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					2009
Pharmacy
FORMULARY
                                   Easy Choice Health Plan

                                        2009 Formulary
                                  (List of Covered Drugs)



    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.




   H5087_Formlry 003a
   CMS Approved 11/08                                            Last Updated November 11, 2008
What is the Easy Choice Health Plan Formulary?
A formulary is a list of covered drugs selected by Easy Choice Health Plan in consultation with a
team of health care providers, which represents the prescription therapies believed to be a
necessary part of a quality treatment program. Easy Choice Health Plan will generally cover the
drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled
at an Easy Choice Health Plan 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 on our 2009 formulary that was covered at the beginning
of the year, we will not discontinue or reduce coverage of the drug during the 2009
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 and/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 on
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, 2009. To get
updated information about the drugs covered by Easy Choice Health Plan, please visit our
Web site at www.EasyChoiceHealthPlan.com or call Customer Services at 1-866-999-3945,
8:00 a.m. – 8:00 p.m., Monday – Sunday. TTY/TDD users should call 1-800-735-2929.


How do I use the Formulary?
There are two ways to find your drug within the formulary:

Medical Condition
The formulary begins on page 6. 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.” If you know
what your drug is used for, look for the category name in the list that begins on page 6. Then
look under the category name for your drug.




                                                 1
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 63. 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?
Easy Choice Health Plan 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: Easy Choice Health Plan requires you (or your physician) to get
       prior authorization for certain drugs. This means that you will need to get approval from
       Easy Choice Health Plan before you fill your prescriptions. If you don’t get approval,
       Easy Choice Health Plan may not cover the drug.

   •   Quantity Limits: For certain drugs, Easy Choice Health Plan limits the amount of the
       drug that Easy Choice Health Plan will cover. For example, Easy Choice Health Plan
       provides 8 tablets per prescription for dostinex. This may be in addition to a standard one
       month or three month supply.

   •   Step Therapy: In some cases, Easy Choice Health Plan 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, Easy
       Choice Health Plan may not cover drug B unless you try Drug A first. If Drug A does
       not work for you, Easy Choice Health Plan will then cover Drug B.

You can find out if your drug has any additional requirements or limits by looking in the
formulary that begins on page 6.

You can ask Easy Choice Health Plan to make an exception to these restrictions or limits. See the
section, “How do I request an exception to the Easy Choice Health Plan’s formulary?” on page 3
for information about how to request an exception.




                                                2
What if my drug is not on the Formulary?
If your drug is not included in this formulary, you should first contact Customer Services and
confirm that your drug is not covered. If you learn that Easy Choice Health Plan does not cover
your drug, you have two options:

   •   You can ask Customer Services for a list of similar drugs that are covered by Easy
       Choice Health Plan. When you receive the list, show it to your doctor and ask him or her
       to prescribe a similar drug that is covered by Easy Choice Health Plan.

   •   You can ask Easy Choice Health Plan 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 Easy Choice Health Plan’s Formulary?
You can ask Easy Choice Health Plan 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 on our formulary.

   •   You can ask us to waive coverage restrictions or limits on your drug. For example, for
       certain drugs, Easy Choice Health Plan 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 Tier 3 drug tier, you can ask us to cover it at the cost-sharing amount
       that applies to drugs in the Tier 2 drug 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
       on 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
       Tier 4 drug tier.


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

You should contact us to ask us for an initial coverage decision for a formulary, tiering or
utilization restriction exception. When you are requesting a formulary, tiering or utilization
restriction exception you should submit a statement from your physician supporting your
request. Generally, we must make our decision within 72 hours of getting your prescribing
physician’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 physician’s supporting statement.


                                                3
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 on our
formulary. Or, you may be taking a drug that is on 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 will 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 on 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 on 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 more information
For more detailed information about your Easy Choice Health Plan prescription drug coverage,
please review your Evidence of Coverage and other plan materials.

If you have questions about Easy Choice Health Plan, please call Customer Services at 1-866-
999-3945, 8:00 a.m. – 8:00 p.m., Monday – Sunday. TTY/TDD users should call 1-800-735-
2929. Or visit www.EasyChoiceHealthPlan.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 users should
call 1-877-486-2048. Or, visit www.medicare.gov.

Easy Choice Health Plan’s Formulary
The formulary that begins on the next page provides coverage information about some of the
drugs covered by Easy Choice Health Plan. If you have trouble finding your drug in the list, turn
to the Index that begins on page 63.

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




                                                 4
The information in the Notes column tells you if Easy Choice Health Plan has any special
requirements for coverage of your drug.

PA= Prior Authorization
QL= Quantity Limits
ST= Step Therapy
*= We provide coverage for this prescription drug in the coverage gap. Please refer to your
Summary of Benefits for more information about this coverage.

Tiers
Drug tiers are definable by the plan. Tiers are used to describe drug groups that are based on
classes of drugs that cost different amounts. This option afford users additional flexibility in
defining the prescription drug benefit. Here is an example how drugs are grouped in tiers:

Tier 1 – Preferred generic drugs.
Tier 2 – Preferred brand-name drugs.
Tier 3 – Non-preferred generic and non-preferred brand-name drugs.
Tier 4 – Specialty drugs.




                                                 5
                     Drug Name                   Drug        Notes
                                                 Tier

Acidifying Agents
       Acidifying Agents
                           AMMONIUM CHLORIDE      2          soln
Adrenals
       Adrenals
                           AEROBID                3          aers
                           AEROBID-M              3          aers
                           ASMANEX 120 METERED    3          aepb
                           DOSES
                           ASMANEX 14 METERED     3          aepb
                           DOSES
                           ASMANEX 30 METERED     3          aepb
                           DOSES
                           ASMANEX 60 METERED     3          aepb
                           DOSES
                           AZMACORT               3          aers
cortisone acetate          (Cortisone Acetate)    1          tabs
                           DEPO-MEDROL            2          susp; 20mg/ml
dexamethasone              (Decadron)             1          elix, tabs
                           ENTOCORT EC            2          cp24
                           FLOVENT HFA            2          aero
fludrocortisone acetate    (Florinef)             1          tabs
hydrocortisone             (Cortef)               1          tabs
hydrocortisone sodium      (Solu-cortef)          1          solr
succinate
methylprednisolone         (Medrol)               1          tabs
methylprednisolone         (Depo-medrol)          1          susp; 40mg/ml,
acetate                                                      80mg/ml
methylprednisolone         (Solu-medrol)          1     HI   solr; 40mg,
sodium succinate                                             125mg, 500mg,
                                                             1000mg
prednisolone anhydrous     (Prelone)              1          syrp, tabs
prednisolone sodium        (Pediapred)            1          liqd, soln
phosphate
                           PREDNISONE             3          soln
prednisone                 (Sterapred)            1          tabs
                           PREDNISONE INTENSOL    3          conc
                           PULMICORT FLEXHALER    2          inha
                           QVAR                   2          aers
                           SOLU-MEDROL            2     HI   solr; 2gm
                           SOLU-MEDROL ACT-O-     2     HI   solr; 500mg
                           VIAL
                           SYMBICORT              2          aero


                                           6
                   Drug Name                     Drug            Notes
                                                 Tier

Alkalinizing Agents
       Alkalinizing Agents
potassium citrate       (Urocit-K)                1              tbcr
sodium bicarbonate      (Sodium Bicarbonate)      1              soln
sodium lactate          (Sodium Lactate)          1              soln
Alpha-Adrenergic Blocking Agents
       Alpha-Adrenergic Blocking Agents
doxazosin mesylate     (Cardura)                  1              tabs
prazosin hydrochloride (Minipress)                1              caps
terazosin hcl          (Hytrin)                   1              caps
Ammonia Detoxicants
        Ammonia Detoxicants
                       BUPHENYL                   2              powd, tabs
lactulose              (Enulose)                  1              soln
                       LITHOSTAT                  2              tabs
Analgesics and Antipyretics
        Non-Steroidal Anti-inflammatory Agents
                         CELEBREX                 2     QL, ST   caps
diclofenac potassium     (Cataflam)               1              tabs
diclofenac sodium        (Voltaren)               1              tb24, tbec
diflunisal               (Dolobid)                1              tabs
                         EQUAGESIC                3              tabs
etodolac                 (Lodine)                 1              caps, tabs, tb24
fenoprofen calcium       (Nalfon)                 1              tabs
flurbiprofen             (Ansaid)                 1              tabs
ibuprofen                (Motrin)                 1              susp, tabs
indomethacin             (Indocin)                1              caps, cpcr
ketoprofen               (Orudis)                 1              caps, cp24
ketorolac tromethamine (Toradol)                  1     QL       soln, tabs
meclofenamate sodium     (Meclomen)               1              caps
meloxicam                (Mobic)                  1              susp, tabs
nabumetone               (Relafen)                1              tabs
naproxen                 (Naprosyn)               1              susp, tabs, tbec
naproxen sodium          (Anaprox)                1              tabs, tb24
oxaprozin                (Daypro)                 1              tabs
piroxicam                (Feldene)                1              caps
                         PREVACID NAPRAPAC        2     ST       kit
sulindac                 (Clinoril)               1              tabs
tolmetin sodium          (Tolectin)               1              caps, tabs
                         VOLTAREN                 2     ST       gel




                                           7
                       Drug Name                         Drug             Notes
                                                         Tier

        Opiate Agonists
acetaminophen and          (Fioricet/codeine)             1              caps
butalbital and caffeine
and codeine phosphate
acetaminophen and          (Panlor SS)                    1              caps, tabs
caffeine and
dihydrocodeine
bitartrate
acetaminophen and          (Tylenol/codeine #3)           1              soln, tabs
codeine phosphate
acetaminophen and          (Vicodin ES)                   1              caps, soln, tabs
hydrocodone bitartrate
acetaminophen and          (Percocet)                     1              caps, tabs
oxycodone hydrochloride
acetaminophen and          (Acetaminophen and             1              tabs
propoxyphene               Propoxyphene Hydrochloride)
hydrochloride
acetaminophen and          (Darvocet-n 100)               1              tabs
propoxyphene napsylate
acetaminophen and          (Ultracet)                     1              tabs
tramadol hcl
aspirin and butalbital     (Fiorinal/codeine #3)          1              caps
and caffeine and codeine
phosphate
                           AVINZA                         3              cp24; 30mg, 60mg,
                                                                         90mg, 120mg
                           DEMEROL                        3              soln; various
                                                                         strengths are
                                                                         available
                           DILAUDID-HP                    3              solr
fentanyl                   (Duragesic)                    1     PA, QL   pt72
fentanyl citrate           (Actiq)                        1     PA, QL   lpop
fentanyl citrate           (Actiq)                        1              soln
                           FENTORA                        4     PA, QL   tabs
hydrocodone bitartrate     (Vicoprofen)                   1              tabs
and ibuprofen
hydromorphone           (Dilaudid)                        1              soln, tabs
hydrochloride
ibuprofen and oxycodone (Combunox)                        1              tabs
hydrochloride
                        KADIAN                            2     ST       cp24; various
                                                                         strengths are
                                                                         available
levorphanol tartrate       (Levorphanol Tartrate)         1              tabs


