTRACEPTIVES

      apri                                     DESOGEN                                1      [MT]
      aranelle                                 TRI-NORINYL                            1      [MT]
      aviane                                   ALESSE-28                              1      [MT]
      balziva                                  OVCON-35                               1      [MT]
      cesia                                    CYCLESSA                               1      [MT]
      cryselle                                 LO-OVRAL-28                            1      [MT]
      enpresse                                                                        1      [MT]
      junel                                    LOESTRIN                               1      [MT]
      junel fe                                 LOESTRIN FE                            1      [MT]
      kariva                                   MIRCETTE                               1      [MT]
      kelnor 1-35                              DEMULEN 1-35-28                        1      [MT]
      leena                                    TRI-NORINYL                            1      [MT]
      lessina                                  ALESSE-28                              1      [MT]
      levora-28                                NORDETTE-28                            1      [MT]
      low-ogestrel                             LO-OVRAL-28                            1      [MT]
      lutera                                   ALESSE-28                              1      [MT]
      microgestin                              LOESTRIN                               1      [MT]
      microgestin fe                           LOESTRIN FE                            1      [MT]
      mononessa                                ORTHO-CYCLEN                           1      [MT]
      necon 0.5-35-28 tablet, -1/35-28                                                1      [MT]
      tablet, -10-11-28 tablet, -7-7-7-28
      tablet
      next choice                              PLAN B                                 1
      nortrel                                  BREVICON                               1      [MT]
      NUVARING                                 etonogestrel/ethin estradiol           3      [MT]
      ogestrel                                 OVRAL-21                               1      [MT]
      ORTHO EVRA                               ethinyl estradiol/norelgest            3      [MT]
      portia                                   NORDETTE-28                            1      [MT]
      previfem                                 ORTHO-CYCLEN                           1      [MT]
      quasense                                 SEASONALE                              1      [MT]
      reclipsen                                DESOGEN                                1      [MT]
      solia                                    DESOGEN                                1      [MT]
      sprintec                                 ORTHO-CYCLEN                           1      [MT]
      sronyx                                   ALESSE-28                              1      [MT]
      tri-legest fe                            ESTROSTEP FE                           1      [MT]
      trinessa                                 ORTHO TRI-CYCLEN                       1      [MT]
      tri-previfem                             ORTHO TRI-CYCLEN                       1      [MT]
      tri-sprintec                             ORTHO TRI-CYCLEN                       1      [MT]
                                                     57
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                         Drug                      Brand/Generic Reference            Tier    Restrictions
      trivora-28                               TRIPHASIL-28                           1      [MT]
      velivet                                  CYCLESSA                               1      [MT]
      YASMIN 28                                eth estradiol/drospirenone             3      [MT]
      YAZ                                      eth estradiol/drospirenone             3      [MT]
      zovia 1-35e                              DEMULEN                                1      [MT]
      zovia 1-50e                              DEMULEN                                1      [MT]

   ESTROGEN DRUGS

      ALORA                                    estradiol                              3      [MT][QL,
                                                                                             10/35]
      CENESTIN                                 estrogen,conjug,synthetic a            3      [MT]
      ESTRACE VAGINAL PRODUCTS                 estradiol                              2      [MT]
      ESTRADERM                                estradiol                              3      [MT][QL,
                                                                                             10/35]
      estradiol adh. patch                                                            1      [MT][QL,
                                                                                             5/35]
      estradiol tablet                         ESTRACE                                1      [MT]
      estropipate                              OGEN                                   1      [MT]
      MENEST                                   estrogens,esterified                   2      [MT]
      MENOSTAR                                 estradiol                              3      [MT][QL,
                                                                                             5/35]
      PREMARIN INJECTION                       estrogens,conjugated                   2
      PREMARIN TABLET, -VAGINAL                estrogens,conjugated                   2      [MT]
      PRODUCTS
      VAGIFEM 25 MCG VAGINAL TAB               estradiol                              2      [MT]
      VIVELLE-DOT                              estradiol                              3      [MT][QL,
                                                                                             10/35]

   ESTROGEN/PROGESTIN COMBINATIONS

      ACTIVELLA                                estradiol/noreth ac                    3      [MT]
      CLIMARA PRO                              estradiol/levonorgestrel               3      [MT][QL,
                                                                                             5/35]
      COMBIPATCH                               estradiol/noreth ac                    3      [MT]
      estradiol-norethindrone acetat           ACTIVELLA                              1      [MT]
      mimvey                                                                          1      [MT]
      PREMPHASE                                estrogen/medroxyprogesterone           2      [MT]
      PREMPRO                                  estrogen/medroxyprogesterone           2      [MT]


                                                     58
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   OB/GYN TOPICAL ANTIINFECTIVES

      clindamycin phosphate vaginal                                                   1
      products
      metronidazole vaginal products                                                  1
      vandazole                                METROGEL-VAGINAL                       1

   OXYTOCICS

      METHERGINE TABLET                        methylergonovine                       2

   PRENATAL VITAMINS

      inatal gt                                                                       1
      inatal ultra                                                                    1
      maternity                                                                       1
      prenatabs fa                                                                    1
      prenatabs obn                            NOVANATAL                              1
      prenatabs rx                                                                    1
      prenatal low iron                                                               1
      prenatal mr 90 fe                                                               1
      prenatal plus tablet                                                            1
      prenatal rx 1                                                                   1
      re-nata 29 ob                                                                   1
      se-natal one                                                                    1
      vinate one                                                                      1
      vinate-m                                                                        1

   PROGESTIN DRUGS

      camila                                   NOR-Q-D                                1      [MT]
      errin                                    NOR-Q-D                                1      [MT]
      heather                                                                         1      [MT]
      jolivette                                NOR-Q-D                                1      [MT]
      medroxyprogesterone acetate              DEPO-PROVERA                           1      [MT][QL, 1
      injection                                                                              ml/90]
      medroxyprogesterone acetate              DEPO-PROVERA                           1      [MT]
      tablet
      nora-be                                  NOR-Q-D                                1      [MT]
      norethindrone acetate tablet                                                    1      [MT]
                                                     59
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier Restrictions
      PROMETRIUM                               progesterone                           2    [MT]

   SPECIALIZED OB/GYN DRUGS

      leuprolide acetate                       LUPRON                                 1
      LUPRON DEPOT 11.25 MG 3MO                leuprolide                             2      [PA]
      KIT, -22.5 MG 3MO KIT, -3.75 MG
      KIT, -4 MONTH KIT
      LUPRON DEPOT 7.5 MG KIT                  leuprolide                             4      [PA]
      LUPRON DEPOT-PED 11.25 MG KIT,           leuprolide                             4      [PA]
      -15 MG KIT
      SYNAREL                                  nafarelin                              4

OPHTHALMIC MEDICATIONS
   ANTIGLAUCOMA DRUGS

      acetazolamide cap sa, -tablet                                                   1      [MT]
      ALPHAGAN P 0.1% DROPS                    brimonidine tartrate                   2      [MT]
      apraclonidine hcl                        IOPIDINE                               1
      AZOPT                                    brinzolamide                           2      [MT][QL,
                                                                                             10/30]
      betaxolol hcl ophth drops                                                       1      [MT]
      brimonidine tartrate                     ALPHAGAN                               1      [MT]
      carteolol hcl                            OCUPRESS                               1      [MT]
      dorzolamide hcl                          TRUSOPT                                1      [MT]
      dorzolamide-timolol                      COSOPT                                 1      [MT]
      levobunolol hcl                          BETAGAN                                1      [MT]
      LUMIGAN                                  bimatoprost                            2      [MT][QL,
                                                                                             2.5/30]
      methazolamide                            NEPTAZANE                              1      [MT]
      metipranolol                             OPTIPRANOLOL                           1      [MT]
      PHOSPHOLINE IODIDE                       echothiophate iodide                   2      [MT]
      pilocarpine 0.5% eye drops, -1%                                                 1      [MT]
      eye drops, -2% eye drops, -4% eye
      drops, -6% eye drops
      timolol 0.25% eye drops, -0.5%           TIMOPTIC                               1      [MT]
      eye drops
      TRAVATAN Z                               travoprost                             2      [MT][QL,
                                                                                             2.5/30]
      TRUSOPT                                  dorzolamide                            3      [MT]

                                                     60
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier Restrictions
      XALATAN                                  latanoprost                            2    [MT][QL,
                                                                                           2.5/30]

   OPHTHALMIC ANTIINFECTIVE/CORTICOSTEROIDS

      dexasporin                               MAXITROL                               1
      methadex                                                                        1
      neomycin-bacitracin-poly-hc              CORTISPORIN                            1
      neomycin-polymyxin-dexameth              MAXITROL                               1
      neomycin-polymyxin-hc ophth                                                     1
      drops
      poly-dex                                 MAXITROL                               1
      sulfacetamide-prednisolone               VASOCIDIN                              1
      TOBRADEX                                 tobramycin sulfate/dexameth            3
      tobramycin-dexamethasone                 TOBRADEX                               1
      ZYLET                                    tobramycin/lotepred etab               2

   OPHTHALMIC CORTICOSTEROID DRUGS

      dexamethasone sodium phosphate                                                  1
      ophth drops
      fluorometholone                          FML                                    1
      FML FORTE                                fluorometholone                        3
      FML S.O.P.                               fluorometholone                        2
      LOTEMAX                                  loteprednol etabonate                  3
      PRED MILD                                prednisolone acetate                   2
      prednisolone acetate ophth drops                                                1
      prednisolone sodium phosphate                                                   1
      ophth drops
      VEXOL                                    rimexolone                             3

   OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS

      ak-poly-bac                              POLYSPORIN                             1
      aktob                                    TOBREX                                 1
      AZASITE                                  azithromycin                           3
      bacitracin 500 unit/gm ointmnt                                                  1
      bacitracin-polymyxin eye oint            POLYSPORIN                             1
      ciprofloxacin hcl ophth drops                                                   1
      erythromycin oint                                                               1

                                                     61
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                       Brand/Generic Reference             Tier   Restrictions
      gentak                                   GARAMYCIN                              1
      gentamicin 3 mg/gm eye oint, -                                                  1
      ophth drops
      gentasol                                 GENOPTIC                               1
      neomycin-bacitracin-polymyxin            CORTISPORIN                            1
      neomycin-polymyxin-gramicidin            NEOSPORIN                              1
      ofloxacin ophth drops                                                           1
      polycin-b                                POLYSPORIN                             1
      polymyxin b sul-trimethoprim             POLYTRIM                               1
      romycin                                  ILOTYCIN                               1
      sulfacetamide sodium ophth drops                                                1
      sulfamide                                                                       1
      tobramycin sulfate ophth drops                                                  1
      tobrasol                                 TOBREX                                 1
      VIGAMOX                                  moxifloxacin                           3
      ZYMAR                                    gatifloxacin                           3

   OPHTHALMIC TOPICAL ANTIVIRAL DRUGS

      trifluridine                             VIROPTIC                               1

   OTHER OPHTHALMIC DRUGS

      ACUVAIL                                  ketorolac                              2
      ak-con                                   ALBALON                                1
      ak-pentolate                                                                    1      [MT]
      atropine sulfate ophth drops                                                    1      [MT]
      cromolyn sodium ophth drops                                                     1
      cyclopentolate hcl                                                              1      [MT]
      diclofenac sodium ophth drops                                                   1
      flurbiprofen sodium                      ANSAID                                 1
      ketorolac tromethamine ophth                                                    1
      drops
      LACRISERT                                hydroxypropylmethylcellulose           2
      mydral                                   MYDRIACYL                              1      [MT]
      naphazoline hcl ophth drops                                                     1
      NATACYN                                  natamycin                              2
      parcaine                                 ALCAINE                                1
      PATANOL                                  olopatadine hcl                        2
      proparacaine hcl                         ALCAINE                                1
                                                     62
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier Restrictions
      RESTASIS                                 cyclosporine                           2    [MT][QL, 60
                                                                                           vials/30]
      tropicamide                              MYDRIACYL                              1    [MT]
      VOLTAREN OPHTH DROPS                     diclofenac sodium                      3

RESPIRATORY MEDICATIONS
   ANTIHISTAMINES

      carbinoxamine maleate                    PALGIC                                 1
      clemastine fum 2.68 mg tab, -syrup       TAVIST                                 1
      diphenhydramine 50 mg cap, -50           BENADRYL                               1
      mg capsule, -50 mg/ml vial
      fexofenadine hcl 180 mg tablet           ALLEGRA                                1      [MT][QL,
                                                                                             30/30]
      fexofenadine hcl 30 mg tablet, -60       ALLEGRA                                1      [MT][QL,
      mg tablet                                                                              60/30]
      palgic                                   HISTEX PD                              1
      XYZAL                                    levocetirizine dihydrochlor            3      [MT][QL,
                                                                                             30/30]

   BETA-2 ADRENERGIC DRUGS

      albuterol 0.083% inhal soln, -0.83                                              1      [CG][MT]
      mg/ml solution, -2.5 mg/0.5 ml sol,
      -5 mg/ml solution, -syrup, -tab sa, -
      tablet
      FORADIL                                  formoterol fumarate                    2      [MT][QL,
                                                                                             120/30]
      metaproterenol sulfate syrup, -                                                 1      [CG][MT]
      tablet
      PROAIR HFA                               albuterol                              2      [MT][QL, 26
                                                                                             gm/30]
      PROVENTIL HFA                            albuterol                              2      [MT][QL, 20
                                                                                             gm/30]
      terbutaline sulfate injection            BRETHINE                               1      [CG]
      terbutaline sulfate tablet               BRETHINE                               1      [CG][MT]
      VENTOLIN HFA                             albuterol                              3      [MT][QL, 54
                                                                                             gm/30]
      XOPENEX HFA                              levalbuterol                           3      [MT][QL, 45
                                                                                             gm/30]


                                                     63
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   LEUKOTRIENE MODIFIERS

      SINGULAIR                                montelukast sodium                     2      [MT][ST]
      ZYFLO CR                                 zileuton                               2      [MT][ST]

   METHYL XANTHINE DRUGS

      aminophylline injection                  AMINOPHYLLINE                          1      [CG]
      aminophylline tablet                                                            1      [CG][MT]
      theochron                                QUIBRON-T/SR                           1      [CG][MT]
      theophylline anhydrous tab sa                                                   1      [CG][MT]
      theophylline tab sa                                                             1      [CG][MT]