                                                  8
                     Drug Name                       Drug             Notes
                                                     Tier

                         MEPERIDINE HCL               3              soln; 25mg/ml,
                                                                     75mg/ml
                         MEPERIDINE HCL               3     HI       soln; 10mg/ml
meperidine               (Demerol)                    1              soln, tabs
hydrochloride
methadone                (Dolophine)                  1              conc, soln, tabs
hydrochloride
methadone                (Methadone Hydrochloride)    2              soln
hydrochloride
                        MORPHINE SULFATE              1              tabs
morphine sulfate        (MS Contin)                   1              soln, tabs, tb12
                        ORAMORPH SR                   1              tb12
oxycodone hydrochloride (Roxicodone)                  1              tabs
propoxyphene            (Darvon)                      1              caps
hydrochloride
tramadol hcl            (Ultram)                      1              tabs
       Opiate Partial Agonists
                        BUPRENEX                      2              soln
                        BUPRENORPHINE HCL             2              soln
butorphanol tartrate    (Stadol)                      1              soln
                        SUBOXONE                      3              subl
                        SUBUTEX                       3              subl
Androgens
       Androgens
                         ANDRODERM                    2     PA, QL   pt24
                         ANDROGEL                     2     PA, QL   gel; 25mg/2.5gm,
                                                                     50mg/5gm
                         ANDROGEL PUMP                2     PA, QL   gel; 1 %
                         ANDROID                      1              caps
danazol                  (Danocrine)                  1              caps
fluoxymesterone          (Halotestin)                 1              tabs
                         METHITEST                    2              tabs
oxandrolone              (Oxandrin)                   1              tabs
                         TESTIM                       3     PA, QL   gel; 1 %
testosterone cypionate   (Depo-testosterone)          1     PA       oil
testosterone enanthate   (Delatestryl)                1     PA       oil
                         TESTRED                      1              caps
Anorexigenics, Respiratory, Cerebral Stimulants
       Amphetamines
                         ADDERALL XR                  2              cp24




                                           9
                     Drug Name                         Drug              Notes
                                                       Tier

amphetamine aspartate (Adderall)                          1              tabs
and amphetamine sulfate
and dextroamphetamine
saccharate and
dextroamphetamine
dextroamphetamine        (Dexedrine)                      1              cp24, tabs
sulfate
                         LIQUADD                          3              soln
                         VYVANSE                          3              caps
        Anorexigenics, Respiratory, Cerebral Stimulants, Miscellaneous
                         CONCERTA                         2              tbcr
dexmethylphenidate       (Focalin)                        1              tabs
hydrochloride
                         FOCALIN XR                       3              cp24
                         METADATE CD                      3              cpcr
                         METHYLIN                         3              chew, soln
methylphenidate          (Ritalin)                        1              tabs, tbcr
hydrochloride
                         PROVIGIL                         2     PA, QL   tabs
                         RITALIN LA                       3              cp24
Anthelmintics
       Anthelmintics
                        ALBENZA                          2               tabs
                        BILTRICIDE                       2               tabs
mebendazole             (Vermox)                         1               chew
                        MINTEZOL                         2               chew, susp
                        STROMECTOL                       2               tabs
Antiallergic Agents
       Antiallergic Agents
                         ALAMAST                         2               soln
                         ALOMIDE                         3               soln
                         ASTELIN                         2               soln; 137mcg/
                                                                         spray
ketotifen fumarate      (Zaditor)                                        drops, soln (OTC)
                        OPTIVAR                          3               soln; 0.05 %
                        PATADAY                          2    ST         soln; 0.2 %
                        PATANASE                         3               soln; 0.6 %
                        PATANOL                          2    ST         soln; 0.1 %
Antibacterials
      Aminoglycosides
amikacin sulfate       (Amikin)                          1    HI         soln
gentamicin sulfate and (Gentamicin Sulfate/sodium)       1    HI         soln
sodium chloride
kanamycin sulfate      (Kantrex)                         1    HI         soln

                                           10
                       Drug Name                       Drug         Notes
                                                       Tier

neomycin sulfate          (Neomycin Sulfate)            1          soln, tabs
                          STREPTOMYCIN SULFATE          3          solr
tobramycin sulfate        (Nebcin)                      1     HI   soln, solr
                          TOBRAMYCIN SULFATE            3     HI   soln
                          ADD-VANTAGE
                          TOBRAMYCIN SULFATE/           3     HI   soln
                          SODIUM CHLORIDE
        Antibacterials, Miscellaneous
bacitracin                (Bacitracin)                  1          solr
clindamycin               (Cleocin)                     1          caps
hydrochloride
clindamycin phosphate     (Cleocin Phosphate)           1     HI   soln
colistimethate sodium     (Coly-mycin-m)                4     HI   solr
                          CUBICIN                       4     HI   solr
                          PYLERA                        2          caps
                          SYNERCID                      4     HI   solr
                          VANCOCIN HCL                  2     HI   soln; 0 -, 1gm/
                                                                   200ml
                          VANCOCIN HCL                  2          caps
                          VANCOCIN HCL ISO-             2     HI   soln; 0 -, 500mg/
                          OSMOTICDEXTROSE                          100ml
vancomycin                (Vancomycin Hydrochloride)    2     HI   solr; 500mg,
hydrochloride                                                      1000mg
vancomycin                (Vancomycin Hydrochloride)    1     HI   solr; 10gm,
hydrochloride                                                      5000mg
                          XIFAXAN                       3          tabs
                          ZYVOX                         4     HI   soln
                          ZYVOX                         4          susr, tabs
       Cephalosporins
                          CEDAX                         3          caps, susr
cefaclor                  (Ceclor)                      1          caps, susr
cefaclor monohydrate      (Ceclor)                      1          tb12
cefadroxil hemihydrate    (Cefadroxil Hemihydrate)      1          caps
cefadroxil monohydrate    (Duricef)                     1          susr, tabs
cefazolin sodium          (Ancef)                       1     HI   solr
cefdinir                  (Omnicef)                     1          caps, susr
cefepime hydrochloride    (Maxipime)                    1     HI   solr; 1gm, 2gm
                          CEFIZOX IN DEXTROSE 5%        2     HI   soln
cefotaxime sodium         (Claforan)                    1     HI   solr; 1gm, 2gm,
                                                                   10gm, 500mg
cefpodoxime proxetil      (Vantin)                      1          susr, tabs
cefprozil                 (Cefzil)                      1          susr, tabs
ceftazidime               (Fortaz)                      1     HI   solr; 1gm, 2gm,
                                                                   6gm

                                           11
                     Drug Name                    Drug         Notes
                                                  Tier

ceftriaxone sodium     (Rocephin)                  1     HI   solr
ceftriaxone sodium and (Ceftriaxone Sodium and     1     HI   soln
dextrose (anhydrous)   Dextrose (anhydrous))
                       CEFTRIAXONE/DEXTROSE        2     HI   solr
cefuroxime axetil      (Ceftin)                    1          susr, tabs
cefuroxime sodium      (Zinacef)                   1     HI   solr
cephalexin             (Keflex)                    1          caps
cephalexin monohydrate (Cephalexin Monohydrate)    1          tabs
                       CLAFORAN                    3     HI   solr; 1gm
                       FORTAZ                      2     HI   solr; 500mg
                       FORTAZ                      2     HI   soln
                       MAXIPIME                    2     HI   solr; 1gm, 2gm,
                                                              500mg
                         ROCEPHIN IN ISO-          2     HI   soln
                         OSMOTIC DEXTROSE
                         SUPRAX                    3          susr
       Chloramphenicol
                         CHLORAMPHENICOL           3     HI   solr
                         SODIUM SUCCINATE
        Macrolides
azithromycin             (Azithromycin)            1     HI   solr
azithromycin             (Zithromax Z-pak)         1          pack, susr, tabs
clarithromycin           (Biaxin)                  1          susr, tabs, tb24
                         E.E.S. 400                2          tabs
                         ERYTHROCIN                2     HI   solr; 1000mg
                         ERYTHROCIN                2     HI   solr; 500mg
                         LACTOBIONATE
                         ERYTHROCIN STEARATE       2          tabs
erythromycin             (Eryc)                    1          cpep
erythromycin and         (Pediazole)               1          susr
sulfisoxazole
                         ERYTHROMYCIN              2          tabs
                         ETHYLSUCCINATE
                         ERYTHROMYCIN              2     HI   solr; 500mg
                         LACTOBIONATE
                         KETEK                     2     ST   tabs
                         ZMAX                      2          susr
        Miscellaneous B-Lactam Antibiotics
                         AZACTAM                   3     HI   solr
                         AZACTAM IN DEXTROSE       3     HI   soln
                         CEFOTETAN                 3     HI   solr; 1gm
cefotetan disodium       (Cefotetan)               1     HI   solr; 2gm, 10gm
cefoxitin sodium         (Mefoxin)                 1     HI   solr
                         DORIBAX                   2     HI   solr

                                      12
                         Drug Name                     Drug         Notes
                                                       Tier

                            INVANZ                      2     HI   solr
                            MERREM                      3     HI   solr
                            PRIMAXIN I.M.               3          solr; 500mg,
                                                                   500mg
                            PRIMAXIN IV                 3     HI   solr; 250mg,
                                                                   250mg, 500mg,
                                                                   500mg
                            PRIMAXIN IV ADD-            3     HI   solr; 250mg,
                            VANTAGE                                250mg, 500mg,
                                                                   500mg
      Penicillins
amoxicillin                 (Amoxil)                    1          caps, chew, susr,
                                                                   tabs
amoxicillin and             (Augmentin)                 1          chew, susr, tabs
clavulanic acid
amoxicillin and             (Augmentin ES-600)          1          susr, tabs
potassium clavulanate
ampicillin                  (Principen)                 1          caps, susr
ampicillin sodium           (Ampicillin Sodium)         1     HI   solr
ampicillin sodium and       (Unasyn)                    1     HI   solr
sulbactam sodium
                            BACTOCILL IN DEXTROSE       3     HI   soln
                            BICILLIN C-R                2          susp
                            BICILLIN L-A                2          susp
dicloxacillin sodium        (Dynapen)                   1          caps
nafcillin sodium            (Unipen)                    1     HI   solr
                            NALLPEN ISO-OSMOTIC IN      3     HI   soln; 0 -, 2gm/
                            DEXTROSE                               100ml
                            NALLPEN/DEXTROSE            3     HI   soln; 0 -, 1gm/
                                                                   50ml, 0 -, 2gm/
                                                                   50ml
                            OXACILLIN SODIUM            3     HI   solr
penicillin g potassium      (Penicillin G Potassium)    1     HI   solr
                            PENICILLIN G POTASSIUM      3     HI   soln
                            IN ISO-OSMOTIC
                            DEXTROSE
                            PENICILLIN G PROCAINE       3          susp
penicillin g sodium         (Penicillin G Sodium)       1     HI   solr
penicillin v potassium      (Pen-vee K)                 1          solr, tabs
                            PIPERACILLIN SODIUM         3     HI   solr; 2gm, 3gm,
                                                                   4gm
piperacillin sodium         (Piperacillin Sodium)       1     HI   solr; 40gm
                            TIMENTIN                    3     HI   soln, solr
                            ZOSYN                       3     HI   solr
                            ZOSYN                       3     HI   soln
                                               13
                       Drug Name                        Drug         Notes
                                                        Tier