   OTHER DRUGS FOR ASTHMA

      ADVAIR DISKUS                            salmeterol/fluticasone                 2      [MT][PA][QL,
                                                                                             120
                                                                                             doses/30]
      ADVAIR HFA                               salmeterol/fluticasone                 2      [MT][PA][QL,
                                                                                             24 gm/30]
      ATROVENT HFA                             ipratropium                            2      [MT][QL, 26
                                                                                             gm/30]
      COMBIVENT                                albuterol sulfate/ipratropium          2      [MT][QL, 44
                                                                                             gm/30]
      cromolyn sodium nebs                                                            1      [MT]
      epinephrine 0.1 mg/ml syringe                                                   1
      EPIPEN                                   epinephrine hcl                        2      [QL, 4
                                                                                             pens/2]
      EPIPEN JR                                epinephrine hcl                        2      [QL, 4
                                                                                             pens/2]
      GASTROCROM                               cromolyn                               2
      QVAR                                     beclomethasone                         2      [MT][QL, 22
                                                                                             gm/30]
      SPIRIVA                                  tiotropium bromide                     2      [MT][QL, 60
                                                                                             capsules/30]
      TWINJECT                                 epinephrine hcl                        2      [QL, 4
                                                                                             pens/2]
      XOLAIR [LA]                              omalizumab                             4      [MT][PA]




                                                     64
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
                       Drug                        Brand/Generic Reference            Tier   Restrictions
   OTHER RESPIRATORY DRUGS

      ARALAST NP [LA]                          alpha-1-proteinase inhibitor           4      [MT][PA]
      PROLASTIN 500 MG VIAL [LA]               alpha-1-proteinase inhibitor           4      [MT][PA]

UROLOGICAL MEDICATIONS
   ANTICHOLINERGIC ANTISPASMODICS

      ENABLEX                                  darifenacin hydrobromide               2      [MT][ST]
      flavoxate hcl                            URISPAS                                1      [MT]
      oxybutynin chloride syrup, -tablet       DITROPAN                               1      [MT]
      oxybutynin cl er 10 mg tablet, -cl er    DITROPAN XL                            1      [MT]
      15 mg tablet
      oxybutynin cl er 5 mg tablet             DITROPAN XL                            1      [MT][QL,
                                                                                             30/30]

   CHOLINERGIC STIMULANTS

      bethanechol chloride tablet              URECHOLINE                             1

   OTHER GENITOURINARY PRODUCTS

      AVODART                                  dutasteride                            3      [MT]
      CYSTADANE                                betaine hcl                            2
      ELMIRON                                  pentosan polysulfate sodium            2
      finasteride                              PROSCAR                                1      [MT]
      neomy-polymyxin b 40 mg/ml amp           NEOSPORIN G.U. IRRIGANT                1
      potassium citrate tab sa                                                        1      [MT]
      tamsulosin hcl                           FLOMAX                                 1      [MT]




                                                     65
CG: We provide coverage of this prescription drug in the coverage gap. Please refer to our Evidence of
Coverage for more information about this coverage.
LA: This prescription may be available only at certain pharmacies. For more information consult your Pharmacy
Directory or call Member Services at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free), Monday through
Sunday, from 7:30 a.m. to 8:00 p.m. TTY/TDD users (hearing impaired) should call 1-866-333-5469.
Drug Index:

8-MOP, 36                                     afeditab cr, 30
a-b otic, 38                                  AFINITOR, 16
abacavir sulfate, 9                           agalsidase, 42
abacavir sulfate/lamivudine, 9                AGGRENOX, 53
abatacept/maltose, 17                         AGRYLIN, 16
ABELCET, 13                                   AIMSCO ULTRA THIN II, 48
ABILIFY DISCMELT, 19                          ak-con, 62
ABILIFY INJECTION, 19                         ak-pentolate, 62
ABILIFY SOLUTION, 19                          ak-poly-bac, 61
ABILIFY TABLET, 19                            aktob, 61
acarbose, 41                                  ALA-CORT, 44
ACCUPRIL, 28                                  ALBALON, 62
ACCURETIC, 33                                 albendazole, 8
ACCUSURE, 48                                  ALBENZA, 8
ACCUTANE, 36                                  albuterol, 63
acebutolol hcl cap, 29                        albuterol 0.083% inhal soln, -0.83 mg/ml
ACEON, 28                                        solution, -2.5 mg/0.5 ml sol, -5 mg/ml
acetaminophen-codeine, 22                        solution, -syrup, -tab sa, -tablet, 63
acetasol hc, 38                               albuterol sulfate/ipratropium, 64
acetazolamide cap sa, -tablet, 60             ALCAINE, 62
acetic acid otic drops, 38                    alclometasone dipropionate, 36
acetic acid-aluminum, 38                      ALCOHOL PREP PADS, 48
acetic acid-hydrocortisone, 38                ALCOHOL PREP SWABS, 48
ACLOVATE, 36                                  alcohol swabs, 48
ACTEMRA 200 MG/10 ML VIAL, 47                 ALCOHOL SWABS, 48
ACTHIB, 45                                    ALCOHOL WIPES, 48
acticin, 36                                   ALDACTAZIDE, 34
ACTIMMUNE, 47                                 ALDACTONE, 34
ACTIQ, 22                                     ALDARA, 37
ACTIVELLA, 58                                 aldesleukin, 48
ACTOPLUS MET, 41                              ALDOMET, 31
ACTOS, 41                                     ALDORIL, 33
ACUVAIL, 62                                   ALDURAZYME, 42
acyclovir cap, -oral susp, -tablet, 12        alefacept, 16
acyclovir sodium 500 mg vial, 12              alemtuzumab, 16
ADACEL VIAL, 45                               alendronate sodium 10 mg tab, -40 mg tab, -
ADAGEN, 38                                       5 mg tablet, 42
ADALAT CC, 30                                 alendronate sodium 35 mg tab, -70 mg tab,
adalimumab, 17                                   42
ADCIRCA, 34                                   ALESSE-28, 57
adcirca (tadalafil), 34                       ALFERON N, 47
adefovir dipivoxil, 12                        ALIMTA 500 MG VIAL, 16
ADVAIR DISKUS, 64                             ALINIA, 11
ADVAIR HFA, 64                                alitretinoin, 37
                                         66
ALLEGRA, 63                               amlodipine besylate, 30
allopurinol tablet, 52                    amlodipine besylate-benazepril, 32
ALORA, 58                                 ammonium chloride, 54
alosetron, 44                             AMMONIUM CHLORIDE INJECTION, 54
alpha-1-proteinase inhibitor, 65          ammonium lactate 12% cream, -12% lotion,
ALPHAGAN, 60                                37
ALPHAGAN P 0.1% DROPS, 60                 amnesteem, 36
ALTACE, 28                                amoclan, 14
altretamine, 17                           amox tr-potassium clavulanate, 14
amantadine, 12                            amoxapine, 26
AMARYL, 41                                AMOXAPINE, 26
AMBIEN, 26                                amoxicillin, 14
AMBISOME, 13                              amoxicillin-clavulanate er, 14
ambrisentan, 31                           AMOXIL, 14
amcinonide, 36                            ampho b c-s, 13
AMEBICIDES, 8                             AMPHOCIN, 13
AMEVIVE, 16                               AMPHOTEC 50 MG VIAL, 13
amifostine, 16                            amphotericin b injection, 13
amiloride hcl tablet, 34                  amphotericin b lipid complex, 13
amiloride-hydrochlorothiazide, 34         amphotericin b liposome, 13
amino acids, 53, 54                       ampicillin 1 gm vial, -125 mg vial, 14
aminocaproic acid tablet, 38              ampicillin trihydrate, 14
AMINOGLYCOSIDES, 8                        ampicillin-sulbactam 15 gm vl, -3 gm vial, 14
AMINOPHYLLINE, 64                         ANADROL-50, 56
aminophylline injection, 64               anagrelide hcl, 16
aminophylline tablet, 64                  ANALGESICS, 18
aminosalicylic acid, 10                   ANAPROX, 52
AMINOSYN, 53                              anastrozole, 16
AMINOSYN II, 53                           anastrozole tablet, 16
AMINOSYN II 3.5% M-DEXTROSE 5%, 53        ANCOBON, 11
AMINOSYN II 3.5%-DEXTROSE 25%, 53         ANDROGEN DRUGS, 56
AMINOSYN II 3.5%-DEXTROSE 5%, 53          ANDROXY, 56
AMINOSYN II 4.25%-DEXTROSE 25%, 54        ANESTHETICS, 8
AMINOSYN II 5% IN 25% DEXTROSE, 54        ANGIOTENSIN CONVERTING ENZYME
AMINOSYN II IN DEXTROSE, 54                 INHIBITORS, 28
AMINOSYN II WITH LYTES-CA-DW, 54          ANGIOTENSIN II RECEPTOR ANTAGONISTS,
AMINOSYN M, 54                              28
AMINOSYN WITH ELECTROLYTES, 54            ANSAID, 52, 62
AMINOSYN-HBC, 54                          ANTABUSE, 26
AMINOSYN-HF, 54                           ANTHELMINTICS, 8
AMINOSYN-PF, 54                           ANTIACNE DRUGS, 35
amiodarone hcl tablet, 28                 ANTICHOLINERGIC ANTISPASMODICS, 65
AMIODARONES, 28                           ANTIDEMENTIA DRUGS, 18
AMITIZA 8 MCG CAPSULE, 44                 ANTIDIARRHEAL DRUGS, 43
amitriptyline hcl tablet, 27              ANTIDYSRHYTHMIC DRUGS, 29
amitriptyline-chlordiazepoxide, 24        ANTIGLAUCOMA DRUGS, 60
                                     67
ANTIHISTAMINES, 63                            ARIXTRA 10 MG SYRINGE, -5 MG SYRINGE, -
ANTIINFECTIVES, 8                               7.5 MG SYRINGE, 54
ANTIINFECTIVES SPECIALIZED                    ARIXTRA 2.5 MG SYRINGE, 54
  INDICATIONS, 8                              AROMASIN, 16
ANTIMANIA DRUGS, 19                           ARTANE, 19
ANTINEOPLASTIC/IMMUNOSUPPRESSANT              ASACOL, 44
  DRUGS, 16                                   ascomp with codeine, 23
ANTIPARKINSON ANTICHOLINERGIC                 asenapine, 20
  DRUGS, 19                                   aspirin/dipyridamole, 53
ANTIPLATELET DRUGS, 53                        ASTELIN, 38
ANTIPRURITIC DRUGS, 35                        ASTEPRO 0.15% NASAL SPRAY, 38
ANTIPSORIASIS AND ANTIECZEMA DRUGS,           ATACAND, 28
  35                                          ATACAND HCT, 32
ANTIPSYCHOTIC DRUGS, 19                       atazanavir sulfate, 9
antipyrine-benzocaine, 38                     atenolol tablet, 29
ANTIRETROVIRALS AND PROTEASE INH, 9           atenolol-chlorthalidone, 32
ANTISPASMODICS/DRUGS AFFECT GI                ATGAM, 45
  MOTILITY, 43                                atomoxetine, 26
ANTI-STICK INSULIN, 48                        atorvastatin calcium, 31
ANTITHYROID DRUGS, 39                         atovaquone, 12
ANTITUBERCULOSIS DRUGS, 10                    atovaquone/proguanil hcl, 14
ANTIULCER DRUGS, 43                           ATRIPLA, 9
ANTIVERT, 21                                  atropine sulfate ophth drops, 62
ANTIVERTIGO AND ANTIEMETIC DRUGS, 21          ATROVENT, 39
ANTIZOL, 38                                   ATROVENT HFA, 64
ANUSOL-HC, 44                                 ATTENUVAX VACCINE WITH DILUENT, 45
ANXIOLYTICS, 21                               AUGMENTIN, 14
apap-caffeine-dihydrocodeine, 22              AUGMENTIN ES, 14
APOKYN, 25                                    auranofin, 53
apomorphine hcl, 25                           aurodex ear drops, 38
apraclonidine hcl, 60                         auroguard, 38
aprepitant, 21                                AUTONOMIC AND CNS MEDICATIONS, 18
APRESOLINE, 34                                AUTOPEN, 48
apri, 57                                      AVALIDE, 33
APTIVUS, 9                                    AVANDAMET, 41
ARALAST NP, 65                                AVANDARYL 4 MG-1 MG TABLET, -4 MG-2
ARALEN, 14                                      MG TABLET, 41
aranelle, 57                                  AVANDARYL 4 MG-4 MG TABLET, -8 MG-2
ARAVA, 17                                       MG TABLET, -8 MG-4 MG TABLET, 41
ARCALYST, 48                                  AVANDIA 2 MG TABLET, -4 MG TABLET, 41
AREDIA, 43                                    AVANDIA 8 MG TABLET, 41
ARICEPT 10 MG TABLET, -5 MG TABLET, 18        AVAPRO, 29
ARICEPT ODT, 18                               AVASTIN, 16
ARIMIDEX, 16                                  AVELOX, 14
aripiprazole, 19                              AVELOX ABC PACK, 14
                                              aviane, 57
                                         68
AVITA, RETIN-A, 35                                    BETAGAN, 60
AVODART, 65                                           betaine hcl, 65
AVONEX, 47                                            betamethasone dipropionate cream, -dp aug
AVONEX ADMINISTRATION PACK, 47                          0.05% lot, -gel, -oint, 36
AXID, 44                                              betamethasone valerate cream, -lotion, -oint,
azacitidine, 18                                         36
AZASAN, 16                                            BETAPACE, 32
AZASITE, 61                                           BETASERON, 47
azathioprine, 16                                      beta-val, 36
azathioprine tablet, 16                               betaxolol hcl ophth drops, 60
azelastine hcl, 38                                    betaxolol hcl tablet, 29
azelastine hcl nasal drops/sprays, 38                 bethanechol chloride tablet, 65
azithromycin, 61                                      bevacizumab, 16
azithromycin 100 mg/5 ml susp, 13                     bexarotene, 18
azithromycin 200 mg/5 ml susp, 13                     BIAXIN, 13
azithromycin 250 mg tablet, 13                        BIAXIN XL, 13
azithromycin 500 mg tablet, 13                        bicalutamide, 16
azithromycin 600 mg tablet, -i.v. 500 mg vial,        BICILLIN C-R, 14
  13                                                  bimatoprost, 60
AZOPT, 60                                             bisoprolol fumarate, 29
AZULFIDINE, 45                                        bisoprolol-hydrochlorothiazide, 33
baciim, 11                                            BLOCADREN, 30
bacitracin 500 unit/gm ointmnt, 61                    BLOOD DETOXICANTS, 53
bacitracin injection, 11                              BONIVA 150 MG TABLET, 42
bacitracin-polymyxin eye oint, 61                     BOOSTRIX VACCINE SYRINGE, 45
baclofen tablet, 52                                   borofair, 38
BACTRIM, 15                                           bortezomib, 18
balsalazide disodium, 44                              bosentan, 31
balziva, 57                                           BRETHINE, 63
BANZEL 200 MG TABLET, 24                              BREVICON, 57
BANZEL 400 MG TABLET, 24                              brimonidine tartrate, 60
BARACLUDE SOLUTION, 12                                brinzolamide, 60
BARACLUDE TABLET, 12                                  bromocriptine mesylate cap, -tablet, 25
becaplermin, 37                                       budeprion sr, 24
beclomethasone, 64                                    budeprion xl, 25
BENADRYL, 63                                          bumetanide injection, 32
benazepril hcl, 28                                    bumetanide tablet, 32
benazepril-hydrochlorothiazide, 33                    BUMEX, 32
BENICAR, 29                                           BUPHENYL, 38
BENICAR HCT, 33                                       buprenorphine/naloxone, 23
BENTYL, 43                                            buproban, 27
BENZAMYCIN, 35                                        bupropion hcl, 25
benztropine mesylate tablet, 19                       bupropion hcl sr, 25
BETA-2 ADRENERGIC DRUGS, 63                           bupropion xl, 25
BETA-ADRENERGIC ANTAGONIST DRUGS,                     BUSPAR, 21
  29                                                  buspirone hcl tablet, 21
                                                 69
butalbital compound-codeine, 23                      CARNITOR, 56
butalbital-caff-apap-codeine, 23                     carteolol hcl, 60
butorphanol 1 mg/ml vial, -2 mg/ml vial, 18          cartia xt, 30
butorphanol tartrate aerosol, 23                     carvedilol, 29
BYETTA 10 MCG DOSE PEN INJ, 40                       CASODEX, 16
BYETTA 5 MCG DOSE PEN INJ, 40                        caspofungin acetate, 13
cabergoline, 42                                      CATAFLAM, 52
CAFERGOT, 23                                         CECLOR, 10
CALCIJEX, 56                                         CECLOR CD, 10
calcipotriene, 35                                    CEENU, 16
calcitonin-salmon, 42                                cefaclor, 10
calcitriol, 35                                       cefaclor er, 10
calcitriol 1 mcg/ml ampul, -2 mcg/ml vial, 56        cefadroxil, 10
calcitriol cap, -solution, 56                        cefazolin 1 gm vial, 10
calcium acetate, 56                                  cefdinir, 10
CALCIUM ANTAGONISTS, 30                              cefepime, 10
camila, 59                                           cefixime, 11
CAMPATH, 16                                          cefotaxime sodium 500 mg vial, 10
CANASA, 44                                           cefoxitin 1 gm vial, -2 gm vial, 10
CANCIDAS, 13                                         cefpodoxime proxetil, 10
candesartan cilexetil, 28                            cefprozil, 10
candesartan cilexetil/hctz, 32                       CEFTIN, 10
CAPASTAT SULFATE, 10                                 ceftriaxone 1 gm vial, -2 gm vial, -250 mg
CAPOTEN, 28                                            vial, -500 mg vial, 10
CAPOZIDE, 33                                         cefuroxime 125 mg/5 ml susp, 10
capreomycin, 10                                      cefuroxime sod 1.5 gm vial, -sod 750 mg
captopril tablet, 28                                   vial, 10
captopril-hydrochlorothiazide, 33                    cefuroxime sod 7.5 gm vial, 10
CARAFATE, 44                                         cefuroxime tablet, 10
CARAFATE ORAL SUSP, 44                               CEFZIL, 10
carbamazepine, 22                                    CELEBREX, 52
carbamazepine chew tab, -oral susp, -tablet,         celecoxib, 52
  21                                                 CELEXA, 26
carbamazepine xr, 22                                 CELLCEPT, 17
CARBAMAZEPINES, 21                                   CELLCEPT ORAL SUSP, 16
carbidopa/levodopa/entacap, 25                       CELONTIN, 27
carbidopa-levodopa, 25                               CENESTIN, 58
carbinoxamine maleate, 63                            CENTRALLY ACTING ANTIHYPERTENSIVES,
CARDIAC GLYCOSIDES, 30                                 31
CARDIOVASCULAR MEDICATIONS, 28                       cephalexin, 10
CARDIZEM, 30                                         CEPHALOSPORINS, 10
CARDIZEM CD, 30                                      CEREBYX, 23
CARDURA, 34                                          CEREZYME 200 UNITS VIAL, 42
CARDURA XL, 34                                       CERVARIX, 45
carisoprodol, 51                                     cesia, 57
carisoprodol tablet, 51                              CHANTIX, 27
                                                70
CHEMET, 37                                             clindamycin phosphate foam (non-
chlorambucil, 17                                          contraceptive), -gel, -lotion, -soln, top, -
chloramphenicol sod succinate, 11                         swabs, applicators, 35
CHLORAMPHENICOLS, 11                                   clindamycin phosphate vaginal products, 59
chlorhexidine gluconate dental/mucous                  CLINDAMYCINS, 11
   membrn products, 39                                 CLINORIL, 52
CHLOROMYCETIN, 11                                      clobetasol emollient, 36
chloroquine phosphate tablet, 14                       clobetasol propionate cream, -foam (non-
chlorothiazide, 34                                        contraceptive), -gel, -oint, -soln, top, 36
chlorpromazine hcl injection, 19                       clomipramine hcl cap, 27
chlorpromazine hcl tablet, 19                          clonidine hcl tablet, 31
chlorthalidone, 34                                     clopidogrel, 53
chlorzoxazone 500 mg tablet, 51                        clotrimazole 1% cream, -1% solution, -af 1%
cholestyramine, 31                                        cream, 13
cholestyramine light, 31                               clotrimazole loz, 11
CHOLINERGIC STIMULANTS, 65                             clotrimazole-betamethasone, 15
ciclopirox cream, -gel, -lotion, -soln, top, 13        clozapine, 19
cilostazol, 53                                         CLOZARIL, 19
cimetidine 200 mg tablet, -solution, 43                CNS MUSCLE RELAXANTS, 51
cimetidine injection, 44                               CNS STIMULANT DRUGS, 23
cinacalcet hcl, 43                                     COGENTIN, 19
CIPRO, 14                                              co-gesic, 22
CIPRO I.V., 14                                         COLAZAL, 44
CIPRO XR, 14                                           colchicine, 52
CIPRODEX, 38                                           COLCRYS, 52
ciprofloxacin 10 mg/ml vial, -400 mg/40 ml             COLESTID, 32
   vl, 14                                              colestipol hcl, 32
ciprofloxacin er, 14                                   colistimethate 150 mg vial, 12
ciprofloxacin hcl ophth drops, 61                      collagenase, 37
ciprofloxacin hcl tablet, 14                           COLY-MYCIN M PARENTERAL, 12
ciprofloxacin/dexameth, 38                             COLYTE, 44
citalopram, 26                                         COMBIPATCH, 58
citalopram hbr, 26                                     COMBIVENT, 64
CLAFORAN, 10                                           COMBIVIR, 9
claravis, 36                                           COMBUNOX, 22
clarithromycin, 13                                     COMPAZINE, 21
clarithromycin er, 13                                  compro, 21
CLASS II NARCOTICS, 22                                 COMTAN, 25
CLASS III NARCOTICS, 22                                COMVAX, 45
clemastine fum 2.68 mg tab, -syrup, 63                 CONDYLOX, 35
CLEOCIN, 11, 35                                        CONDYLOX GEL, 35
CLIMARA PRO, 58                                        constulose, 53
clinda-derm, 35                                        CONTRACEPTIVES, 57
clindamycin 150 mg/ml addvan, -ph 300                  COPAXONE, 38
   mg/2 ml vl, 11                                      COPEGUS, 12
clindamycin hcl cap, 11                                CORDARONE, 28
                                                  71
COREG, 29                                        danazol cap, 56
CORGARD, 29                                      DANTRIUM, 52
cormax oint, -soln, top, 36                      dantrolene sodium, 52
CORTEF, 39                                       dapsone, 8
cortisone tablet, 39                             DAPSONE, 8
CORTISPORIN, 61, 62                              DAPTACEL, 46
cortomycin otic drops, -suspensions, (not        daptomycin, 12
  oral), 38                                      DARAPRIM, 14
CORZIDE, 33                                      darifenacin hydrobromide, 65
COSOPT, 60                                       darunavir ethanolate, 9
COUMADIN, 55                                     dasatinib, 18
COUMADIN TABLET, 55                              DAYPRO, 52
COZAAR, 29                                       DDAVP, 42
CRESTOR, 31                                      DECADRON, 39
CRIXIVAN, 9                                      DECADRON PHOSPHATE, 39
cromolyn, 64                                     DECLOMYCIN, 15
cromolyn sodium nebs, 64                         deferasirox, 37
cromolyn sodium ophth drops, 62                  delavirdine mesylate, 9
crotamiton, 36                                   DELTASONE, 40
cryselle, 57                                     DEMADEX, 32
CUBICIN, 12                                      demeclocycline hcl, 15
CUPRIMINE, 53                                    DEMEROL 75 MG/ML SYRINGE, 22
CURAD GAUZE PADS, 48                             DEMSER, 31
CURITY ALCOHOL PREPS, 48                         DEMULEN, 58
CYCLESSA, 57, 58                                 DEMULEN 1-35-28, 57
CYCLOCORT, 36                                    DENAVIR, 12
cyclopentolate hcl, 62                           depade, 26
cyclophosphamide tablet, 16                      DEPAKENE, 28
cycloserine, 10                                  DEPAKOTE, 28
cyclosporine, 63                                 DEPAKOTE ER, 28
cyclosporine cap, -solution, 16                  DEPO-MEDROL, 39
cyclosporine modified, 16                        DEPO-PROVERA, 59
CYKLOKAPRON, 38                                  DEPO-PROVERA 400 MG/ML VIAL, 16
CYMBALTA 20 MG CAPSULE, 25                       DERMATOLOGICAL MEDICATIONS, 35
CYMBALTA 30 MG CAPSULE, -60 MG                   DERMATOP, 37
  CAPSULE, 25                                    DERMOTIC, 38
CYSTADANE, 65                                    desipramine hcl, 26
CYSTAGON, 54                                     desmopressin ac 4 mcg/ml vl, 42
cysteamine, 54                                   desmopressin acetate nasal drops/sprays, -
CYTOMEL, 43                                        solution, -tablet, 42
CYTOTEC, 44                                      DESOGEN, 57
CYTOVENE, 12                                     desonide cream, -lotion, -oint, 36
CYTOXAN, 16                                      desoximetasone cream, -gel, -oint, 36
cytra-2, 55                                      desvenlafaxine succinate, 25
d5-1/3ns/kcl 30 meq/l iv sol, 54                 DESYREL, 25
d5w/kcl 10 meq/l iv solution, 54                 dexamethasone 4 mg/ml vial, 39
                                            72
dexamethasone elix, -tablet, 39                      diltiazem 125 mg/25 ml vial, -25 mg/5 ml
dexamethasone intensol, 39                              vial, -5 mg/ml vial, -50 mg/10 ml vial, 30
dexamethasone sodium phosphate ophth                 diltiazem 24hr er cap sa, 30
   drops, 61                                         diltiazem 24hr er tab sa, 30
dexasporin, 61                                       diltiazem er, 30
dextroamphetamine sulfate cap sa, 23                 diltiazem hcl tablet, 30
dextrose 10%-1/4ns, 54                               dilt-xr, 30
dextrose 10%-water iv solution, -5%-water            diltzac er, 30
   iv soln, 54                                       DIOVAN, 29
dextrose 2.5%-1/2ns iv soln, -5%-1/2ns iv            DIOVAN HCT, 33
   soln., -5%-1/2ns iv solution, -5%-1/4ns iv        diphenhydramine 50 mg cap, -50 mg
   soln., -5%-1/4ns iv solution, -5%-ns iv              capsule, -50 mg/ml vial, 63
   solution, 54                                      diphenoxylate-atropine, 43
DEXTROSE 5%-1/4NS-KCL, 54                            diphther,pertuss,tetanus vac, 45, 46
dextrose 5%-lr iv solution, 55                       DIPHTHERIA-TETANUS TOXOID, 46
DIABETA, 42                                          dipyridamole tablet, 53
DIABETIC SUPPLIES, 48                                DIRECT MUSCLE RELAXANTS, 52
DIAGNOSTIC AND MISCELLANEOUS                         disulfiram, 26
   MEDICATIONS, 37                                   DITROPAN, 65
DIAGNOSTIC PRODUCTS, 37                              DITROPAN XL, 65
diazoxide, 40                                        DIURIL, 34
DIBENZYLINE, 31                                      divalproex sodium, 28
diclofenac potassium, 52                             divalproex sodium er, 28
diclofenac sodium, 37, 63                            dofetilide, 32
diclofenac sodium e.c. tab, -tab sa, 52              DOLOBID, 53
diclofenac sodium ophth drops, 62                    DOLOPHINE HCL, 22
dicloxacillin sodium, 14                             DOMEBORO, 38
dicyclomine, 43                                      donepezil, 18
didanosine, 9                                        dorzolamide, 60
DIDRONEL, 42                                         dorzolamide hcl, 60
diflorasone diacetate, 36                            dorzolamide-timolol, 60
DIFLUCAN, 11                                         DOSTINEX, 42
DIFLUCAN IN DEXTROSE, 13                             DOVONEX, 35
diflunisal, 53                                       DOVONEX CREAM, 35
digoxin, 30                                          doxazosin, 34
digoxin 0.25 mg/ml ampul, 30                         doxazosin mesylate 1 mg tab, -2 mg tab, -4
digoxin solution, -tablet, 30                           mg tab, 34
DILACOR XR, 30                                       doxazosin mesylate 8 mg tab, 34
DILANTIN, 23                                         doxepin, 37
DILANTIN 100 MG CAPSULE, -30 MG                      doxepin 10 mg capsule, -100 mg capsule, -
   CAPSULE, -CHEW TAB, 23                               25 mg capsule, -50 mg capsule, -75 mg
DILANTIN-125, 23                                        capsule, -solution, 28
DILAUDID, 22                                         doxercalciferol, 56
dilt-cd, 30                                          doxycycline hyclate 100 mg tab, -cap, -e.c.
diltia xt, 30                                           cap, -injection, 15
                                                     doxycycline hyclate 20 mg tab, 39
                                                73
doxycycline monohydrate, 15                        EMEND TRIFOLD PACK, 21
doxycycline tablet, 15                             EMSAM, 24
dp (a) ped/hib conj-tet, 46                        emtricitabine, 9
dronabinol 10 mg capsule, -5 mg capsule, 21        emtricitabine/tenofovir, 9
dronabinol 2.5 mg capsule, 21                      emtricitabine/tenofovir/efavir, 9
DRUGS AFFECTING THE EAR, 38                        EMTRIVA, 9
DRUGS AFFECTING THE NOSE, 38                       ENABLEX, 65
DRUGS AFFECTING THE THROAT AND                     enalapril maleate tablet, 28
   MOUTH, 39                                       enalapril-hydrochlorothiazide, 33
DRUGS FOR PHEOCHROMOCYTOMA, 31                     ENBREL, 16
DRUGS TO PREVENT AND TREAT GOUT, 52                endocet, 22
DRUGS TO PREVENT AND TREAT                         ENDOCRINE MEDICATIONS, 39
   HEADACHES, 23                                   endodan, 22
DUETACT, 41                                        ENDOTHELIN RECPTR ANTAGONIST, 31
duloxetine, 25                                     ENDURON, 34
DURAGESIC, 22                                      enfuvirtide, 9
DURICEF, 10                                        ENGERIX-B 10 MCG/0.5 ML PED VL, -10
dutasteride, 65                                      MCG/0.5 ML SYRN, -20 MCG/ML SYRINGE,
DYNACIRC, 30                                         -20 MCG/ML VIAL, 46
DYNAPEN, 14                                        enoxaparin, 55
EAR-NOSE-THROAT MEDICATIONS, 38                    enoxaparin 100 mg/ml syr, -120 mg/0.8 ml
EASY COMFORT INSULIN SYRINGE, 48                     syr, -150 mg/ml syr, -60 mg/0.6 ml syr, -
EASY TOUCH INSULIN NEEDLES -                         80 mg/0.8 ml syr, 55
   DISPOSABLE, -INSULIN SYRINGES -                 enoxaparin 30 mg/0.3 ml syr, -40 mg/0.4 ml
   DISPOSABLE, 48                                    syr, 55
echothiophate iodide, 60                           enpresse, 57
econazole nitrate cream, 13                        entacapone, 25
efavirenz, 9                                       entecavir, 12
EFFEXOR, 25                                        enulose, 53
ELAPRASE, 42                                       epinephrine 0.1 mg/ml syringe, 64
ELAVIL, 27                                         epinephrine hcl, 64
electrolyte solutions, 54                          EPIPEN, 64
ELECTROLYTES, IRRIGATING SOLUTIONS,                EPIPEN JR, 64
   ETC., 53                                        epitol, 22
ELIDEL, 37                                         EPIVIR, 9
ELIGARD, 16                                        EPIVIR HBV, 12
ELIMITE, 36                                        eplerenone, 34
eliphos, 56                                        epoetin alfa, 46
ELITEK 1.5 MG VIAL, 16                             eprosartan mesylate, 29
ELMIRON, 65                                        eprosartan mesylate/hctz, 33
ELOCON, 37                                         EPZICOM, 9
eltrombopag olamine, 48                            ergoloid mesylates tablet, 38
EMCYT, 16                                          ergotamine-caffeine, 23
EMEND 125 MG CAPSULE, -40 MG CAPSULE,              erlotinib hcl, 18
   21                                              errin, 59
EMEND 80 MG CAPSULE, 21                            ertapenem sodium, 12
                                              74
ery, 35                                       EVISTA, 42
ERYCETTE, 35                                  EXEL INSULIN SYRINGE, 49
ERY-TAB, 11                                   EXELDERM, 13
erythrocin stearate, 11                       EXELON, 18
erythromycin base, 11                         exemestane, 16
erythromycin e.c. cap, -tablet, 11            exenatide, 40
erythromycin ethylsuccinate tablet, 11        EXJADE, 37
erythromycin gel, -soln, top, 35              ezetimibe, 32
erythromycin oint, 61                         ezetimibe/simvastatin, 31
ERYTHROMYCIN STEARATE, 11                     FABRAZYME 35 MG VIAL, 42
erythromycin-benzoyl peroxide, 35             famciclovir 125 mg tablet, -500 mg tablet, 12
ERYTHROMYCINS, 11                             famciclovir 250 mg tablet, 12
erythromycin-sulfisoxazole, 15                famotidine 20 mg tablet, -40 mg tablet, 44
esomeprazole mag trihyd, 45                   FAMVIR, 12
ESTRACE, 58                                   FANAPT 1 MG TABLET, -10 MG TABLET, -12
ESTRACE VAGINAL PRODUCTS, 58                     MG TABLET, -2 MG TABLET, -4 MG
ESTRADERM, 58                                    TABLET, -6 MG TABLET, -8 MG TABLET, 19
estradiol, 58                                 FANAPT TITRATION PACK, 19
estradiol adh. patch, 58                      FARESTON, 16
estradiol tablet, 58                          fat emulsions, 56
estradiol/levonorgestrel, 58                  FAZACLO 100 MG ODT, -100 MG TABLET, -
estradiol/noreth ac, 58                          12.5 MG ODT, -12.5 MG TABLET, -25 MG
estradiol-norethindrone acetat, 58               ODT, -25 MG TABLET, 19
estramustine phosphate sodium, 16             felbamate, 24
ESTROGEN DRUGS, 58                            FELBATOL, 24
estrogen,conjug,synthetic a, 58               felodipine er, 30
estrogen/medroxyprogesterone, 58              FEMARA, 16
ESTROGEN/PROGESTIN COMBINATIONS, 58           fenofibrate, 32
estrogens,conjugated, 58                      fenofibric acid, 32
estrogens,esterified, 58                      fenoprofen calcium, 52
estropipate, 58                               fentanyl, 22