       Quinolones
                          AVELOX                         2     HI   soln
                          AVELOX                         2          tabs
                          AVELOX ABC PACK                2          tabs
ciprofloxacin             (Cipro I.V.)                   1     HI   soln
ciprofloxacin and         (Cipro XR)                     1          tb24
ciprofloxacin hcl
ciprofloxacin and         (Cipro I.V. in D5W)            1     HI   soln
dextrose (anhydrous)
ciprofloxacin hcl         (Cipro)                        1          tabs
                          FACTIVE                        3          tabs
                          LEVAQUIN                       2     HI   soln
                          LEVAQUIN                       2     HI   soln; 5 %, 750mg/
                                                                    150ml
                          LEVAQUIN                       2          soln, tabs
                          LEVAQUIN LEVA-PAK              2          tabs
                          LEVAQUIN PREMIX                2     HI   soln; 5 %, 250mg/
                                                                    50ml
                         NOROXIN                         3          tabs
ofloxacin                (Floxin)                        1          tabs
        Sulfonamides (Systemic)
                         GANTRISIN PEDIATRIC             2          susp
sulfadiazine             (Sulfadiazine)                  1          tabs
sulfamethoxazole and     (Bactrim)                       1          susp, tabs
trimethoprim
sulfamethoxazole and     (Bactrim)                       1     HI   soln
trimethoprim
sulfasalazine            (Azulfidine)                    1          tabs, tbec
                         TRIMETHOPRIM/                   1          tabs
                         SULFAMETHOXAZOLE DS
        Tetracyclines
demeclocycline           (Declomycin)                    1          tabs
hydrochloride
                         DORYX                           3          tbec
doxycycline hyclate      (Doxycycline Hyclate)           1     HI   solr
doxycycline hyclate      (Vibramycin)                    1          caps, cpep, tabs
doxycycline              (Adoxa)                         1          caps, susr, tabs
monohydrate
minocycline              (Minocin)                       1          caps, tabs
hydrochloride
tetracycline             (Tetracycline Hydrochloride)    1          caps
hydrochloride
                         TYGACIL                         4     HI   solr
                         VIBRAMYCIN                      2          syrp

                                                14
                   Drug Name                          Drug            Notes
                                                      Tier

                       VIBRAMYCIN                      2              susr
Anticholinergic Agents
       Antimuscarinics/Antispasmodics
atropine sulfate        (Atropine Sulfate)             1              soln
                        ATROVENT HFA                   2              aers
                        CANTIL                         2              tabs
glycopyrrolate          (Robinul)                      1              tabs
methscopolamine         (Pamine)                       1              tabs
bromide
                        SPIRIVA HANDIHALER             2              caps
Anticonvulsants
       Anticonvulsants, Miscellaneous
carbamazepine           (Tegretol)                     1              chew, susp, tabs
                        CARBATROL                      2              cp12
                        DEPAKOTE                       2              tbec
                        DEPAKOTE ER                    2              tb24
                        DEPAKOTE SPRINKLES             2              cpsp
divalproex sodium       (Depakote)                     1              tbec
                        FELBATOL                       2              susp, tabs
gabapentin              (Neurontin)                    1              caps, tabs
                        GABITRIL                       2              tabs
                        KEPPRA                         2     HI       soln
                        KEPPRA                         2              soln, tabs
                        LAMICTAL STARTER/NOT           2              kit; 25mg-100mg
                        TAKING CARBAMAZEPINE
                        LAMICTAL STARTER/              2              kit; 25mg-100mg
                        TAKING
                        CARBAMAZEPINE/NOT
                        TAKING VALPROATE
                        LAMICTAL STARTER/              2              kit; 25mg
                        TAKING VALPROATE
lamotrigine             (Lamictal)                     1              tabs, tbdp
                        LYRICA                         2     PA, QL   caps
magnesium sulfate,      (Magnesium Sulfate Abbojec)    1     HI       soln
heptahydrate
                        NEURONTIN                      2              soln
oxcarbazepine           (Trileptal)                    1              tabs
                        TEGRETOL-XR                    2              tb12
                        TOPAMAX                        2              tabs
                        TOPAMAX SPRINKLE               2              cpsp
                        TRILEPTAL                      2              susp, tabs
valproate sodium        (Depacon)                      1     HI       soln
valproate sodium        (Depakene)                     1              syrp
valproic acid           (Depakene)                     1              caps

                                         15
                     Drug Name                     Drug            Notes
                                                   Tier

zonisamide               (Zonegran)                 1              caps
       Barbiturates (Anticonvulsants)
primidone                (Mysoline)                 1              tabs
       Hydantoins
                         DILANTIN                   2              caps; 30mg
                         DILANTIN INFATABS          2              chew
fosphenytoin sodium      (Cerebyx)                  1     HI       soln
                         PEGANONE                   2              tabs
                         PHENYTEK                   2              caps; 200mg,
                                                                   300mg
phenytoin               (Dilantin)                  1              susp
phenytoin sodium        (Dilantin)                  1              caps; 100mg
                        PHENYTOIN SODIUM            2     HI       soln
      Succinimides
                        CELONTIN                    2              caps
ethosuximide            (Zarontin)                  1              caps, soln
Antidiabetic Agents
       Alpha-Glucosidase Inhibitors
acarbose                 (Precose)                  1              tabs
                         GLYSET                     3              tabs
       Amylinomimetics
                         SYMLIN                     2              soln; 600mcg/ml
                         SYMLINPEN 120              2              soln; 1000mcg/ml
                         SYMLINPEN 60               2              soln; 1000mcg/ml
       Biguanides
metformin hydrochloride (Glucophage)                1              tabs, tb24
       Dipeptidyl Peptidase-4 (dpp-4) Inhibitors
                         JANUMET                    2     ST       tabs
                         JANUVIA                    2     ST       tabs
       Incretin Mimetics
                         BYETTA                     2     QL, ST   soln
       Insulins
                         HUMALOG                    2              soln
                         HUMALOG MIX 50/50          2              susp; 50 %, 50 %
                         HUMALOG MIX 50/50 PEN      2              susp; 50 %, 50 %
                         HUMALOG MIX 75/25          2              susp; 25 %, 75 %
                         HUMALOG MIX 75/25 PEN      2              susp; 25 %, 75 %
                         HUMALOG PEN                2              soln
                         HUMULIN 50/50              2              susp; 50 %, 50 %
                         HUMULIN 70/30              2              susp; 30 %, 70 %
                         HUMULIN 70/30 PEN          2              susp; 30 %, 70 %
                         HUMULIN N                  2              susp
                         HUMULIN N U-100 PEN        2              susp
                         HUMULIN R                  2              soln

                                        16
                     Drug Name                    Drug        Notes
                                                  Tier

                        LANTUS                     2          soln
                        LANTUS SOLOSTAR            2          soln
                        LEVEMIR                    2          soln
                        LEVEMIR FLEXPEN            2          soln
                        NOVOLIN 70/30              2          susp; 30 %, 70 %
                        NOVOLIN 70/30 INNOLET      2          susp; 30 %, 70 %
                        NOVOLIN 70/30 PENFILL      2          susp; 30 %, 70 %
                        NOVOLIN N                  2          susp
                        NOVOLIN N INNOLET          2          susp
                        NOVOLIN N U-100 PENFILL    2          susp
                        NOVOLIN R                  2          soln
                        NOVOLIN R INNOLET          2          soln
                        NOVOLIN R U-100 PENFILL    2          soln
                        NOVOLOG                    2          soln
                        NOVOLOG FLEXPEN            2          soln
                        NOVOLOG MIX 70/30          2          susp
                        NOVOLOG MIX 70/30          2          susp
                        PENFILL
                        NOVOLOG MIX 70/30          2          susp
                        PREFILLED FLEXPEN
                        NOVOLOG PENFILL            2          soln
                        RELION 70/30               2          susp; 30 %, 70 %
                        RELION 70/30 INNOLET       2          susp; 30 %, 70 %
                        RELION N                   2          susp
                        RELION N INNOLET           2          susp
                        RELION R                   2          soln
      Meglitinides
                        PRANDIN                    2          tabs
                        STARLIX                    2          tabs
        Sulfonylureas
glimepiride              (Amaryl)                  1          tabs
glipizide                (Glucotrol)               1          tabs, tb24
glipizide and metformin (Metaglip)                 1          tabs
hydrochloride
glyburide                (Micronase)               1          tabs
glyburide and metformin (Glucovance)               1          tabs
hydrochloride
tolazamide               (Tolinase)                1          tabs
tolbutamide              (Orinase)                 1          tabs
        Thiazolidinediones
                         ACTOPLUS MET              2     ST   tabs
                         ACTOS                     2     ST   tabs
                         AVANDAMET                 2     ST   tabs
                         AVANDARYL                 2     ST   tabs

                                        17
                    Drug Name                          Drug             Notes
                                                       Tier

                         AVANDIA                        2     ST       tabs
                         DUETACT                        2     ST       tabs
Antidiarrhea Agents
       Antidiarrhea Agents
atropine sulfate and   (Lomotil)                        1              liqd, tabs
diphenoxylate
hydrochloride
loperamide             (Imodium)                        1              caps
hydrochloride
                       MOTOFEN                          2              tabs
Antiemetics
       5-HT3 Receptor Antagonists
                        ALOXI                           3              soln
granisetron hcl         (Kytril)                        1     PA       soln, tabs
granisetron hcl         (Kytril)                        1              soln (vial)
ondansetron             (Zofran)                        1     PA       tbdp
ondansetron hcl         (Zofran)                        1              soln (vial)
ondansetron hcl         (Zofran)                        1     PA       soln, tabs
       Antiemetics, Miscellaneous
                        CESAMET                         3              caps
dronabinol              (Marinol)                       1              caps
                        EMEND                           2     PA, QL   caps, misc
                        TRANSDERM-SCOP                  2              pt72
       Antihistamines (GI Drugs)
                        ANTIVERT                        2              tabs; 50mg
meclizine hydrochloride (Antivert)                      1              tabs; 12.5mg,
                                                                       25mg
prochlorperazine         (Compazine)                    1              supp
prochlorperazine         (Compazine)                    1              soln
edisylate
prochlorperazine         (Compazine)                    1              tabs
maleate
trimethobenzamide        (Tigan)                        1              caps
hydrochloride
Antifungals (Systemic)
       Allylamines
terbinafine              (Lamisil)                      1              tabs
hydrochloride
       Antifungals, Miscellaneous
griseofulvin             (Grifulvin V)                  1              susp
                         GRIS-PEG                       3              tabs
       Azoles
dextrose (anhydrous)     (Diflucan in Iso-osmotic D)    1     HI       soln
and fluconazole