ESTROSTEP FE, 57                              fentanyl 0.05 mg/ml syringe, 22
etanercept, 16                                fentanyl cit otfc 1,200 mcg, -otfc 200 mcg, -
eth estradiol/drospirenone, 58                   otfc 400 mcg, -otfc 600 mcg, -otfc 800
ethambutol hcl tablet, 10                        mcg, 22
ethinyl estradiol/norelgest, 57               fentanyl cit otfc 1,600 mcg, 22
ethionamide, 10                               FENTANYL CITRATE, 22
ethosuximide, 27                              fexofenadine hcl 180 mg tablet, 63
ethotoin, 23                                  fexofenadine hcl 30 mg tablet, -60 mg tablet,
etidronate disodium, 42                          63
etodolac, 52                                  filgrastim, 48
etonogestrel/ethin estradiol, 57              finasteride, 65
etravirine, 9                                 FIORICET WITH CODEINE, 23
EULEXIN, 16                                   FIORINAL WITH CODEINE, 23
EURAX, 36                                     FIORINAL WITH CODEINE #3, 23
everolimus, 16                                flavoxate hcl, 65
                                         75
FLEBOGAMMA, 46                                         FML S.O.P., 61
flecainide acetate, 29                                 fomepizole, 38
FLOMAX, 65                                             fondaparinux sodium, 54
FLONASE, 39                                            FORADIL, 63
FLORINEF, 41                                           formoterol fumarate, 63
FLOXIN, 14                                             FORTEO, 42
fluconazole 100 mg tablet, -200 mg tablet, -           fortical, 42
   50 mg tablet, -suspension, 11                       FOSAMAX, 42
fluconazole 150 mg tablet, 11                          fosamprenavir calcium, 9
fluconazole-dext 400 mg/200 ml, 13                     foscarnet sodium, 12
flucytosine, 11                                        FOSCAVIR, 12
fludrocortisone acetate tablet, 41                     fosinopril sodium, 28
FLUMADINE, 12                                          fosinopril-hydrochlorothiazide, 33
flunisolide 0.025% spray, 39                           fosphenytoin 100 mg pe/2 ml vl, 23
flunisolide 29 mcg-0.025% spr, 39                      fosphenytoin 500 mg pe/10 ml, 23
fluocinolone acetonide, 38                             FURADANTIN, 15
fluocinolone acetonide cream, -oint, -soln,            FUROSEMIDE, 32
   top, 36                                             furosemide 10 mg/ml vial, 32
fluocinonide cream, -gel, -oint, -soln, top, 36        furosemide solution, -tablet, 32
fluocinonide emollient, 36                             FUZEON, 9
fluocinonide-e, 36                                     gabapentin, 24
fluorometholone, 61                                    gabapentin cap, -tablet, 24
FLUOROPLEX, 37                                         GABITRIL, 24
fluorouracil, 37                                       galantamine hbr, 18
fluorouracil cream, -soln, top, 37                     galantamine hydrobromide, 18
fluoxetine dr, 26                                      galsulfase, 43
fluoxetine hcl 10 mg capsule, -10 mg tablet,           GAMUNEX, 46
   26                                                  ganciclovir, 12
fluoxetine hcl 20 mg capsule, -20 mg tablet,           GARAMYCIN, 15, 62
   -solution, 27                                       GARDASIL VIAL, 46
fluoxetine hcl 40 mg capsule, 27                       GASTROCROM, 64
fluoxymesterone, 56                                    GASTROINTESTINAL MEDICATIONS, 43
fluphenazine decanoate, 19                             gatifloxacin, 62
fluphenazine hcl elix, -tablet, 19                     gavilyte-c, 44
fluphenazine hcl injection, -solution, 19              gefitinib, 17
flurbiprofen sodium, 62                                gemfibrozil, 32
flurbiprofen tablet, 52                                generlac, 53
flutamide, 16                                          gengraf, 16
fluticasone propionate cream, -oint, 36                GENOPTIC, 62
fluticasone propionate nasal inhaled steroids,         gentak, 62
   39                                                  gentamicin 0.1% ointment, -cream, 15
fluvoxamine maleate 100 mg tab, 27                     gentamicin 10 mg/ml vial, -40 mg/ml vial, 8
fluvoxamine maleate 25 mg tab, 27                      gentamicin 3 mg/gm eye oint, -ophth drops,
fluvoxamine maleate 50 mg tab, 27                        62
FML, 61                                                gentasol, 62
FML FORTE, 61                                          GEODON CAP, 19
                                                  76
GEODON INJECTION, 19                         HAVRIX 1,440 UNITS/ML SYRINGE, -1,440
glatiramer acetate, 38                         UNITS/ML VIAL, -720 UNIT/0.5 ML
GLEEVEC, 16                                    SYRINGE, 46
glimepiride, 41                              hctz/valsartan, 33
glipizide er, 41                             heather, 59
glipizide tablet, 41                         HECTOROL CAP, 56
glipizide xl, 41                             hep b vaccine/dp (a) t-polio, 46
glipizide-metformin, 42                      hep b vir recomb/hep a vir, 46
GLUCAGON EMERGENCY KIT, 40                   heparin na 1,000 units/ml vial, -na 5,000
glucagon, human recombinant, 40                units/ml vial, -sod 1,000 unit/ml vial, -sod
GLUCOCORTICOID DRUGS, 39                       10,000 unit/ml vl, -sod 2,000 unit/ml vial, -
GLUCOPHAGE, 42                                 sod 2,500 unit/ml vial, -sod 20,000 unit/ml
GLUCOPHAGE XR, 42                              vl, -sod 5,000 unit/ml vial, 55
GLUCOPRO INSULIN SYRINGES -                  heparin sodium in 0.45% nacl, 55
   DISPOSABLE, 49                            heparin sodium in 0.9% nacl, 55
GLUCOSE ELEVATING DRUGS, 40                  heparin-d5w 20,000 unit/500 ml, 55
GLUCOTROL XL, 41                             hepatatis a virus vaccine, 46, 47
GLUCOVANCE, 42                               hepatitis b virus vaccine, 46
glyburide, 42                                hepatitis b/haemophilus b vacc, 45
glyburide micronized, 42                     HEPSERA, 12
glyburide-metformin hcl, 42                  HEXALEN, 17
glycopyrrolate injection, -tablet, 43        HIPREX, 15
glycron, 42                                  HISTEX PD, 63
GLYNASE, 42                                  HMG-COA REDUCTASE INHIBITORS, 31
GLYSET, 42                                   HUMALOG 100 UNITS/ML VIAL, 40
granisetron hcl tablet, 21                   HUMALOG MIX 50-50 VIAL, 40
GRIFULVIN V TABLET, 11                       HUMALOG MIX 75-25 VIAL, 40
griseofulvin microsize, 11                   human papillomav vacc bival/pf, 45
griseofulvin oral susp, 11                   human papillomavirus vacc, 46
griseofulvin ultramicrosize, 11              HUMATIN, 8
GRIS-PEG, 11                                 HUMATROPE, 45
GROWTH HORMONES AND RELATED                  HUMIRA, 17
   DRUGS, 45                                 HUMULIN 70-30 VIAL, 40
guanabenz acetate, 31                        HUMULIN N 100 UNITS/ML VIAL, 40
guanfacine, 26                               HUMULIN R 100 UNITS/ML VIAL, 40
guanfacine hcl, 31                           HUMULIN R 500 UNITS/ML VIAL, 40
guanidine hcl, 26                            HYDANTOINS, 23
haemophilus b vaccine, 46                    hydralazine hcl injection, 34
haemophilus b-tet toxoid, 45                 hydralazine hcl tablet, 34
HALDOL, 19, 20                               hydra-zide, 33
HALDOL DECANOATE, 19                         hydrochlorothiazide cap, -tablet, 34
halobetasol propionate, 36                   hydrocodone bit-ibuprofen, 23
haloperidol decanoate, 19                    hydrocodone-acetaminophen, 23
haloperidol lactate injection, 19            hydrocortisone 1% absorbase, -1% cream, -
haloperidol lactate solution, 20               1% lotion, -1% oin, -1% oint, -1%
haloperidol tablet, 20                         ointment, -2.5% cream, -2.5% lotion, -
                                        77
   2.5% ointment, -aloe 1% cream, -plus 1%        INNOPRAN XL, 29
   cream, 37                                      INSPRA, 34
hydrocortisone butyrate, 37                       INSULIN, 40
hydrocortisone rectal, 44                         INSULIN LIKE GROWTH FACTORS-1, 47
hydrocortisone tablet, 39                         INSULIN PEN NEEDLE, 49
hydrocortisone valerate, 37                       INSULIN SYRINGE 0.3 ML, -0.3 ML 29GX1/2,
hydromorphone hcl 10 mg/ml amp, -tablet,             -0.3 ML 30GX5/16, -0.3 ML 31GX5/16, -0.3
   22                                                ML SYRINGE, -0.3M, -0.5 ML, -0.5 ML
hydroxychloroquine sulfate tablet, 14                28GX1/2, -0.5 ML 29GX1/2, -0.5 ML
hydroxypropylmethylcellulose, 62                     30GX5/16, -0.5 ML 31GX5/16, -0.5 ML
hydroxyurea cap, 17                                  SYRINGE, -1 ML, -1 ML 28GX1/2, -1 ML
hydroxyzine hcl injection, -tablet, 35               29GX1/2, -1 ML 30GX1/2, -1 ML, 49
HYPOGLYCEMIC DRUGS, 40                            INSULIN SYRINGE U100 1ML, 49
HYPOLIPOPROTEINEMICS, 31                          INSUMED SYR 0.3 ML 31GX5/16, -SYR 0.5
HYTRIN, 34, 35                                       ML 31GX5/16, -SYRINGE 1 ML 30GX5/16,
HYZAAR, 33                                           49
ibandronate, 42                                   INSUPEN, 49
ibuprofen 100 mg/5 ml, -100 mg/5 ml sus, -        INTEGRA SYRINGE INSULIN SYRINGES -
   100 mg/5 ml susp, -400 mg tablet, -600            DISPOSABLE, 49
   mg tablet, -800 mg tablet, 52                  INTELENCE, 9
idursulfase, 42                                   interferon alfa-2b , recomb., 47
iloperidone, 19                                   interferon alfacon-1, 47
ILOTYCIN, 62                                      interferon alfa-n3, 47
imatinib mesylate, 16                             interferon beta-1a, 47
imiglucerase, 42                                  interferon beta-1a/albumin, 47
imipenem/cilastatin sodium, 12                    interferon beta-1b, 47
imipramine hcl tablet, 28                         interferon gamma-1b,recomb., 47
imipramine pamoate, 28                            INTERFERONS, 47
imiquimod, 37                                     INTERLEUKIN RECPTR ANTAGONIST, 47
IMITREX, 23                                       INTERLEUKINS, 48
immune globulin - iv, 46                          INTRALIPID 30% IV FAT EMUL, 56
IMMUNOLOGICALS AND VACCINES, 45                   INTRON A 10 MILLION UNIT PEN, -5
IMOVAX RABIES VACCINE, 46                            MILLION UNIT/ML PEN, 47
IMURAN, 16                                        INTRON A 10 MILLION UNIT/ML, -6 MILLION
inatal gt, 59                                        UNIT/ML VL, 47
inatal ultra, 59                                  INTRON A 10 MILLION UNITS VIAL, 47
INCRELEX, 47                                      INTRON A 3 MILLION UNIT/ML PEN, 47
indapamide, 34                                    INTUNIV, 26
INDERAL, 29, 30                                   INVANZ 1 GM VIAL, 12
INDERIDE-80/25, 33                                INVEGA ER 1.5 MG TABLET, -ER 3 MG
indinavir, 9                                         TABLET, -ER 9 MG TABLET, 20
indomethacin cap, -cap sa, 52                     INVEGA ER 6 MG TABLET, 20
INFANRIX, 46                                      INVEGA SUSTENNA 117 MG PREF SY, -156
INFERGEN 9 MCG/0.3 ML VIAL, 47                       MG PREF SY, -234 MG PREF SY, 20
infliximab, 17                                    INVEGA SUSTENNA 39 MG PREF SYR, -78
INJECTABLE ANTICOAGULANTS, 54                        MG PREF SYR, 20
                                             78
INVIRASE, 9                                      KEPIVANCE, 46
IOPIDINE, 60                                     KEPPRA, 24
IPOL VIAL, 46                                    KEPPRA INJECTION, 24
ipratropium, 64                                  keratol 40 gel, 37
ipratropium 0.03% spray, 39                      KERATOLYTIC DRUGS, 35
ipratropium 0.06% spray, 39                      KERLONE, 29
irbesartan, 29                                   ketoconazole cream, -oil,shampoo,cleanser,
irbesartan/hctz, 33                                 13
IRESSA, 17                                       ketoconazole tablet, 11
IRRITABLE BOWEL DRUGS, 44                        ketoprofen cap, -cap sa, 52
ISENTRESS, 9                                     ketorolac, 62
isocarboxazid, 24                                ketorolac tromethamine ophth drops, 62
ISOCHRON, 32                                     kionex oral susp, 55
isonarif, 10                                     klor-con 10, 56
isoniazid injection, 10                          klor-con 20 meq packet, 56
isoniazid syrup, -tablet, 10                     klor-con 8, 56
isosorbide dinitrate, 32                         klor-con m10, 56
isosorbide mononitrate, 32                       klor-con m15, 56
isradipine, 30                                   klor-con m20, 56
itraconazole cap, 11                             klor-con-ef, 56
ivermectin, 8                                    K-TAB, 55, 56
IXIARO, 46                                       KUVAN, 42
jantoven, 55                                     KYTRIL, 21
JANUMET, 42                                      labetalol hcl 5 mg/ml vial, 29
JANUVIA, 42                                      labetalol hcl tablet, 29
japanese encephalitis vaccine, 46                LAC-HYDRIN, 37
JE-VAX, 46                                       lacosamide, 24
jolivette, 59                                    LACRISERT, 62
junel, 57                                        lactated ringers injection, 54
junel fe, 57                                     lactulose, 53
KALETRA 100-25 MG TABLET, 9                      LAMICTAL, 24
KALETRA 200-50 MG TABLET, -SOLUTION, 9           LAMISIL, 11
kalexate, 55                                     lamivudine, 9, 12
kaon-cl 10, 55                                   lamivudine/zidovudine, 9
kariva, 57                                       lamotrigine 100 mg tablet, -150 mg tablet, -
KAYEXALATE, 55                                      200 mg tablet, -25 mg disper tab, -25 mg
kcl 20 meq in d5w-lact ringer, -40 meq in           tablet, -5 mg disper tablet, 24
   d5w-lact ringer, 56                           lamotrigine tablet starter kit, 24
kcl 40 meq in d5w-lact ringer, 56                LANOXIN, 30
K-DUR, 56                                        LANOXIN TABLET, 30
KEFLEX, 10                                       lansoprazole, 45
KEFTAB, 10                                       lansoprazole cap sa, 45
KEFZOL, 10                                       LANTUS 100 UNITS/ML VIAL, 40
kelnor 1-35, 57                                  lapatinib ditosylate, 18
KENALOG, 37                                      LARIAM, 14
KENALOG IN ORABASE, 39                           laronidase, 42
                                            79
LASIX, 32                                   liotrix, 43
latanoprost, 61                             LIPITOR, 31
LAXATIVES AND CATHARTICS, 44                lisinopril tablet, 28
leena, 57                                   lisinopril-hydrochlorothiazide, 33
leflunomide, 17                             LITE TOUCH INSULIN PEN NEEDLES, 49
lenalidomide, 17                            LITE TOUCH INSULIN SYRINGES -
lessina, 57                                    DISPOSABLE, 49
LETAIRIS, 31                                lithium, 19
letrozole, 16                               lithium carbonate cap, -tab sa, -tablet, 19
leucovorin calcium tablet, 17               lithium citrate, 19
LEUKERAN, 17                                LOCAL ANESTHETICS, 8
LEUKINE, 48                                 LOCOID, 37
LEUKOTRIENE MODIFIERS, 64                   LODINE, 52