                                             18
                       Drug Name                    Drug             Notes
                                                    Tier

fluconazole               (Diflucan)                 1              susr, tabs
fluconazole and sodium    (Diflucan in NaCl)         1     HI       soln
chloride
itraconazole              (Sporanox)                 1              caps
ketoconazole              (Nizoral)                  1              tabs
                          NOXAFIL                    3              susp
                          SPORANOX                   2              soln
                          VFEND                      3              susr, tabs
                          VFEND IV                   3     HI       solr
       Echinocandins
                          CANCIDAS                   4     HI       solr
                          ERAXIS                     3     HI       solr
       Polyenes
                          ABELCET                    2     PA, HI   susp
                          AMBISOME                   2     PA, HI   susr; 50mg
                          AMPHOTEC                   2     PA, HI   susr; 50mg, 100mg
amphotericin b            (Amphocin)                 1     PA, HI   solr
nystatin                  (Mycostatin)               1              susp, tabs
        Pyrimidines
                          ANCOBON                    2              caps
Antiglaucoma Agents
       Alpha-Adrenergic Agonists (EENT)
                       ALPHAGAN P                    2              soln; 0.1 %, 0.15
                                                                    %
brimonidine tartrate     (Brimonidine Tartrate)      1              soln; 0.2 %
                         COMBIGAN                    2              soln
        Beta-Adrenergic Blocking Agents (EENT)
betaxolol hydrochloride (Betaxolol Hydrochloride)    1              soln
                         BETIMOL                     2              soln
                         BETOPTIC-S                  3              susp
                         ISTALOL                     2              soln; 0.5 %
levobunolol              (Betagan)                   1              soln
hydrochloride
metipranolol             (Optipranolol)              1              soln
timolol maleate          (Timoptic)                  1              solg, soln
                         TIMOPTIC OCUDOSE            2              soln; 0.25 %, 0.5
                                                                    %
       Carbonic Anhydrase Inhibitors (EENT)
acetazolamide         (Diamox)                       1              tabs
                      ACETAZOLAMIDE                  2              solr
                      SODIUM
                      AZOPT                          2              susp
                      COSOPT                         3              soln
methazolamide         (Neptazane)                    1              tabs

                                               19
                       Drug Name                       Drug    Notes
                                                       Tier

                          TRUSOPT                       3     soln
       Miotics
                        PHOSPHOLINE IODIDE              3     solr
                        PILOPINE HS                     3     gel
       Prostaglandin Analogs
                        TRAVATAN                        2     soln
                        TRAVATAN Z                      2     soln
                        XALATAN                         2     soln
Antihemorrhagic Agents
       Hemostatics
                          CYKLOKAPRON                   2     soln
Antihypoglycemic Agents
       Glycogenolytic Agents
                        GLUCAGEN HYPOKIT                2     solr
                        GLUCAGON EMERGENCY              2     kit
                        KIT
Anti-infectives (EENT)
        Antibacterials (EENT)
                          AZASITE                       3     soln
bacitracin                (Bacitracin)                  1     oint
bacitracin zinc and       (Bacitracin Zinc and          1     oint
hydrocortisone acetate    Hydrocortisone Acetate and
and neomycin sulfate      Neomycin Sulfate and
and polymyxin b sulfate Polymyxin B Sulfate)
bacitracin zinc and       (Neosporin)                   1     oint
neomycin sulfate and
polymyxin b sulfate
bacitracin zinc and       (Bacitracin Zinc and          1     oint
polymyxin b sulfate       Polymyxin B Sulfate)
                          BACTROBAN NASAL               2     oint
                          BLEPHAMIDE                    2     susp
                          BLEPHAMIDE S.O.P.             2     oint
                          CILOXAN                       3     oint
                          CIPRO HC                      2     susp
                          CIPRODEX                      2     susp
ciprofloxacin hcl         (Ciloxan)                     1     soln
                          COLY-MYCIN-S                  2     susp; 3mg/ml, 1 %,
                                                              5mg/ml, 0.05 %
                          CORTISPORIN-TC                2     susp; 3mg/ml,
                                                              10mg/ml, 3.3mg/
                                                              ml, 0.5mg/ml
dexamethasone and         (Maxitrol)                    1     oint, susp
neomycin sulfate and
polymyxin b sulfate

                                            20
                     Drug Name                          Drug    Notes
                                                        Tier

doxycycline hyclate       (Periostat)                    1     tabs
erythromycin              (Romycin)                      1     oint
gentamicin sulfate        (Garamycin)                    1     oint, soln
gramicidin and neomycin   (Neosporin)                    1     soln
sulfate and polymyxin b
sulfate
hydrocortisone and        (Cortisporin)                  1     soln, susp
neomycin sulfate and
polymyxin b sulfate
                          IQUIX                          3     soln
ofloxacin                 (Ocuflox)                      1     soln
                          PEDIOTIC                       2     susp
polymyxin b sulfate and   (Polytrim)                     1     soln
trimethoprim sulfate
                          POLY-PRED                      2     susp
prednisolone sodium       (Prednisolone Sodium           1     soln
phosphate and             Phosphate and Sulfacetamide
sulfacetamide sodium      Sodium)
                          QUIXIN                         3     soln
sulfacetamide sodium      (Sulfacetamide Sodium)         1     oint, soln
                          TOBRADEX                       3     oint, susp
tobramycin sulfate        (Tobrex)                       1     soln
                          VIGAMOX                        2     soln
                          ZYLET                          2     susp
                          ZYMAR                          2     soln
         Antifungals (EENT)
                          NATACYN                        2     susp
         Antivirals (EENT)
trifluridine              (Viroptic)                     1     soln
         EENT Anti-infectives, Miscellaneous
acetic acid               (Vosol)                        1     soln
acetic acid and           (Domeboro)                     1     soln
aluminum acetate
acetic acid and           (Vosol HC)                     1     soln
hydrocortisone
chlorhexidine gluconate (Peridex)                        1     soln
Anti-infectives (Skin and Mucous Membrane)
       Antibacterials (Skin and Mucous Membrane)
                         ALTABAX                         3     oint
                         BENZACLIN                       2     gel
benzoyl peroxide and     (Benzamycin)                    1     gel
erythromycin
clindamycin phosphate    (Cleocin)                       1     crea, gel, lotn,
                                                               soln, swab

                                            21
                     Drug Name                       Drug    Notes
                                                     Tier

erythromycin              (Erygel)                    1     gel, pads, soln
gentamicin sulfate        (Gentamicin Sulfate)        1     crea, oint
metronidazole             (Metrogel Vaginal)          1     gel
mupirocin                 (Bactroban)                 1     oint
neomycin sulfate and      (Neosporin Gu Irrigant)     1     soln
polymyxin b sulfate
        Antifungals (Skin and Mucous Membrane)
betamethasone             (Lotrisone)                 1     crea, lotn
dipropionate and
clotrimazole
ciclopirox                (Penlac Nail Lacquer)       1     soln
ciclopirox olamine        (Loprox)                    1     crea, susp
clotrimazole              (Mycelex)                   1     crea, lozg, soln,
                                                            troc
econazole nitrate         (Spectazole)                1     crea
                          EXELDERM                    2     crea, soln
                          EXTINA                      3     foam
                          GYNAZOLE-1                  2     crea
ketoconazole              (Nizoral)                   1     crea, sham
                          LAMISIL                     2     soln
                          LOPROX SHAMPOO              2     sham
miconazole nitrate        (Monistat 3)                1     supp
                          NAFTIN                      2     crea, gel
                          NAFTIN-MP                   2     crea
nystatin                  (Mycostatin)                1     crea, oint, powd
nystatin and              (Mycolog II)                1     crea, oint
triamcinolone acetonide
terconazole                (Terazol 3)                1     crea, supp
                           XOLEGEL                    3     gel
        Antivirals (Skin and Mucous Membrane)
                           DENAVIR                    2     crea
                           VEREGEN                    3     oint
                           ZOVIRAX                    2     crea, oint
        Local Anti-infectives, Miscellaneous
isopropyl alcohol pad      (Isopropyl Alcohol Pad)    2     pads
metronidazole              (Metrogel)                 1     crea, gel, lotn
selenium sulfide           (Selsun Shampoo)           1     lotn
silver sulfadiazine        (Silvadene)                1     crea
sulfacetamide sodium       (Klaron)                   1     lotn
                           SULFAMYLON                 3     crea, pack
        Scabicides and Pediculicides
                           EURAX                      2     crea, lotn
lindane                    (Lindane)                  1     lotn, sham
                           OVIDE                      2     lotn

                                              22
                   Drug Name                           Drug            Notes
                                                       Tier

permethrin             (Elimite)                        1              crea
Anti-inflammatory Agents (EENT)
        Corticosteroids (EENT)
                          ALREX                         2              susp; 0.2 %
                          BECONASE AQ                   3              susp
                          DERMOTIC                      2              oil
dexamethasone sodium (Dexamethasone Sodium              1              soln
phosphate                 Phosphate)
flunisolide               (Nasarel)                     1              soln
fluorometholone           (FML Liquifilm)               1              susp
fluticasone propionate    (Flonase)                     1              susp
                          LOTEMAX                       2              susp; 0.5 %
                          NASACORT AQ                   3              aers
                          NASONEX                       2              susp
                          OMNARIS                       3              susp
prednisolone acetate      (Pred Forte)                  1              susp
prednisolone sodium       (Prednisolone Sodium          1              soln
phosphate                 Phosphate)
                          RHINOCORT AQUA                3              susp
                          VERAMYST                      3              susp
        EENT Anti-inflammatory Agents, Miscellaneous
                          RESTASIS                      3     PA, QL   emul
        EENT Non-Steroidal Anti-inflammatory Agents
                          ACULAR                        2              soln; 0.5 %
                          ACULAR LS                     2              soln; 0.4 %
                          ACULAR PF                     2              soln; 0.5 %
diclofenac sodium         (Voltaren)                    1              soln
flurbiprofen sodium       (Ocufen)                      1              soln
                          NEVANAC                       2              susp
                          XIBROM                        3              soln
Anti-inflammatory Agents (GI Drugs)
       Anti-inflammatory Agents (GI Drugs)
                       ASACOL                           2              tbec; 400mg
balsalazide disodium   (Colazal)                        1              caps
                       CANASA                           2              supp
                       DIPENTUM                         2              caps
                       LIALDA                           3              tbec; 1.2gm
mesalamine (5-asa)     (Rowasa)                         1              enem
                       PENTASA                          3              cpcr
Anti-inflammatory Agents (Respiratory)
      Leukotriene Modifiers
                      ACCOLATE                          3     ST       tabs
                      SINGULAIR                         2     ST       chew, pack, tabs
                      ZYFLO CR                          2              tb12