leuprolide, 16, 60                          LOESTRIN, 57
leuprolide acetate, 60                      LOESTRIN FE, 57
levalbuterol, 63                            LOFIBRA, 32
LEVAQUIN TABLET, 14                         LOMOTIL, 43
LEVEMIR 100 UNITS/ML VIAL, 41               lomustine, 16
levetiracetam, 24                           LONITEN, 34
levetiracetam injection, 24                 lonox, 43
levetiracetam solution, -tablet, 24         LOOP DIURETICS, 32
levobunolol hcl, 60                         LO-OVRAL-28, 57
levocarnitine solution, -tablet, 56         loperamide cap, 43
levocetirizine dihydrochlor, 63             LOPID, 32
LEVO-DROMORAN, 22                           LOPRESSOR, 29
levofloxacin, 14                            LOPRESSOR HCT, 33
levora-28, 57                               LORCET 10-650, 23
levorphanol tartrate tablet, 22             LORTAB, 22
levothroid, 43                              losartan, 29
levothyroxine, 43                           losartan /hctz, 33
levothyroxine sodium tablet, 43             losartan potassium, 29
levoxyl, 43                                 losartan-hydrochlorothiazide, 33
LEXIVA ORAL SUSP, 9                         LOTEMAX, 61
LEXIVA TABLET, 9                            LOTENSIN, 28
LIDEX-E, 36                                 LOTENSIN HCT, 33
lidocaine, 8                                loteprednol etabonate, 61
lidocaine hcl 0.5% vial, -1% vial, 8        LOTREL, 32
lidocaine hcl dental/mucous membrn          LOTRIMIN, 13
   products, -gel, -oint, 8                 LOTRISONE, 15
lidocaine hcl viscous, 8                    LOTRONEX, 44
lidocaine-prilocaine, 8                     lovastatin 10 mg tablet, 31
LIDODERM, 8                                 lovastatin 20 mg tablet, -40 mg tablet, 31
LIMBITROL, 24                               LOVENOX, 55
linezolid, 12                               LOVENOX 100 MG PREFILLED SYR, -120 MG
liothyronine sodium injection, 43              PREFILLED SYR, -150 MG PREFILLED SYR,
liothyronine sodium tablet, 43
                                       80
   -60 MG PREFILLED SYRN, -80 MG             meclizine 12.5 mg tablet, -25 mg tablet, 21
   PREFILLED SYRN, 55                        meclofenamate sodium cap, 52
LOVENOX 30 MG PREFILLED SYRN, -40 MG         MEDICAL (MISCELLANEOUS) SUPPLIES, 48
   PREFILLED SYRN, 55                        MEDROL, 39
low-ogestrel, 57                             medroxyprogesterone, 16
loxapine, 20                                 medroxyprogesterone acetate injection, 59
LOXITANE, 20                                 medroxyprogesterone acetate tablet, 59
LOZOL, 34                                    mefloquine hcl, 14
lubiprostone, 44                             MEFOXIN, 10
LUDIOMIL, 25                                 MEGACE, 17
LUER-LOK SYRINGE INSULIN SYRINGES -          megestrol acetate oral susp, 17
   DISPOSABLE, 49                            megestrol acetate tablet, 17
LUMIGAN, 60                                  MELLARIL, 20
LUPRON, 60                                   meloxicam oral susp, 52
LUPRON DEPOT 11.25 MG 3MO KIT, -22.5         meloxicam tablet, 52
   MG 3MO KIT, -3.75 MG KIT, -4 MONTH        memantine hcl, 18
   KIT, 60                                   MENACTRA 4 MCG/0.5 ML SYRINGE, 46
LUPRON DEPOT 7.5 MG KIT, 60                  MENEST, 58
LUPRON DEPOT-PED 11.25 MG KIT, -15 MG        meningococcal vac a,c,y,w-135, 46
   KIT, 60                                   MENOMUNE-A-C-Y-W-135, 46
lutera, 57                                   MENOSTAR, 58
LUVOX, 27                                    meperidine, 22
lymphocyte immune globulin, 45               meprobamate, 21
LYRICA, 24                                   meprolone unipak, 39
LYSODREN, 17                                 MEPRON, 12
magnesium sulfate 50% syringe, 54            mercaptopurine tablet, 17
MALARONE, 14                                 MERUVAX II VACCINE W-DILUENT, 46
MAO INHIBITORS, 24                           mesalamine, 44
maprotiline hcl, 25                          mesalamine rectal, 44
maraviroc, 9                                 mesna, 17
margesic h, 23                               MESNEX TABLET, 17
MARINOL, 21                                  MESTINON, 26
MARPLAN, 24                                  MESTINON TAB SA, 26
maternity, 59                                metadate er 20 mg tablet, 23
MATULANE, 17                                 METAGLIP, 42
MAVIK, 28                                    metaproterenol sulfate syrup, -tablet, 63
MAXALT, 23                                   metformin hcl, 42
MAXALT MLT, 23                               metformin hcl er, 42
MAXIPIME 2 GM ADD-VANTAGE VL, 10             methadex, 61
MAXITROL, 61                                 methadone hcl 10 mg tablet, -5 mg tablet, -
MAXZIDE, 34                                   injection, -solution, 22
measles vaccine,atten, 45                    methadose 10 mg tablet, -5 mg tablet, 22
measles,mumps&rubella vaccine, 46            methazolamide, 60
measles,mumps,rub,varicella, 46              methenamine hippurate, 15
mebendazole chew tab, 8                      METHERGINE TABLET, 59
mecasermin, 47                               methimazole tablet, 39
                                        81
METHITEST, 56                                        miglitol, 42
methotrexate injection, 17                           miglustat, 43
methotrexate tablet, 17                              milnacipran hcl, 25
methoxsalen, 36                                      MILTOWN, 21
methscopolamine bromide, 43                          mimvey, 58
methsuximide, 27                                     MINERALOCORTICOID DRUGS, 41
methyclothiazide tablet, 34                          MINIPRESS, 34
METHYL XANTHINE DRUGS, 64                            MINITRAN, 32
methyldopa, 31                                       minocycline hcl cap, -tab sa, -tablet, 15
methyldopa-hydrochlorothiazide, 33                   minoxidil tablet, 34
methyldopate hcl, 31                                 MIRAPEX, 25
methylergonovine, 59                                 MIRAPEX ER, 25
methylnaltrexone bromide, 44                         MIRCETTE, 57
methylprednisolone 125 mg vial, -40 mg vial,         mirtazapine, 25
  -ss 1 gm vl, 39                                    misc supp (dress,tape,gauze), 48
methylprednisolone acetate injection, 39             MISCELLANEOUS DRUGS, 38
methylprednisolone tab(in convenience                misoprostol, 44
  package), -tablet, 39                              mitotane, 17
methyltestosterone, 56                               mitoxantrone hcl injection, 17
metipranolol, 60                                     M-M-R II VACCINE, 46
metoclopramide 5 mg/ml vial, -syrup, -tablet,        MOBIC, 52
  43                                                 modafinil, 23
metolazone, 34                                       MODURETIC, 34
metoprolol succinate, 29, 30                         moexipril hcl, 28
metoprolol tart 1 mg/ml vial, -tart 5 mg/5 ml        moexipril-hydrochlorothiazide, 33
  vial, 29                                           mometasone furoate, 37
metoprolol tartrate tablet, 29                       MONOJECT 1 ML SYRN 25X5/8, -1 ML SYRN
metoprolol-hydrochlorothiazide, 33                     27X1/2, -1 ML SYRN 28GX1/2, -INSUL SYR
METROCREAM, METROGEL, METROLOTION,                     U100, -INSUL SYR U100 0.5 ML, -INSUL
  35                                                   SYR U100 1 ML, -INSULIN SYR 0.3 ML, -
METROGEL-VAGINAL, 16, 59                               INSULIN SYR 0.5 ML, -INSULIN SYR 1 ML,
metronidazole cap, -injection, -tablet, 8              -INSULIN SYR U-100, -INSULIN SYRN 3/10
metronidazole cream, -gel, -lotion, 35                 ML, -SYR 1/2 ML BULK PACK,, 49
metronidazole vaginal products, 59                   MONOJECT INSULIN SAFETY SYRNG, 49
metyrosine, 31                                       MONOKET, 32
MEVACOR, 31                                          mononessa, 57
mexiletine hcl cap, 29                               MONOPRIL, 28
MIACALCIN, 42                                        MONOPRIL HCT, 33
micafungin sodium, 14                                montelukast sodium, 64
MICARDIS, 29                                         morphine 0.5 mg/ml vial, -1 mg/ml vial, -1
MICARDIS HCT, 33                                       mg/ml vial p-f, -5 mg/ml vial, -solution, -
miconazole 3 200 mg vag supp, 16                       tab sa, -tablet, 22
microgestin, 57                                      MOTRIN, 52
microgestin fe, 57                                   moxifloxacin, 14, 62
MIDAMOR, 34                                          mupirocin oint, 15
midodrine hcl, 33                                    MUSCULOSKELETAL MEDICATIONS, 51
                                                82
MYCAMINE, 14                                         neomycin-polymyxin-hc ophth drops, 61
MYCOBUTIN, 10                                        neomycin-polymyxin-hc otic drops, -solution,
MYCOLOG II, 15                                          -suspensions, (not oral), 38
mycophenolate mofetil, 16                            neomy-polymyxin b 40 mg/ml amp, 65
mycophenolate mofetil cap, 17                        NEORAL, 16
mycophenolate mofetil tablet, 17                     NEOSPORIN, 62
mycophenolate sodium, 17                             NEOSPORIN G.U. IRRIGANT, 65
MYCOSTATIN, 13                                       NEPTAZANE, 60
mydral, 62                                           NEULASTA, 48
MYDRIACYL, 62, 63                                    NEUMEGA, 48
MYELOID STIMULANTS, 48                               NEUPOGEN, 48
MYFORTIC, 17                                         NEURONTIN SOLUTION, 24
MYSOLINE, 24                                         nevirapine, 9
nabumetone, 52                                       NEXAVAR, 17
nadolol tablet, 29                                   NEXIUM, 45
nadolol-bendroflumethiazide, 33                      next choice, 57
nafarelin, 60                                        niacin, 32
nafcillin 1 gm add-van vial, -1 gm vial, 14          NIASPAN, 32
NAGLAZYME, 43                                        nicardipine hcl cap, 30
NALLPEN, 14                                          nicotine inhaler, 27
naloxone 0.4 mg/ml ampul, -0.4 mg/ml                 nicotine ns, 27
  syringe, -0.4 mg/ml vial, -1 mg/ml syringe,        NICOTROL, 27
  26                                                 NICOTROL NS, 27
naltrexone hcl tablet, 26                            nifediac cc, 30
NAMENDA 10 MG TABLET, -5 MG TABLET, -                nifedical xl, 30
  SOLUTION, 18                                       nifedipine er, 30
NAMENDA 5-10 MG TITRATION PK, 18                     NILANDRON, 17
naphazoline hcl ophth drops, 62                      nilotinib hydrochloride, 18
naproxen e.c. tab, -oral susp, -tablet, 52           nilutamide, 17
naproxen sodium 275 mg tab, -550 mg tab,             nimodipine, 30
  52                                                 NIMOTOP, 30
NARCAN, 26                                           nisoldipine er 20 mg tablet, -er 30 mg tablet,
NARDIL, 24                                              -er 40 mg tablet, 30
NASALIDE, 39                                         nitazoxanide, 11
NATACYN, 62                                          nitisinone, 38
natamycin, 62                                        NITRATES, 32
NAVANE, 20                                           nitro-bid, 32
necon 0.5-35-28 tablet, -1/35-28 tablet, -10-        nitrofurantoin, 15
  11-28 tablet, -7-7-7-28 tablet, 57                 nitroglycerin, 32
nefazodone hcl, 25                                   NITROGLYCERIN, 32
nelfinavir mesylate, 9                               nitroglycerin patch, 32
neomycin sulfate tablet, 8                           nitroglycerin tab, sl, 32
neomycin-bacitracin-poly-hc, 61                      nitroquick, 32
neomycin-bacitracin-polymyxin, 62                    NITROSTAT, 32
neomycin-polymyxin-dexameth, 61                      nizatidine, 44
neomycin-polymyxin-gramicidin, 62                    NIZORAL, 11
                                                83
NOLVADEX, 18                                          octreotide acet 100 mcg/ml amp, -acet 200
NON-STEROIDAL ANTIINFLAMMATORY                          mcg/ml vl, 17
  AGENTS, 52                                          octreotide acet 50 mcg/ml amp, 17
nora-be, 59                                           octreotide acet 50 mcg/ml vial, 17
NORDETTE-28, 57                                       OCUPRESS, 60
NORDITROPIN, 45                                       ofloxacin ophth drops, 62
NORDITROPIN FLEXPRO, 45                               ofloxacin otic drops, 38
NORDITROPIN NORDIFLEX 30 MG/3, -5                     ofloxacin tablet, 14
  MG/1.5, -NORDIFLX 15 MG/1.5, 45                     OGEN, 58
norethindrone acetate tablet, 59                      ogestrel, 57
NORPRAMIN, 26                                         olanzapine, 20, 21
NOR-Q-D, 59                                           olmesartan medoxomil, 29
nortrel, 57                                           olmesartan medoxomil/hctz, 33
nortriptyline hcl cap, -solution, 26                  olopatadine hcl, 62
NORVASC, 30                                           omalizumab, 64
NORVIR CAP, -TABLET, 9                                omeprazole 20 mg capsule dr, -dr 10 mg
NORVIR SOLUTION, 9                                      capsule, -dr 20 mg capsule, -dr 40 mg
NOVANATAL, 59                                           capsule, 45
NOVANTRONE, 17                                        OMNICEF, 10
NOVOFINE 32, 49                                       ondansetron hcl 24 mg tablet, 21
NOVOFINE AUTOCOVER, 50                                ondansetron hcl 4 mg tablet, -8 mg tablet,
NOVOLIN 70-30 100 UNIT/ML VIAL, -RELION                 21
  VIAL, 41                                            ondansetron hcl 4 mg/2 ml vial, -40 mg/20
NOVOLIN N 100 UNITS/ML VIAL, -RELION                    ml vial, 21
  100 UNITS/ML, 41                                    ondansetron hcl solution, 21
NOVOLIN R 100 UNITS/ML VIAL, -RELION                  ondansetron odt, 21
  100 UNITS/ML, 41                                    ONGLYZA, 42
NOVOLOG 100 UNIT/ML VIAL, 41                          OPHTHALMIC
NOVOLOG MIX 70-30 VIAL, 41                              ANTIINFECTIVE/CORTICOSTEROIDS, 61
NOVOPEN 3, 50                                         OPHTHALMIC CORTICOSTEROID DRUGS, 61
NOVOPEN JR, 50                                        OPHTHALMIC MEDICATIONS, 60
NUTRITION,BLOOD                                       OPHTHALMIC TOPICAL ANTIBACTERIAL
  MODIFIERS,ELECTROLYTES, 53                            DRUGS, 61
NUVARING, 57                                          OPHTHALMIC TOPICAL ANTIVIRAL DRUGS,
nyamyc, 13                                              62
nystatin 100,000 unit/gm powd, -cream, -              oprelvekin, 48
  oint, 13                                            OPTIPRANOLOL, 60
nystatin 500,000 unit oral tab, -oral susp, 11        ORAL ANTICOAGULANTS, VITAMIN K, 55
nystatin-triamcinolone, 15                            ORAL ANTIFUNGAL DRUGS, 11
nystop, 13                                            ORAL DERMATOLOGICAL DRUGS, 36
OB/GYN TOPICAL ANTIINFECTIVES, 59                     ORAL HYPOGLYCEMICS AND COMBOS, 41
OBSTETRICAL AND GYNECOLOGICAL                         ORAP, 20
  MEDICATIONS, 56                                     ORENCIA, 17
octreotide, 17                                        ORFADIN, 38
octreotide 1,000 mcg/ml vial, -acet 500               ORINASE, 42
  mcg/ml amp, -acet 500 mcg/ml vl, 17                 ORSINI INSULIN SYRINGE, 50