                                         23
                     Drug Name                      Drug    Notes
                                                    Tier

      Mast Cell Stablilizers
                         ALOCRIL                     3     soln
cromolyn sodium          (Cromolyn Sodium)           1     soln
                         GASTROCROM                  3     conc
                         INTAL INHALER               3     aers
Anti-inflammatory Agents (Skin and Mucous)
       Anti-inflammatory Agents (Skin and Mucous)
alclometasone          (Aclovate)                    1     crea, oint
dipropionate
amcinonide             (Cyclocort)                   1     crea, lotn, oint
augmented              (Diprolene)                   1     crea, gel, lotn, oint
betamethasone
dipropionate
betamethasone          (Alphatrex)                   1     crea, lotn, oint
dipropionate
betamethasone valerate (Betamethasone Valerate)      1     crea, lotn, oint
clobetasol propionate  (Olux)                        1     crea, foam, gel,
                                                           oint, soln
                          CLODERM                    2     crea
                          CORDRAN                    2     lotn
                          CORDRAN SP                 2     crea
                          CORDRAN TAPE               2     tape
                          CUTIVATE                   2     lotn
desonide                  (Desowen)                  1     crea, lotn, oint
desoximetasone            (Topicort)                 1     crea, gel, oint
diflorasone diacetate     (Psorcon)                  1     crea, oint
fluocinolone acetonide    (Synalar)                  1     crea, oint, soln
fluocinonide              (Lidex)                    1     crea, gel, oint, soln
fluticasone propionate    (Cutivate)                 1     crea, oint
halobetasol propionate    (Ultravate)                1     crea, oint
hydrocortisone            (Hytone)                   1     crea, enem, lotn,
                                                           oint
hydrocortisone acetate    (Carmol-HC)                1     crea
and urea (carbamide)
hydrocortisone butyrate   (Locoid)                   1     crea, oint, soln
hydrocortisone valerate   (Westcort)                 1     crea, oint
                          KENALOG                    3     aers
mometasone furoate        (Elocon)                   1     crea, oint, soln
prednicarbate             (Dermatop)                 1     crea, oint
triamcinolone acetonide   (Kenalog)                  1     crea, lotn, oint,
                                                           pste
                          TRIAMCINOLONE              3     oint
                          ACETONIDE IN
                          ABSORBASE

                                             24
                    Drug Name                     Drug         Notes
                                                  Tier

Antilipemic Agents
        Antilipemic Agents, Miscellaneous
                          LOVAZA                   2          caps
                          NIASPAN                  2          tbcr
        Bile Acid Sequestrants
cholestyramine            (Questran)               1          pack, powd
                          COLESTID FLAVORED        3          pack
colestipol hydrochloride (Colestid)                1          gran, tabs
                          WELCHOL                  2          tabs
        Cholesterol Absorption Inhibitors
                          ZETIA                    3          tabs
        Fibric Acid Derivatives
                          ANTARA                   3          caps
fenofibrate               (Lofibra)                1          caps, tabs
gemfibrozil               (Lopid)                  1          tabs
                          TRICOR                   2          tabs
        HMG-CoA Reductase Inhibitors
                          ADVICOR                  3          tb24
                          ALTOPREV                 3          tb24
                          CADUET                   3          tabs
                          CRESTOR                  2          tabs
                          LESCOL                   3          caps
                          LESCOL XL                3          tb24
                          LIPITOR                  2          tabs
lovastatin                (Mevacor)                1          tabs
pravastatin sodium        (Pravachol)              1          tabs
                          SIMCOR                   3          tb24
simvastatin               (Zocor)                  1          tabs
Antimanic Agents
        Antimanic Agents
lithium carbonate        (Lithobid)                1          caps, tabs, tbcr
lithium citrate          (Lithium Citrate)         1          syrp
Antimigraine Agents
       Selective Serotonin Agonists
                         AMERGE                    3     QL   tabs
                         AXERT                     3     QL   tabs
                         FROVA                     3     QL   tabs
                         IMITREX                   2     QL   soln
                         IMITREX                   2     QL   soln, tabs
                         IMITREX STATDOSE          2     QL   kit
                         REFILL
                         MAXALT                    2     QL   tabs
                         MAXALT-MLT                2     QL   tbdp
                         RELPAX                    3     QL   tabs
                                             25
                 Drug Name                   Drug             Notes
                                             Tier

                      ZOMIG                   3     QL       soln, tabs
                      ZOMIG ZMT               3     QL       tbdp
Antimycobacterials
        Antimycobacterials, Miscellaneous
                          DAPSONE             2              tabs
        Antituberculosis Agents
                          CAPASTAT SULFATE    2              solr
ethambutol                (Myambutol)         1              tabs
hydrochloride
isoniazid                 (Isoniazid)         2              syrp
isoniazid                 (Nydrazid)          1              soln, tabs
isoniazid and rifampin    (Rifamate)          1              caps
                          MYCOBUTIN           2              caps
                          PASER               2              pack
                          PRIFTIN             2              tabs
pyrazinamide              (Pyrazinamide)      1              tabs
rifampin                  (Rifadin)           1     HI       solr
rifampin                  (Rifadin)           1              caps
                          RIFATER             2              tabs
                          SEROMYCIN           2              caps
                          TRECATOR            2              tabs
Antineoplastic Agents
        Antineoplastic Agents
                         ABRAXANE             2     HI       susr
                         ALIMTA               2     HI       solr
                         ALKERAN              2     HI       solr
                         ARIMIDEX             2              tabs
                         AROMASIN             2              tabs
                         ARRANON              2     HI       soln
                         AVASTIN              2     HI       soln
                         BICNU W/DILUENT      2     HI       solr
                         ABSOLUTEETHANOL
bleomycin sulfate        (Blenoxane)          1     PA, HI   solr
                         BUSULFEX             2     HI       soln
                         CAMPATH              2     HI       soln
carboplatin              (Paraplatin)         1     HI       soln
                         CASODEX              2              tabs
                         CEENU                2              caps
cisplatin                (Platinol AQ)        1     HI       soln
cladribine               (Leustatin)          1     PA, HI   soln
                         CLOLAR               2     HI       soln
                         COSMEGEN             2     HI       solr
cyclophosphamide         (Cytoxan)            1     ST       tabs
cyclophosphamide         (Cytoxan)            1     HI       solr

                                      26
                   Drug Name                        Drug             Notes
                                                    Tier

cytarabine              (Cytosar-U)                  2     PA, HI   solr
cytarabine              (Cytosar-U)                  1     PA, HI   soln
                        DACARBAZINE                  2     HI       solr; 100mg
dacarbazine             (DTIC-Dome)                  1     HI       solr; 200mg
                        DACOGEN                      2     HI       solr
daunorubicin            (Cerubidine)                 1     HI       solr
hydrochloride
                        DAUNOXOME                    2     HI       inj
                        DOXIL                        2     PA, HI   inj
doxorubicin             (Adriamycin)                 1     PA, HI   soln, solr
hydrochloride
                        DROXIA                       2              caps; 200mg,
                                                                    300mg, 400mg
                        ELIGARD                      3              kit; 7.5mg,
                                                                    22.5mg, 30mg,
                                                                    45mg
                         ELOXATIN                    2     HI       soln
                         ELSPAR                      2     HI       solr
                         EMCYT                       2              caps
epirubicin hcl           (Ellence)                   1     HI       soln
                         ERBITUX                     2     HI       soln
                         ETOPOPHOS                   2     HI       solr
etoposide                (Vepesid)                   1     HI       soln
                         FARESTON                    2              tabs
                         FASLODEX                    2              soln
                         FEMARA                      2              tabs
fludarabine phosphate    (Fludara)                   1     HI       soln, solr
fluorouracil             (Adrucil)                   1     PA, HI   soln
flutamide                (Eulexin)                   1              caps
                         GEMZAR                      2     HI       solr
                         GLEEVEC                     4              tabs
                         HERCEPTIN                   2     HI       solr
                         HEXALEN                     4              caps
                         HYCAMTIN                    2     HI       solr
hydroxyurea              (Hydrea)                    1              caps; 500mg
idarubicin hcl           (Idamycin)                  1     HI       soln
ifosfamide               (Ifex)                      1     HI       solr
                         IFOSFAMIDE                  2     HI       soln
ifosfamide and mesna     (Ifex/mesnex Combo Pack)    1     HI       kit
                         IRESSA                      4              tabs
irinotecan hydrochloride (Camptosar)                 2     HI       soln
                         IXEMPRA KIT                 4     HI       solr
                         LEUKERAN                    2              tabs
leuprolide acetate       (Lupron)                    1              kit, soln

                                          27
                      Drug Name                Drug        Notes
                                               Tier

                         LUPRON DEPOT           3          kit; 3.75mg,
                                                           7.5mg, 11.25mg,
                                                           22.5mg, 30mg
                         LUPRON DEPOT-PED       3          kit; 7.5mg,
                                                           11.25mg, 15mg
                         LYSODREN               2          tabs
                         MATULANE               4          caps
                         MEGACE ES              2          susp
megestrol acetate        (Megace)               1          susp, tabs
mercaptopurine           (Purinethol)           1          tabs
methotrexate             (Methotrexate)         1     ST   tabs
methotrexate sodium      (Methotrexate)         1     HI   solr
mitomycin c              (Mutamycin)            1     HI   solr
mitoxantrone             (Novantrone)           1     HI   conc
hydrochloride
                         MUSTARGEN              2     HI   solr
                         MYLOTARG               2     HI   solr
                         NEXAVAR                4          tabs
                         NILANDRON              2          tabs
                         ONCASPAR               2          soln
                         ONTAK                  2     HI   soln
paclitaxel               (Taxol)                1     HI   conc
pentostatin              (Nipent)               1     HI   solr
                         PHOTOFRIN              2     HI   solr
                         PROLEUKIN              2     HI   solr
                         RHEUMATREX             2     ST   tabs
                         RITUXAN                2     HI   conc
                         SOLTAMOX               2          soln
                         SPRYCEL                4          tabs
                         SUTENT                 4          caps
                         TABLOID                2          tabs
tamoxifen citrate        (Nolvadex)             1          tabs
                         TARCEVA                4          tabs
                         TARGRETIN              2          caps
                         TASIGNA                4          caps
                         TAXOTERE               2     HI   conc
thiotepa                 (Thioplex)             1     HI   solr
                         TORISEL                4     HI   soln
                         TREANDA                4          solr
                         TRELSTAR DEPOT         2          susr; 3.75mg
                         TRELSTAR LA            2          susr; 11.25mg
tretinoin                (Vesanoid)             1          caps
                         TREXALL                2     ST   tabs
                         TRISENOX               2     HI   soln