                                                 84
ORTHO EVRA, 57                                     PALGIC, 63
ORTHO TRI-CYCLEN, 57                               palifermin, 46
ORTHO-CYCLEN, 57                                   paliperidone, 20
oseltamivir phosphate, 12, 13                      pamidronate 30 mg/10 ml vial, -90 mg/10 ml
OSMOPREP, 44                                         vial, 43
OTHER ANTIARRHYTHMICS, 32                          PAMINE, 43
OTHER ANTICONVULSANTS, 24                          PANLOR SS, 22
OTHER ANTIDEPRESSANTS, 24                          PANRETIN, 37
OTHER ANTIHYPERTENSIVES, 32                        pantoprazole, 45
OTHER ANTIINFECTIVE DRUGS, 11                      pantoprazole sodium, 45
OTHER ANTIPARKINSON DRUGS, 25                      PARAFON FORTE DSC, 51
OTHER ANTIULCER DRUGS, 44                          parcaine, 62
OTHER ANTIVIRAL DRUGS, 12                          PARCOPA, 25
OTHER CARDIOVASCULAR DRUGS, 33                     PARENTERAL ANTIFUNGALS, 13
OTHER CNS/AUTONOMIC DRUGS, 26                      PARNATE, 24
OTHER DRUGS FOR ARTHRITIS, 53                      paromomycin sulfate, 8
OTHER DRUGS FOR ASTHMA, 64                         paroxetine cr 12.5 mg tablet, 27
OTHER ENDOCRINE DRUGS, 42                          paroxetine cr 25 mg tablet, 27
OTHER GENITOURINARY PRODUCTS, 65                   paroxetine hcl 10 mg tablet, -40 mg tablet,
OTHER GI DRUGS, 44                                   27
OTHER MACROLIDES, 13                               paroxetine hcl 20 mg tablet, -30 mg tablet,
OTHER OPHTHALMIC DRUGS, 62                           27
OTHER RESPIRATORY DRUGS, 65                        paroxetine hcl oral susp, 27
OTHER TOPICAL ANTIFUNGALS, 13                      PASER, 10
OTHER VASODILATING DRUGS, 34                       PATANOL, 62
oticin hc suspensions, (not oral), 38              PAXIL, 27
OVCON-35, 57                                       PAXIL CR, 27
OVRAL-21, 57                                       pazopanib, 18
OXANDRIN, 56                                       PEDIARIX 0.5 ML VIAL, 46
oxandrolone, 56                                    PEDIAZOLE, 15
oxaprozin, 52                                      pedi-dri, 13
oxcarbazepine, 22                                  PEDVAXHIB, 46
OXSORALEN-ULTRA, 36                                peg 3350-electrolyte, 44
oxybutynin chloride syrup, -tablet, 65             pegademase bovine, 38
oxybutynin cl er 10 mg tablet, -cl er 15 mg        PEGANONE, 23
  tablet, 65                                       PEGASYS 180 MCG/0.5 ML CONV.PK, 47
oxybutynin cl er 5 mg tablet, 65                   PEGASYS 180 MCG/ML VIAL, 47
oxycodone hcl cap, -tablet, 22                     pegfilgrastim, 48
oxycodone hcl-acetaminophen, 22                    peginterferon alfa-2a, 47
oxycodone hcl-ibuprofen, 22                        pegvisomant, 43
oxycodone-acetaminophen, 22                        pemetrexed disodium, 16
oxycodone-aspirin, 22                              PEN 12MM 29G NEEDLES, -31GX3/16, -
oxymetholone, 56                                     31GX5/16, -6MM 31G, -8MM 31G
OXYTOCICS, 59                                        NEEDLES, -AURORA 6MM 31G, -AURORA S
pacerone 200 mg tablet, 28                           12MM 29G, -AURORA S 8MM 31G, -BD
palgic, 63                                           29GX1/2, -BD 29GX3/16, -BD 29GX5/16, -
                                              85
   BD MINI 31GX3/16, -BD ORIG 29GX1/2, -          pindolol, 29
   BD SHORT 31GX5/16, -LIVE BETTER 6MM            pioglitazone hcl, 41
   31G, -LIVE B, 50                               pioglitazone hcl/metformin hc, 41
pen g procaine/pen g benz, 14                     pioglitazone/glimepiride, 41
PEN NEEDLES, 50                                   piperacillin 3 gm vial, 14
penciclovir, 12                                   PIPRACIL, 14
penicillamine, 53                                 piroxicam cap, 52
penicillin g k 5 million unit, 14                 PLAN B, 57
penicillin g sodium, 14                           PLAQUENIL, 14
penicillin v potassium, 14                        PLASMA-LYTE 56, 54
PENICILLINS, 14                                   PLASMODICIDES, 14
PENTASA, 44                                       PLAVIX 300 MG TABLET, 53
pentopak, 33                                      PLAVIX 75 MG TABLET, 53
pentosan polysulfate sodium, 65                   PLENDIL, 30
pentoxifylline tab sa, 33                         PLETAL, 53
PEN-V, 14                                         podofilox, 35
PEPCID, 44                                        poliomyelitis vac,killed, 46
PERCOCET, 22                                      polycin-b, 62
PERCODAN, 22                                      poly-dex, 61
PERIDEX, 39                                       polyethylene glycol 3350, -pkt, -powd, 44
perindopril erbumine, 28                          POLYGESIC, 23
periogard, 39                                     polymyxin b sulfate injection, 12
PERIOSTAT, 39                                     polymyxin b sul-trimethoprim, 62
permethrin cream, 36                              POLYSPORIN, 61, 62
perphenazine, 20                                  POLYTRIM, 62
perphenazine-amitriptyline, 25                    portia, 57
PERSANTINE, 53                                    POTASSIUM CHLORIDE, 56
PFIZERPEN, 14                                     potassium chloride cap sa, -cl 10% (20
phenadoz, 21                                        meq/15 ml, -cl 10% (40 meq/30 ml, -cl
phenelzine, 24                                      20% (40 meq/15 ml, -tab sa, 56
PHENERGAN, 21                                     potassium chloride-nacl, 54
phenoxybenzamine, 31                              potassium citrate tab sa, 65
phenytoin, 23                                     potassium cl 2 meq/ml vial, 56
phenytoin 50 mg/ml ampul, 23                      POTASSIUM REMOVING RESINS, 55
phenytoin oral susp, 23                           POTASSIUM SPARING DIURETICS, 34
phenytoin sod ext 100 mg cap, 23                  POTASSIUM SUPPLEMENTS, 55
phenytoin sodium, 23                              pramipexole, 25
PHENYTOIN SODIUM, 23                              pramipexole dihydrochloride, 25
PHOSLO, 56                                        pramlintide acetate, 40
PHOSPHOLINE IODIDE, 60                            PRANDIN, 42
pilocarpine 0.5% eye drops, -1% eye drops,        PRAVACHOL, 31
   -2% eye drops, -4% eye drops, -6% eye          pravastatin sodium, 31
   drops, 60                                      prazosin hcl, 34
pilocarpine hcl tablet, 39                        PRECISION INSULIN SYRINGES -
pimecrolimus, 37                                    DISPOSABLE, 50
pimozide, 20                                      PRECOSE, 41
                                             86
PRED MILD, 61                                     probenecid, 52
prednicarbate, 37                                 probenecid-colchicine, 52
prednisolone, 40                                  procainamide 500 mg/ml vial, 29
prednisolone acetate, 61                          procarbazine, 17
prednisolone acetate ophth drops, 61              PROCARDIA XL, 30
prednisolone sodium phosphate ophth drops,        prochlorperazine edisylate, 21
  61                                              prochlorperazine maleate rectal, -tablet, 21
prednisolone sodium phosphate solution, 40        PROCRIT 10,000 UNITS/ML VIAL, -2,000
prednisolone syrup, 40                              UNITS/ML VIAL, -3,000 UNITS/ML VIAL, -
prednisone intensol, 40                             4,000 UNITS/ML VIAL, 46
prednisone solution, -tab(in convenience          PROCRIT 20,000 UNITS/ML VIAL, -40,000
  package), -tablet, 40                             UNITS/ML VIAL, 46
pregabalin, 24                                    procto-pak, 44
PREMARIN INJECTION, 58                            proctozone-hc, 44
PREMARIN TABLET, -VAGINAL PRODUCTS,               PRODIGY INSULIN SYRINGE, 50
  58                                              PRODIGY PEN NEEDLE, 50
PREMPHASE, 58                                     progesterone, 60
PREMPRO, 58                                       PROGESTIN DRUGS, 59
prenatabs fa, 59                                  PROGLYCEM, 40
prenatabs obn, 59                                 PROGRAF, 18
prenatabs rx, 59                                  PROGRAF 0.5 MG CAPSULE, -1 MG CAPSULE,
prenatal low iron, 59                               17
prenatal mr 90 fe, 59                             PROGRAF 5 MG CAPSULE, 17
prenatal plus tablet, 59                          PROLASTIN 500 MG VIAL, 65
prenatal rx 1, 59                                 PROLEUKIN, 48
PRENATAL VITAMINS, 59                             PROLIXIN DECANOATE, 19
PREVACID, 45                                      PROLOPRIM, 15
prevalite, 32                                     PROMACTA, 48
previfem, 57                                      PROMETRIUM, 60
PREZISTA 150 MG TABLET, -300 MG                   propafenone hcl, 29
  TABLET, -400 MG TABLET, -600 MG                 proparacaine hcl, 62
  TABLET, 9                                       propranolol, 29
PREZISTA 75 MG TABLET, 9                          propranolol 1 mg/ml vial, 29
PRIFTIN, 10                                       propranolol hcl cap sa, -solution, -tablet, 30
primaquine, 14                                    propranolol-hydrochlorothiazid, 33
PRIMAQUINE, 14                                    propylthiouracil, 39
PRIMAXIN 250 MG VIAL, 12                          PROQUAD, 46
PRIMAXIN 500 MG VIAL, 12                          PROSCAR, 65
PRIMAXIN I.M., 12                                 PROTON PUMP INHIBITORS, 45
primidone, 24                                     PROTONIX, 45
PRINCIPEN 250, 14                                 PROTONIX IV, 45
PRINIVIL, 28                                      PROTOPIC, 37
PRINZIDE, 33                                      protriptyline hcl, 26
PRISTIQ, 25                                       PROVENTIL HFA, 63
PROAIR HFA, 63                                    PROVIGIL, 23
PROAMATINE, 33                                    PROZAC, 26, 27
                                             87
PSORCON, 36                                        repaglinide, 42
PURINETHOL, 17                                     REQUIP, 25
pyrazinamide, 10                                   RESCRIPTOR, 9
pyridostigmine, 26                                 reserpine, 33
pyridostigmine bromide, 26                         RESPIRATORY MEDICATIONS, 63
pyrimethamine, 14                                  RESTASIS, 63
quasense, 57                                       RETROVIR, 10
QUESTRAN, 31                                       RETROVIR INJECTION, 9
QUESTRAN LIGHT, 31, 32                             revatio (sildenafil citrate), 34
quetiapine fumarate, 20                            REVATIO TABLET, 34
QUIBRON-T/SR, 64                                   REVIA, 26
quinapril hcl, 28                                  REVLIMID, 17
quinapril-hydrochlorothiazide, 33                  REYATAZ, 9
quinidine gluconate tab sa, 29                     RHEUMATREX, 17
quinidine sulfate tab sa, -tablet, 29              ribapak, 12
QUINOLONES, 14                                     ribasphere 200 mg tablet, 12
quinupristin/dalfopristin, 12                      ribasphere 400 mg tablet, -600 mg tablet, -
QVAR, 64                                              cap, 12
RABAVERT, 46                                       RIBATAB, 12
rabies vac,pf chick-emb cell, 46                   ribavirin, 13
rabies vaccine,human diploid, 46                   ribavirin 200 mg tablet, 12
raloxifene, 42                                     ribavirin 400 mg tablet, -600 mg tablet, -cap,
raltegravir potassium, 9                              12
ramelteon, 26                                      RIDAURA, 53
ramipril, 28                                       rifabutin, 10
RANEXA, 33                                         RIFADIN, 10
ranitidine 150 mg tablet, -300 mg tablet, -        RIFAMATE, 10
  cap, -syrup, 44                                  rifampin cap, 10
ranitidine hcl injection, 44                       rifampin injection, 10
ranolazine, 33                                     rifapentine, 10
RAPAMUNE, 17                                       rilonacept, 48
rasburicase, 16                                    RILUTEK, 51
RAZADYNE, 18                                       riluzole, 51
REBIF 22 MCG/0.5 ML SYRINGE, -44                   rimantadine hcl, 12
  MCG/0.5 ML SYRINGE, 47                           rimexolone, 61
REBIF TITRATION PACK, 47                           RISPERDAL, 20
reclipsen, 57                                      RISPERDAL CONSTA 25 MG SYR, 20
RECOMBIVAX HB 10 MCG/ML VIAL, -40                  RISPERDAL CONSTA 37.5 MG SYR, -50 MG
  MCG/ML VIAL, 46                                     SYR, 20
REGRANEX, 37                                       RISPERDAL M-TAB, 20
RELAFEN, 52                                        risperidone, 20
RELISTOR 12 MG/0.6 ML VIAL, 44                     risperidone 0.25 mg odt, -1 mg odt, 20
REMERON, 25                                        risperidone 0.5 mg odt, -2 mg odt, -3 mg
REMICADE, 17                                          odt, -4 mg odt, 20
re-nata 29 ob, 59                                  risperidone m-tab 0.5 mg odt, -2 mg odt, -3
RENVELA TABLET, 53                                    mg odt, -4 mg odt, 20
                                              88
risperidone m-tab 1 mg odt, 20                SAVELLA 100 MG TABLET, -12.5 MG TABLET,
risperidone solution, 20                         -25 MG TABLET, -50 MG TABLET, 25
risperidone tablet, 20                        SAVELLA TITRATION PACK, 25
RITALIN-SR, 23                                saxagliptin hydrochloride, 42
ritonavir, 9                                  SCABICIDES, 36
ritonavir/lopinavir, 9                        SEASONALE, 57
RITUXAN, 17                                   SECONDARY AMINES, 26
rituximab, 17                                 SEDATIVE/HYPNOTIC DRUGS, 26
rivastigmine, 19                              SELECTIVE SEROTONIN REUPTAKE
rivastigmine tartrate, 18                        INHIBITORS, 26
rizatriptan benzoate, 23                      selegiline, 24
ROBINUL, 43                                   selegiline hcl cap, -tablet, 25
ROCEPHIN, 10                                  selenium sulfide 2.5% lotion, -sulf 2.5%
romycin, 62                                      shampoo, 35
ropinirole hcl, 25                            SELZENTRY, 9
rosiglitazone maleate, 41                     se-natal one, 59
rosiglitazone maleate/glimepir, 41            SENSIPAR, 43
rosiglitazone/metformin hcl, 41               SEPTRA, 15
rosuvastatin calcium, 31                      SEROMYCIN, 10
ROTATEQ, 46                                   SEROQUEL 100 MG TABLET, -200 MG
rotavirus vac, live pentav, 46                   TABLET, 20
roxicet tablet, 22                            SEROQUEL 25 MG TABLET, -50 MG TABLET,
ROZEREM, 26                                      20
rubella vaccine, 46                           SEROQUEL 300 MG TABLET, -400 MG
rufinamide, 24                                   TABLET, 20
RYTHMOL, 29                                   sertraline hcl 100 mg tablet, -50 mg tablet,
SABRIL PWD, 24                                   27
SABRIL TABLET, 24                             sertraline hcl 25 mg tablet, 27
sacrosidase, 44                               sertraline hcl solution, 27
SAFESNAP INSULIN SYRINGE, 50                  SERZONE, 25
SAFETYGLIDE INSULIN SYRINGE, 50               sevelamer carbonate, 53
SAFETYGLIDE SYRINGE INSULIN SYRINGES          SILVADENE, 15
   - DISPOSABLE, 50                           silver sulfadiazine, 15