                                          28
                       Drug Name                    Drug              Notes
                                                    Tier

                          TYKERB                        2            tabs
                          VANTAS                        3            kit
                          VECTIBIX                      2   HI       soln
                          VELCADE                       2   HI       solr
                          VIDAZA                        2            susr
                          VINBLASTINE SULFATE           2   PA, HI   soln, solr
vincristine sulfate       (Oncovin)                     1   PA, HI   soln
vinorelbine tartrate      (Navelbine)                   1   HI       soln
                          ZANOSAR                       2   HI       solr
                          ZOLINZA                       2            caps
Antiparkinsonian Agents
       Adamantanes (CNS)
amantadine              (Symmetrel)                     1            caps, tabs
hydrochloride
       Anticholinergic Agents (CNS)
benztropine mesylate    (Cogentin)                      1            tabs
                        COGENTIN                        2            soln
                        KEMADRIN                        2            tabs
trihexyphenidyl         (Artane)                        1            elix, tabs
hydrochloride
       Catechol-O-Methyltransferase (COMT) Inhibitors
                        COMTAN                          2            tabs
                        TASMAR                          2            tabs
       Dopamine Precursors
carbidopa anhydrous     (Sinemet)                       1            tabs, tbcr
and levodopa
                        LODOSYN                         2            tabs
                        STALEVO 100                     2            tabs; 25mg,
                                                                     200mg, 100mg
                          STALEVO 150                   2            tabs; 37.5mg,
                                                                     200mg, 150mg
                          STALEVO 200                   2            tabs; 50mg,
                                                                     200mg, 200mg
                          STALEVO 50                    2            tabs; 12.5mg,
                                                                     200mg, 50mg
       Dopamine Receptor Agonists
                         APOKYN                         3            soln
bromocriptine mesylate (Parlodel)                       1            caps, tabs
cabergoline              (Dostinex)                     1            tabs
                         MIRAPEX                        2            tabs
                         REQUIP XL                      3            tb24
ropinirole hydrochloride (Requip)                       1            tabs
       Monoamine Oxidase B Inhibitors
                         AZILECT                        2            tabs

                                        29
                       Drug Name                         Drug             Notes
                                                         Tier

                          EMSAM                           3              pt24
selegiline hcl            (Eldepryl)                      1              caps, tabs
                          ZELAPAR                         2              tbdp
Antiprotozoals
       Amebicides
paromomycin sulfate       (Humatin)                       1              caps
       Antimalarials
chloroquine phosphate     (Aralen)                        1              tabs
                          DARAPRIM                        2              tabs
                          FANSIDAR                        2              tabs
hydroxychloroquine        (Plaquenil)                     1              tabs
sulfate
                        MALARONE                          2              tabs
mefloquine hcl          (Lariam)                          1              tabs
                        PRIMAQUINE PHOSPHATE              2              tabs
                        QUALAQUIN                         3     PA       caps
       Antiprotozoals, Miscellaneous
                        ALINIA                            3              susr, tabs
                        MEPRON                            3              susp
metronidazole           (Flagyl)                          1              caps, tabs
metronidazole and       (Flagyl IV)                       1     HI       soln
sodium chloride
                        NEUTREXIN                         3     HI       solr
                        TINDAMAX                          3              tabs
Antipruritics and Local Anesthetics
       Antipruritics and Local Anesthetics
lidocaine and prilocaine (EMLA)                           1              crea
lidocaine hydrochloride (Xylocaine)                       1              oint
                         LIDODERM                         3              ptch
                         ZONALON                          3              crea
Antithrombotic Agents
       Anticoagulants
                          ARIXTRA                         4     PA, QL   soln
                          COUMADIN                        2              solr
dextrose (anhydrous)      (Heparin Sodium/D5W)            1     HI       soln
and heparin sodium
(porcine)
                         FRAGMIN                          3     PA, QL   inj
heparin sodium (porcine) (Heparin Sodium (porcine))       1     HI       soln; 5000 unit/ml,
                                                                         10000 unit/ml
heparin sodium (porcine) (Heparin Sodium (porcine))       2     HI       soln; 20000 unit/
                                                                         ml
heparin sodium (porcine) (Heparin Sodium (porcine) and    1     HI       soln; 2 unit/ml, 0.9
and sodium chloride      Sodium Chloride)                                %

                                             30
                     Drug Name                 Drug            Notes
                                               Tier

                         HEPARIN SODIUM         2     HI       soln; 2000 unit/ml,
                                                               25000 unit/ml
                         HEPARIN SODIUM/NACL    2     HI       soln; 50 unit/ml,
                         0.45%                                 0.45 %, 100 unit/
                                                               ml, 0.45 %
                         INNOHEP                2     PA, QL   soln
                         LOVENOX                4     PA, QL   soln; various
                                                               strengths are
                                                               available
                         LOVENOX                2     PA, QL   soln; 30mg/0.3ml,
                                                               40mg/0.4ml
warfarin sodium           (Coumadin)            1              tabs
        Platelet Aggregation Inhibitors
cilostazol                (Pletal)              1              tabs
                          PLAVIX                2              tabs
ticlopidine hydrochloride (Ticlid)              1              tabs
Antiulcer Agents and Acid Suppressants
        Histamine H2-Antagonists
cimetidine               (Tagamet)              1              tabs
cimetidine hydrochloride (Tagamet)              1              soln
famotidine               (Pepcid)               1     HI       soln
famotidine               (Pepcid)               1              tabs
famotidine and sodium    (Pepcid IV)            1     HI       soln
chloride
nizatidine               (Axid)                 1              caps
ranitidine hydrochloride (Zantac)               1              caps, syrp, tabs
ranitidine hydrochloride (Zantac)               1     HI       soln
        Prostaglandins
misoprostol              (Cytotec)              1              tabs
        Protectants
                         CARAFATE               3              susp
sucralfate               (Carafate)             1              tabs
        Proton Pump Inhibitors
omeprazole               (Prilosec)             1              cpdr
omeprazole               (Prilosec)                            tbec (OTC)
pantoprazole sodium      (Protonix)             1              tbec
sesquihydrate
                         PREVACID               2     ST       cpdr
                         PREVACID SOLUTAB       2     ST       tbdp
                         PREVPAC                2              misc
                         PROTONIX               2     HI       solr
                         ZEGERID                3     ST       caps, pack




                                          31
                    Drug Name                    Drug            Notes
                                                 Tier

Antivirals (Systemic)
      Adamantanes
                         FLUMADINE                3              tabs
rimantadine              (Flumadine)              1              tabs
hydrochloride
       Antiretrovirals
                         APTIVUS                  4              caps
                         ATRIPLA                  4              tabs
                         COMBIVIR                 4              tabs
                         CRIXIVAN                 2              caps
didanosine               (Videx EC)               1              cpdr; 200mg,
                                                                 250mg, 400mg
                         EMTRIVA                  2              caps, soln
                         EPIVIR                   2              soln, tabs; 10mg/
                                                                 ml, 150mg, 300mg
                         EPIVIR HBV               2              soln, tabs; 5mg/ml,
                                                                 100mg
                          EPZICOM                 4              tabs
                          FUZEON                  4              kit
                          INTELENCE               4              tabs
                          INVIRASE                4              caps, tabs
                          ISENTRESS               2              tabs
                          KALETRA                 2              caps, soln, tabs
                          LEXIVA                  2              susp, tabs
                          NORVIR                  2              caps, soln
                          PREZISTA                4              tabs
                          RESCRIPTOR              2              tabs
                          RETROVIR IV INFUSION    2     HI       soln
                          REYATAZ                 2              caps
                          SELZENTRY               2              tabs
                          SUSTIVA                 2              caps, tabs
                          TRIZIVIR                4              tabs
                          TRUVADA                 4              tabs
                          VIDEX                   2              solr
                          VIDEX EC                2              cpdr; 125mg
                          VIRACEPT                2              powd, tabs
                          VIRAMUNE                2              susp, tabs
                          VIREAD                  2              tabs
                          ZERIT                   2              caps, solr
                          ZIAGEN                  2              soln, tabs
zidovudine                (Retrovir)              1              caps, syrp, tabs
       Antivirals, Miscellaneous
foscarnet sodium          (Foscavir)              1     PA, HI   soln


                                       32
                    Drug Name                           Drug             Notes
                                                        Tier

      Interferons
                         ALFERON N                        4             soln
                         INFERGEN                         4             inj
                         INTRON-A                         2             kit
                         INTRON-A                         4             kit, soln
                         INTRON-A W/DILUENT               4             solr
                         PEGASYS                          4             kit
                         PEG-INTRON                       4             kit
                         PEG-INTRON REDIPEN               4             kit
                         PEG-INTRON REDIPEN               4             kit
                         PAK 4
        Monoclonal Antibodies
                         SYNAGIS                          3             soln
        Neuraminidase Inhibitors
                         RELENZA DISKHALER                3             aepb
                         TAMIFLU                          2             caps, susr
        Nucleosides and Nucleotides
acyclovir                (Zovirax)                        1             caps, susp, tabs
acyclovir sodium         (Zovirax)                        1    PA, HI   solr
                         BARACLUDE                        3             soln, tabs
                         CYTOVENE                         4    PA, HI   solr
famciclovir              (Famvir)                         1             tabs
ganciclovir              (Cytovene)                       1             caps
                         HEPSERA                          3             tabs
                         REBETOL                          2             soln
ribavirin                (Copegus)                        1             caps, misc, tabs
                         TYZEKA                           2             tabs
                         VALCYTE                          4             tabs
                         VALTREX                          2             tabs
                         VISTIDE                          4    HI       soln
Anxiolytics, Sedatives and Hypnotics
       Anxiolytics, Sedatives and Hypnotics, Miscellaneous
buspirone hydrochloride (Buspar)                           1            tabs
hydroxyzine              (Atarax)                          1            soln, syrp, tabs
hydrochloride
hydroxyzine pamoate      (Vistaril)                        1            caps
                         LUNESTA                           2            tabs
meprobamate              (Miltown)                         1            tabs
                         ROZEREM                           3            tabs
zaleplon                 (Sonata)                          1            caps
zolpidem tartrate        (Ambien)                          1            tabs
Autonomic Drugs, Miscellaneous
      Autonomic Drugs, Miscellaneous
                      CHANTIX                             2             misc, tabs