SALAGEN, 39                                   simvastatin tablet, 31
SALICYLATES AND RELATED DRUGS, 53             SINEQUAN, 28
salmeterol/fluticasone, 64                    SINGLE USE SWAB, 50
salsalate tablet, 53                          SINGULAIR, 64
SANDOSTATIN, 17                               sirolimus, 17
SANDOSTATIN LAR 10 MG KIT, -30 MG KIT,        sitagliptin phos/metformin hcl, 42
   17                                         sitagliptin phosphate, 42
SANDOSTATIN LAR 20 MG KIT, 17                 SMOKING CESSATION PRODUCTS, 27
SANTYL, 37                                    sodium bicarbonate 7.5% syring, -bicarb
SAPHRIS, 20                                      7.5% abboject, 54
sapropterin dihydrochloride, 42               sodium chloride 0.45% soln, -0.45% soln-
saquinavir mesylate, 9                           excel con, -0.9% irrig., -0.9% soln, -0.9%
sargramostim, 48                                 soln., -0.9% soln-excel cont, -0.9%
                                         89
   solution, -cl 2.5 meq/ml vial, -sterile saline        SUCCINIMIDES, 27
   0.9% irr, 54                                          SUCRAID, 44
sodium lactate 5 meq/ml vial, 54                         sucralfate, 44
sodium oxybate, 26                                       sucralfate tablet, 44
sodium phenylbutyrate, 38                                sulconazole nitrate, 13
sodium phosphate/na biphos, 44                           sulfacetamide sod 10% top susp, -
sodium polystyrene sulfonate, 55                           sulfacetamide 10% lot, 35
sodium sulfacetamide-sulfur foam (non-                   sulfacetamide sodium ophth drops, 62
   contraceptive), 35                                    sulfacetamide-prednisolone, 61
SOLARAZE, 37                                             sulfadiazine tablet, 15
solia, 57                                                sulfamethoxazole-trimethoprim, 15
SOMA, 51                                                 sulfamide, 62
somatropin, 45                                           sulfasalazine dr, 45
SOMAVERT, 43                                             sulfasalazine tablet, 45
SONATA, 26                                               sulfatrim, 15
sorafenib tosylate, 17                                   sulfazine, 45
sorine, 32                                               sulfazine ec, 45
sotalol, 32                                              SULFONAMIDES, 15
sotret, 36                                               sulindac tablet, 52
SPECIALIZED OB/GYN DRUGS, 60                             sumatriptan 4 mg/0.5 ml kit, -4 mg/0.5 ml
SPECTAZOLE, 13                                             refill, -4 mg/0.5 ml syrng, -6 mg/0.5 ml kit,
SPIRIVA, 64                                                -6 mg/0.5 ml refill, -6 mg/0.5 ml syrng, 23
spironolactone tablet, 34                                sumatriptan 4 mg/0.5 ml vial, -6 mg/0.5 ml
spironolactone-hctz, 34                                    vial, 23
sprintec, 57                                             sumatriptan succinate tablet, 23
SPRYCEL, 18                                              sunitinib malate, 18
sps oral susp, 55                                        SUPRAX, 11
sronyx, 57                                               SURE COMFORT, 50
ssd, 15                                                  SURE COMFORT ALCOHOL, 50
ssd af, 15                                               SURE-FINE PEN NEEDLES, 50
STADOL, 18                                               SURE-JECT INSULIN SYRINGE, 50
stagesic, 23                                             SURE-PREP ALCOHOL PREP PADS, 50
STALEVO 100, 25                                          SURMONTIL, 28
STALEVO 125, 25                                          SUSTIVA 200 MG CAPSULE, -50 MG
STALEVO 150, 25                                            CAPSULE, -TABLET, 9
STALEVO 200, 25                                          SUTENT, 18
STALEVO 50, 25                                           SYMLIN, 40
STALEVO 75, 25                                           SYMMETREL, 12
stavudine, 9                                             SYNAREL, 60
STELAZINE, 20                                            SYNERCID, 12
STRATTERA, 26                                            SYNTHROID, 43
streptomycin, 10                                         SYPRINE, 53
STREPTOMYCIN SULFATE INJECTION, 10                       tacrolimus, 17, 37
STROMECTOL, 8                                            tacrolimus 0.5 mg capsule, -1 mg capsule, 18
SUBOXONE TAB, SL, 23                                     tacrolimus 5 mg capsule, 18
succimer, 37                                             TAGAMET, 43, 44
                                                    90
TAMBOCOR, 29                                     TETANUS-DIPHTERIA-DECAVAC, 46
TAMIFLU 30 MG GELCAP, 12                         tetrabenazine, 26
TAMIFLU 45 MG GELCAP, 12                         tetracycline hcl cap, 15
TAMIFLU 75 MG GELCAP, 12                         TETRACYCLINES, 15
TAMIFLU SUSPENSION, 13                           tetrahydrozoline, 39
tamoxifen citrate tablet, 18                     TEVETEN, 29
tamsulosin hcl, 65                               TEVETEN HCT, 33
TAPAZOLE, 39                                     thalidomide, 38
TARCEVA, 18                                      THALOMID, 38
TARGRETIN CAP, 18                                theochron, 64
TARGRETIN GEL, 18                                theophylline anhydrous tab sa, 64
TARKA, 33                                        theophylline tab sa, 64
TASIGNA, 18                                      THERAPEUTIC VITAMINS AND MINERALS, 56
TASMAR 100 MG TABLET, 25                         thermazene, 15
TAVIST, 63                                       THIAZIDE AND RELATED DRUGS, 34
tazarotene, 35                                   THINPRO INSULIN SYRINGE, 51
TAZORAC, 35                                      thioguanine, 18
taztia xt, 30                                    THIOGUANINE, 18
TEGRETOL, 22                                     THIOLA, 37
TEGRETOL XR, 22                                  thioridazine hcl, 20
telbivudine, 13                                  thiothixene, 20
telmisartan, 29                                  THORAZINE, 19
telmisartan/hctz, 33                             THROMBOPOIETIC AGENTS, 48
TEMOVATE EMOLLIENT, 36                           THYROID SUPPLEMENTS, 43
TENEX, 31                                        THYROLAR-1, 43
tenofovir disproxil fumarate, 9                  THYROLAR-1/4, 43
TENORETIC, 32                                    THYROLAR-2, 43
TENORMIN, 29                                     THYROLAR-3, 43
TERAZOL 3, 16                                    tiagabine, 24
TERAZOL 7, 16                                    TIAZAC, 30
terazosin 1 mg capsule, -2 mg capsule, -5        TICLID, 53
  mg capsule, 34                                 ticlopidine hcl, 53
terazosin 10 mg capsule, 35                      tigecycline, 12
terbinafine hcl, 11                              TIKOSYN, 32
terbutaline sulfate injection, 63                timolol 0.25% eye drops, -0.5% eye drops,
terbutaline sulfate tablet, 63                      60
terconazole 0.4% cream, 16                       timolol maleate tablet, 30
terconazole 0.8% cream, 16                       TIMOPTIC, 60
terconazole 80 mg suppository, 16                tiopronin, 37
teriparatide, 42                                 tiotropium bromide, 64
TERTIARY AMINES, 27                              tipranavir/vitamin e tpgs, 9
TERUMO INSULIN SYRINGE, 50                       tizanidine hcl, 52
TERUMO SURGUARD, 51                              TOBRADEX, 61
TETANUS DIPHTHERIA TOXOIDS, 46                   tobramycin 10 mg/ml vial, -40 mg/ml vial, 8
tetanus toxoid adsorbed, 46                      tobramycin sulfate ophth drops, 62
tetanus,diphtheria toxoid, 46                    tobramycin sulfate/dexameth, 61
                                            91
tobramycin/lotepred etab, 61                     tretinoin cap, 18
tobramycin-dexamethasone, 61                     triamcinolone acetonide cream, -lotion, -oint,
tobrasol, 62                                        37
TOBREX, 61, 62                                   triamcinolone acetonide paste, 39
tocilizumab, 47                                  triamterene-hctz, 34
TOFRANIL, 28                                     TRIAVIL 25-4, 25
TOFRANIL-PM, 28                                  TRICOR, 32
tolazamide, 42                                   triderm, 37
tolbutamide, 42                                  trientine, 53
tolcapone, 25                                    trifluoperazine hcl, 20
TOLECTIN 600, 53                                 trifluridine, 62
TOLINASE, 42                                     trihexyphenidyl hcl, 19
tolmetin sodium, 53                              TRIHIBIT, 46
TOPAMAX, 24                                      TRILAFON, 20
TOPCARE CLICKFINE, 51                            tri-legest fe, 57
TOPCARE ULTRA COMFORT, 51                        TRILEPTAL, 22
TOPICAL ANESTHETICS, 8                           TRILEPTAL SUSPENSION, 22
TOPICAL ANTIBACTERIAL DRUGS, 15                  TRILIPIX, 32
TOPICAL ANTIFUNGAL-CORTICOSTEROID                trimethoprim tablet, 15
   COMB., 15                                     trimipramine, 28
TOPICAL CORTICOSTEROID DRUGS, 36                 trinessa, 57
TOPICAL DERMATOLOGICAL DRUGS, 37                 TRI-NORINYL, 57
topiragen, 24                                    TRIOSTAT, 43
topiramate sprinkle, -tablet, 24                 TRIPEDIA, 46
TOPROL XL, 29, 30                                TRIPHASIL-28, 58
toremifene, 16                                   tri-previfem, 57
torsemide tablet, 32                             triptorelin pamoate, 18
TOTACILLIN, 14                                   tri-sprintec, 57
TRACLEER, 31                                     trivora-28, 58
tramadol hcl tablet, 18                          TRIZIVIR, 9
tramadol hcl-acetaminophen, 18                   tropicamide, 63
TRANDATE, 29                                     TRUSOPT, 60
trandolapril, 28                                 TRUVADA, 9
trandolapr-verapam er 2-180 mg, -er 2-240        TWINJECT, 64
   mg, -er 4-240 mg, 33                          TWINRIX VACCINE VIAL, 46
tranexamic acid, 38                              TYGACIL, 12
tranylcypromine sulfate, 24                      TYKERB, 18
TRAVATAN Z, 60                                   TYLENOL-CODEINE, 22
travoprost, 60                                   TYPHIM VI 25 MCG/0.5 ML VIAL, 46
trazodone hcl tablet, 25                         typhoid vaccine, 46, 47
TRECATOR, 10                                     TYZEKA, 13
TRELSTAR DEPOT, 18                               TYZINE, 39
TRELSTAR LA, 18                                  ULTICARE INSULIN NEEDLES - DISPOSABLE,
TRENTAL, 33                                         -INSULIN SYRINGES - DISPOSABLE, 51
tretinoin 0.025% cream, -0.05% cream, -          ULTIGUARD 30GX0.3 ML SYRINGE, -31GX0.3
   0.1% cream, -gel, 35                             ML SYRINGE, 51
                                            92
ULTILET ALCOHOL SWAB, 51                         varicella vacc/pf, 47
ULTILET INSULIN SYRINGE, 51                      varicella virus vaccine live, 47
ULTILET PEN NEEDLE, 51                           VARIVAX VACCINE, 47
ULTRA COMFORT 0.3 ML 29GX1/2, -0.3 ML            VASERETIC, 33
  30GX5/16, -0.3 ML 31GX5/16, -0.3 ML            VASOCIDIN, 61
  SYRINGE, -0.5 ML 28GX1/2, -0.5 ML              VASODILATOR ANTIHYPERTENSIVES, 34
  29GX1/2, -0.5 ML 30GX5/16, -0.5 ML SYR,        VASOTEC, 28
  -0.5 ML SYRINGE, -1 ML 28GX1/2, -1 ML          VECTICAL, 35
  29GX1/2, -1 ML 30GX5/16, -1 ML                 VELCADE, 18
  SYRINGE, -3/10 ML SYR, -DRUG MART              velivet, 58
  SYR, 51                                        venlafaxine hcl, 25
ULTRACET, 18                                     VENTOLIN HFA, 63
ULTRACOMFORT INSUL SYR 0.5 ML, -                 verapamil er, 30
  INSULIN NEEDLES - DISPOSABLE, -                verapamil hcl cap sa, -tab sa, -tablet, 30
  INSULIN SYR 1 ML, 51                           VERELAN PM, 30
ULTRAM, 18                                       veripred 20, 40
ULTRAVATE, 36                                    VEXOL, 61
UNASYN, 14                                       VIBRAMYCIN, 15
UNIFINE PENTIPS, 51                              VICOPROFEN, 23
UNIRETIC, 33                                     VIDAZA, 18
unithroid, 43                                    VIDEX 2 GM PEDIATRIC SOLN, 9
UNIVASC, 28                                      VIDEX EC, 9
urea 35% lotion, -40% cream, -40% gel, -         vigabatrin, 24
  40% lotion, -45% cream, -50% cream, -          VIGAMOX, 62
  50% nail gel, -oint, 37                        VIMPAT INJECTION, 24
urealac cream, -lotion, 37                       VIMPAT SOLUTION, -TABLET, 24
URECHOLINE, 65                                   vinate one, 59
URINARY ANTIINFECTIVES, 15                       vinate-m, 59
URISPAS, 65                                      VIRACEPT, 9
UROLOGICAL MEDICATIONS, 65                       VIRAMUNE, 9
ursodiol cap, -tablet, 45                        VIRAZOLE, 13
VAGIFEM 25 MCG VAGINAL TAB, 58                   VIREAD, 9
VAGINAL ANTIFUNGALS, 16                          VIROPTIC, 62
VALCYTE, 13                                      VISICOL, 44
valganciclovir, 13                               VISKEN, 29
valproate sodium injection, 28                   VISTARIL, 35
valproic acid, 28                                VITAMINS AND MINERALS AND RELATED
VALPROIC ACID AND DERIVATIVES, 28                   PRODUCTS, 56
valproic acid cap, -syrup, 28                    vitazol, 35
valsartan, 29                                    VIVACTIL, 26
VANCOCIN HCL, 12                                 VIVELLE-DOT, 58
vancomycin 1 gm vial, 12                         VIVOTIF BERNA, 47
vandazole, 59                                    VOLTAREN OPHTH DROPS, 63
VANTIN, 10                                       vorinostat, 18
VAQTA 25 UNITS/0.5 ML VIAL, 47                   VOSOL HC, 38
varenicline tartrate, 27                         VOTRIENT, 18
                                            93
VYTORIN, 31                     zidovudine, 9, 10
warfarin sodium, 55             zidovudine/lamivudine/abacavir, 9
WEBCOL, 51                      zileuton, 64
WELLBUTRIN, 25                  ZINACEF, 10
WELLBUTRIN SR, 24, 25           ziprasidone, 19
WELLBUTRIN XL, 25               ZITHROMAX, 13
WESTCORT, 37                    ZOFRAN, 21
XALATAN, 61                     ZOFRAN ODT, 21
XENAZINE, 26                    zoledronic acid, 43
XOLAIR, 64                      ZOLINZA, 18
XOPENEX HFA, 63                 ZOLOFT, 27
XYLOCAINE, 8                    zolpidem tartrate, 26
XYLOCAINE VISCOUS, 8            ZOMETA, 43
XYREM, 26                       ZONALON, 37
XYZAL, 63                       ZONEGRAN, 24
YASMIN 28, 58                   zonisamide, 24
YAZ, 58                         ZOSTAVAX, 47
yellow fever vaccine, 47        zovia 1-35e, 58
YF-VAX, 47                      zovia 1-50e, 58
zaleplon, 26                    ZOVIRAX, 12
ZANAFLEX, 52                    ZYBAN, 27
ZANTAC, 44                      ZYFLO CR, 64
ZARONTIN, 27                    ZYLET, 61
ZAROXOLYN, 34                   ZYLOPRIM, 52
ZAVESCA, 43                     ZYMAR, 62
ZEBETA, 29                      ZYPREXA INJECTION, 20
ZERIT, 9                        ZYPREXA TABLET, 21
ZETIA, 32                       ZYPREXA ZYDIS, 21
ZIAC, 33                        ZYVOX 600 MG/300 ML IV SOLN, -ORAL
ZIAGEN, 9                          SUSP, -TABLET, 12




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