                                            33
                   Drug Name                             Drug        Notes
                                                         Tier

nicotine                (Nicotine Patch)                  1          pt24
                        NICOTROL INHALER                  2          inha
                        NICOTROL NS                       2          soln
Beta-Adrenergic Blocking Agents
        Beta-Adrenergic Blocking Agents
acebutolol hydrochloride (Sectral)                        1          caps
atenolol                 (Tenormin)                       1          tabs
atenolol and             (Tenoretic)                      1          tabs
chlorthalidone
bendroflumethiazide and (Corzide)                         1          tabs
nadolol
betaxolol hydrochloride (Kerlone)                         1          tabs
bisoprolol fumarate      (Zebeta)                         1          tabs
bisoprolol fumarate and (Ziac)                            1          tabs
hydrochlorothiazide
                         BYSTOLIC                         3     ST   tabs
carvedilol               (Coreg)                          1          tabs
                         COREG CR                         2          cp24
hydrochlorothiazide and (Lopressor HCT)                   1          tabs
metoprolol tartrate
hydrochlorothiazide and (Inderide)                        1          tabs
propranolol
hydrochloride
                         INNOPRAN XL                      3          cp24
labetalol hydrochloride (Trandate Iv)                     1     HI   soln
labetalol hydrochloride (Trandate)                        1          tabs
metoprolol succinate     (Toprol XL)                      1          tb24
metoprolol tartrate      (Lopressor)                      1          tabs
metoprolol tartrate      (Lopressor)                      1     HI   soln
nadolol                  (Corgard)                        1          tabs
pindolol                 (Visken)                         1          tabs
propranolol              (Inderal LA)                     1          cp24, tabs
hydrochloride
sotalol hydrochloride    (Betapace)                       1          tabs
timolol maleate          (Blocadren)                      1          tabs
Calcium Channel Blocking Agents
        Calcium Channel Blocking Agents, Miscellaneous
                        CARDIZEM CD                       2          cp24
                        DILTIAZEM HCL                     2     HI   solr
diltiazem hydrochloride (Cardizem CD)                     1          cp12, cp24, tabs
diltiazem hydrochloride (Cardizem)                        1     HI   soln
verapamil hydrochloride (Calan SR)                        1          cp24, tabs, tbcr
verapamil hydrochloride (Verapamil Hydrochloride)         1     HI   soln


                                          34
                     Drug Name                           Drug            Notes
                                                         Tier

      Dihydropyridines
amlodipine besylate     (Norvasc)                         1              tabs
amlodipine besylate and (Lotrel)                          1              caps; various
benazepril hcl                                                           strengths are
                                                                         available
                            AZOR                          3              tabs
                            CARDENE I.V.                  3     HI       soln
                            CARDENE SR                    3              cp12
                            DYNACIRC CR                   3              tb24; 10mg
                            DYNACIRC-CR                   3              tb24; 5mg
                            EXFORGE                       2              tabs
felodipine                  (Plendil)                     1              tb24
isradipine                  (Dynacirc)                    1              caps
                            LOTREL                        2              caps; 5mg, 40mg,
                                                                         10mg, 40mg
nicardipine hcl             (Cardene)                     1              caps
nifedipine                  (Procardia XL)                1              caps, tb24
nimodipine                  (Nimotop)                     1              caps
nisoldipine                 (Sular)                       1              tb24; 20mg, 30mg,
                                                                         40mg
                            SULAR                         3              tb24; 8.5mg,
                                                                         17mg, 25.5mg,
                                                                         34mg
Caloric Agents
       Caloric Agents
alanine and arginine and    (Alanine and Arginine and     1     PA, HI   soln; various
dextrose (anhydrous)        Dextrose (anhydrous) and                     strengths are
and glycine and histidine   Glycine and Histidine)                       available
alcohol, usp and            (Alcohol, USP and Dextrose    1     HI       soln
dextrose (anhydrous)        (anhydrous))
                            AMINOSYN 7%/                  2     PA, HI   soln; various
                            ELECTROLYTES                                 strengths are
                                                                         available
                            AMINOSYN 8.5%/                2     PA, HI   soln; various
                            ELECTROLYTES                                 strengths are
                                                                         available
                            AMINOSYN                      2     PA, HI   soln
                            AMINOSYN                      2     PA, HI   soln; various
                                                                         strengths are
                                                                         available
                            AMINOSYN II 3.5%/             2     PA, HI   soln; various
                            DEXTROSE 25%                                 strengths are
                                                                         available



                                              35
Drug Name                 Drug            Notes
                          Tier

   AMINOSYN II 3.5%/       2     PA, HI   soln
   DEXTROSE 25%
   AMINOSYN II 3.5%/       2     PA, HI   soln; various
   DEXTROSE 5%                            strengths are
                                          available
   AMINOSYN II 4.25%/      1     PA, HI   soln; various
   DEXTROSE 20%                           strengths are
                                          available
   AMINOSYN II 5%/         2     PA, HI   soln; various
   DEXTROSE 25%                           strengths are
                                          available
   AMINOSYN II 8.5%/       2     PA, HI   soln; various
   ELECTROLYTES                           strengths are
                                          available
   AMINOSYN II             1     PA, HI   soln; various
                                          strengths are
                                          available
   AMINOSYN II             2     PA, HI   soln; various
                                          strengths are
                                          available
   AMINOSYN II M 3.5%/     2     PA, HI   soln; various
   DEXTROSE 5%                            strengths are
                                          available
   AMINOSYN M              2     PA, HI   soln; various
                                          strengths are
                                          available
   AMINOSYN-HBC            2     PA, HI   soln; various
                                          strengths are
                                          available
   AMINOSYN-HF             1     PA, HI   soln
   AMINOSYN-PF 7%          2     PA, HI   soln
   CLIMIMIX E 4.25%/       2     PA, HI   soln; various
   DEXTROSE 5%                            strengths are
                                          available
   CLINIMIX 2.75%/         2     PA, HI   soln; various
   DEXTROSE 5%                            strengths are
                                          available
   CLINIMIX 4.25%/         2     PA, HI   soln; various
   DEXTROSE 5%                            strengths are
                                          available
   CLINIMIX 5%/DEXTROSE    2     PA, HI   soln; various
   15%                                    strengths are
                                          available



                     36
                       Drug Name                        Drug            Notes
                                                        Tier

                          CLINIMIX 5%/DEXTROSE           2     PA, HI   soln; various
                          20%                                           strengths are
                                                                        available
                          CLINIMIX 5%/DEXTROSE           2     PA, HI   soln; various
                          25%                                           strengths are
                                                                        available
                          CLINIMIX E 2.75%/              2     PA, HI   soln; various
                          DEXTROSE 10%                                  strengths are
                                                                        available
                          CLINIMIX E 2.75%/              2     PA, HI   soln; various
                          DEXTROSE 5%                                   strengths are
                                                                        available
                          CLINIMIX E 5%/DEXTROSE         2     PA, HI   soln; various
                          15%                                           strengths are
                                                                        available
                          CLINIMIX E 5%/DEXTROSE         2     PA, HI   soln; various
                          20%                                           strengths are
                                                                        available
                          CLINIMIX E 5%/DEXTROSE         2     PA, HI   soln; various
                          25%                                           strengths are
                                                                        available
                          CLINIMIX E 5%/DEXTROSE         2     PA, HI   soln; various
                          35%                                           strengths are
                                                                        available
dextrose (anhydrous)      (Dextrose 25%)                 1     PA, HI   soln
dextrose (anhydrous)      (Dextrose 5%/sodium Chlori)    1     HI       soln
and sodium chloride
                          FREAMINE HBC 6.9%              2     PA, HI   soln; various
                                                                        strengths are
                                                                        available
                          FREAMINE III 3%                2     PA, HI   soln; various
                                                                        strengths are
                                                                        available
glycerin and              (Liposyn III)                  1     PA, HI   emul
phospholipids and
soybean oil
                          HEPATASOL                      1     PA, HI   soln
                          NEPHRAMINE                     2     PA, HI   soln
                          PREMASOL                       1     PA, HI   soln; various
                                                                        strengths are
                                                                        available
                          PROCALAMINE                    2     PA, HI   soln
                          PROSOL                         2     PA, HI   soln
                          RENAMIN                        2     PA, HI   soln


                                            37
Drug Name                Drug             Notes
                         Tier

   TRAVASOL 2.75%/        2     PA, HI   soln; various
   DEXTROSE 10%                          strengths are
                                         available
   TRAVASOL 2.75%/        2     PA, HI   soln; various
   DEXTROSE 5%                           strengths are
                                         available
   TRAVASOL 3.5%/         2     PA, HI   soln
   ELECTROLYTES
   TRAVASOL 4.25%/        2     PA, HI   soln; various
   DEXTROSE 25%                          strengths are
                                         available
   TRAVASOL 5.5%/         2     PA, HI   soln; 44 meq/l, 0 -,
   DEXTROSE 10%                          10 %, 250mg/
                                         100ml, 560mg/
                                         100ml
   TRAVASOL 5.5%/         2     PA, HI   soln; 44 meq/l, 0 -,
   DEXTROSE 20%                          20 %, 250mg/
                                         100ml, 560mg/
                                         100ml
   TRAVASOL 5.5%/         2     PA, HI   soln; various
   ELECTROLYTES                          strengths are
                                         available
   TRAVASOL 8.5%/         2     PA, HI   soln; various
   DEXTROSE 10%                          strengths are
                                         available
   TRAVASOL 8.5%/         2     PA, HI   soln; various
   DEXTROSE 20%                          strengths are
                                         available
   TRAVASOL 8.5%/         2     PA, HI   soln; various
   DEXTROSE 50%                          strengths are
                                         available
   TRAVASOL 8.5%/         2     PA, HI   soln; various
   ELECTROLYTES                          strengths are
                                         available
   TRAVASOL               2     PA, HI   soln; various
                                         strengths are
                                         available
   TRAVASOL               1     PA, HI   soln; various
                                         strengths are
                                         available
   TROPHAMINE             1     PA, HI   soln; various
                                         strengths are
                                         available



                    38
                    Drug Name                           Drug         Notes
                                                        Tier

Cardiac Drugs
        Antiarrhythmic Agents
amiodarone hcl           (Cordarone)                     1          soln, tabs
disopyramide phosphate (Norpace)                         1          caps, cp12
flecainide acetate       (Tambocor)                      1          tabs
lidocaine hydrochloride (Lidocaine HCl)                  1     HI   soln
mexiletine hydrochloride (Mexitil)                       1          caps
                         PACERONE                        2          tabs
procainamide             (Procainamide Hydrochloride)    1          caps, soln, tbcr
hydrochloride
                         PROCANBID                       2          tb12
                         PRONESTYL                       2          caps
propafenone hcl          (Rythmol)                       1          tabs
                         QUINIDINE GLUCONATE             2          soln
quinidine gluconate      (Quinidine Gluconate)           1          tbcr
quinidine sulfate        (Quinidine Sulfate)             1          tabs, tbcr
                         RYTHMOL SR                      2          cp12
                         TIKOSYN                         2          caps
        Cardiac Drugs, Miscellaneous
                         RANEXA                          2     PA   tb12
        Cardiotonic Agents
                         DIGOXIN                         2          soln; 0.05mg/ml
digoxin                  (Lanoxin)                       1          soln, tabs
                         LANOXIN                         2          soln; 0.1mg/ml
Cathartics and Laxatives
       Cathartics and Laxatives
                        AMITIZA                          2          caps
polyethylene glycol     (Miralax)                        1          powd
polyethylene glycol and (Nulytely)                       1          solr
potassium chloride and
sodium bicarbonate and
sodium chloride
polyethylene glycol and (Colyte)                         1          solr
potassium chloride and
sodium bicarbonate and
sodium chloride and
sodium sul
Cell Stimulants and Proliferants
        Cell Stimulants and Proliferants
                          ATRALIN                        3          gel; 0.05 %
                          KEPIVANCE                      2          solr
                          RETIN-A MICRO                  3          gel; 0.04 %, 0.1 %
tretinoin                 (Retin-A)                      1          crea, gel


                                           39
                     Drug Name                        Drug         Notes
                                                      Tier

Central Nervous System Agents, Miscellaneous
       Central Nervous System Agents, Miscellaneous
                        CAMPRAL                        2          tbec
                        NAMENDA                        2          soln, tabs
                        NAMENDA TITRATION              2          tabs
                        PAK
                        RILUTEK                        3          tabs
                        STRATTERA                      2          caps
                        XYREM                          3     LA   soln
Cholelitholytic Agents
       Cholelitholytic Agents
ursodiol                 (Actigall)                    1          caps
Contraceptives
        Contraceptives
desogestrel and ethinyl    (Ortho-cept-28)             1          tabs
estradiol
drospirenone and ethinyl   (Yasmin 28)                 1          tabs; 3mg, 0.03mg
estradiol
ethinyl estradiol and      (Demulen 1/35-28)           1          tabs
ethynodiol diacetate
ethinyl estradiol and      (Loestrin Fe 1/20)          1          tabs
ferrous fumarate and
norethindrone acetate
ethinyl estradiol and      (Seasonale)                 1          tabs
levonorgestrel
ethinyl estradiol and      (Ovcon-35/28)               1          tabs
norethindrone
ethinyl estradiol and      (Loestrin 1/20-21)          1          tabs
norethindrone acetate
ethinyl estradiol and      (Ortho Tri-cyclen)          1          tabs
norgestimate
ethinyl estradiol and      (Ovral)                     1          tabs
norgestrel
mestranol and              (Norinyl 1+50)              1          tabs
norethindrone
norethindrone              (Ortho Micronor)            1          tabs
                           NUVARING                    2          ring
                           ORTHO EVRA                  2          ptwk
                           PLAN B                      2          tabs
                           YAZ                         2          tabs; 3mg, 0.02mg
Depigmenting and Pigmenting Agents
       Depigmenting Agents
                       BENOQUIN                        3          crea


                                                40
                     Drug Name                       Drug    Notes
                                                     Tier

       Pigmenting Agents
                       8-MOP                          2     caps
                       OXSORALEN                      3     lotn
                       OXSORALEN ULTRA                2     caps
                       UVADEX                         2     soln
Devices
       Devices
                           DIABETIC SUPPLIES, MISC    2     misc, insulin
                                                            syringe (disp) u-
                                                            100 1/2ml
                           DIABETIC SUPPLIES, MISC    2     misc, insulin
                                                            syringe (disp) u-
                                                            100 0.3ml
                           DIABETIC SUPPLIES, MISC    2     misc, insulin
                                                            syringe (disp) u-
                                                            100 1ml
                           DIABETIC SUPPLIES, MISC    2     n/a, insulin safety
                                                            syringe
                           DIABETIC SUPPLIES, MISC    2     misc, insulin pen
                                                            needle
Digestants
        Digestants
amylase (diastase) and     (Pancrease MT 10)          1     caps, cpep, tabs
lipase (as pancrelipase)
and protease
                           CREON 5                    2     cpep; 16600 unit,
                                                            5000 unit, 18750
                                                            unit
                           CREON 10                   2     cpep; 33200 unit,
                                                            10000 unit, 37500
                                                            unit
                           CREON 20                   2     cpep; 66400 unit,
                                                            20000 unit, 75000
                                                            unit
                           ENZYMAX                    2     tabs
                           KU-ZYME HP                 2     caps
                           PANCREASE MT 4             2     cpep; 12000 unit,
                                                            4000 unit, 12000
                                                            unit
                           PANCRECARB MS-16           2     cpep; 52000 unit,
                                                            16000 unit, 52000
                                                            unit




                                               41
                   Drug Name                    Drug    Notes
                                                Tier

                        PANCRECARB MS-4          2     cpep; 25000 unit,
                                                       4000 unit, 25000
                                                       unit
                        PANCRECARB MS-8          2     cpep; 40000 unit,
                                                       8000 unit, 45000
                                                       unit
                        ULTRASE                  2     cpep; 20000 unit,
                                                       4500 unit, 25000
                                                       unit
                        VIOKASE                  2     powd
Diuretics
       Loop Diuretics
bumetanide               (Bumex)                 1     tabs
furosemide               (Lasix)                 1     soln, tabs
torsemide                (Demadex)               1     tabs
       Potassium-Sparing Diuretics
amiloride hydrochloride (Midamor)                1     tabs
(anhydrous)
amiloride hydrochloride (Moduretic 5-50)         1     tabs
(anhydrous) and
hydrochlorothiazide
                         DYRENIUM                3     caps
hydrochlorothiazide and (Dyazide)                1     caps, tabs
triamterene
       Thiazide Diuretics
chlorothiazide           (Diuril)                1     tabs
hydrochlorothiazide      (Microzide)             1     caps, tabs
methyclothiazide         (Enduron)               1     tabs
       Thiazide-Like Diuretics
chlorthalidone           (Hygroton)              1     tabs
indapamide               (Lozol)                 1     tabs
metolazone               (Zaroxolyn)             1     tabs
EENT Drugs, Miscellaneous
       EENT Drugs, Miscellaneous
carteolol hcl         (Ocupress)                 1     soln
                      IOPIDINE                   3     soln
ipratropium bromide   (Atrovent)                 1     soln
                      LACRISERT                  2     inst
                      LUMIGAN                    3     soln
Emollients, Demulcents, and Protectants
        Basic Lotions and Liniments
ammonium lactate          (Ammonium Lactate)     1     lotn
lactic acid               (Lac-hydrin)           1     lotn


                                           42
                    Drug Name                Drug         Notes
                                             Tier

Enzymes
       Enzymes
                        ADAGEN                4          soln
                        ALDURAZYME            4     HI   soln
                        ARALAST               4     HI   solr; 400mg,
                                                         800mg
                        CEREDASE              4     HI   soln
                        CEREZYME              4     HI   solr
                        ELAPRASE              4     HI   soln
                        ELITEK                4     HI   solr
                        FABRAZYME             4     HI   solr
                        MYOZYME               4     HI   solr
                        NAGLAZYME             4     HI   soln
                        PROLASTIN             4     HI   solr, susr
                        SUCRAID               2          soln
                        ZEMAIRA               4     HI   solr; 1000mg
Estrogens and Antiestrogens
       Estrogen Agonist-Antagonists
                        EVISTA                2          tabs
       Estrogens
                        ACTIVELLA             3          tabs; 0.5mg, 0.1mg
                        ALORA                 2          pttw; various
                                                         strengths are
                                                         available
                        ANGELIQ               3          tabs
                        CENESTIN              3          tabs
                        CLIMARA               2          ptwk; various
                                                         strengths are
                                                         available
                        CLIMARA PRO           3          ptwk
                        COMBIPATCH            2          pttw
                        DELESTROGEN           3          oil
                        DEPO-ESTRADIOL        3          oil
                        DIVIGEL               3          gel; 0.25mg/
                                                         0.25gm, 0.5mg/
                                                         0.5gm, 1mg/gm
                        ELESTRIN              3          gel; 0.06 %
                        ESTRACE               2          crea
                        ESTRADERM             2          pttw; 0.05mg/24hr,
                                                         0.1mg/24hr
estradiol               (Climara)             1          ptwk, tabs
estradiol and           (Activella)           1          tabs; 1mg, 0.5mg
norethindrone acetate
estradiol valerate      (Delestrogen)         1          oil

                                        43
                    Drug Name                          Drug         Notes
                                                       Tier

                        ESTRASORB                        3         emul
                        ESTRING                          3         ring
                        ESTROGEL                         3         gel; 0.06 %
estropipate             (Ogen)                           1         tabs
                        EVAMIST                          3         soln
                        FEMHRT 1/5                       3         tabs; 5mcg, 1mg
                        FEMHRT LOW DOSE                  3         tabs; 2.5mcg,
                                                                   0.5mg
                        FEMRING                          3         ring
                        FEMTRACE                         3         tabs
                        GYNODIOL                         3         tabs; 1.5mg
                        MENEST                           3         tabs
                        MENOSTAR                         3         ptwk; 14mcg/24hr
                        PREFEST                          3         tabs
                        PREMARIN                         2         solr, tabs
                        PREMARIN W/                      2         crea
                        APPLICATOR
                        PREMPHASE                        2         tabs; 0.625mg,
                                                                   5mg
                        PREMPRO                          2         tabs; various
                                                                   strengths are
                                                                   available
                        VAGIFEM                          3         tabs; 25mcg
                        VIVELLE-DOT                      2         pttw; various
                                                                   strengths are
                                                                   available
First Generation Antihistamines
       Ethanolamine Derivatives
carbinoxamine maleate (Pediatex)                          1        liqd
clemastine fumarate      (Tavist Allergy)                 1        syrp, tabs
diphenhydramine          (Benadryl)                       1        caps, elix, soln
hydrochloride
       First Generation Antihistamine Derivatives, Miscellaneous
cyproheptadine           (Periactin)                      1        syrp, tabs
hydrochloride
       Phenothiazine Derivatives
phenylephrine            (Phenylephrine Hydrochloride     1        syrp
hydrochloride and        and Promethazine
promethazine             Hydrochloride)
hydrochloride
promethazine             (Phenergan)                      1        soln, supp, syrp,
hydrochloride                                                      tabs




                                           44
                    Drug Name                          Drug            Notes
                                                       Tier

       Propylamine Derivatives
dexchlorpheniramine    (Dexchlorpheniramine             1              syrp
maleate                Maleate)
Genitourinary Smooth Muscle Relaxants
       Genitourinary Smooth Muscle Relaxants
                        DETROL                          2              tabs
                        DETROL LA                       2              cp24
flavoxate hydrochloride (Urispas)                       1              tabs
oxybutynin chloride     (Ditropan)                      1              tabs, tb24
                        OXYTROL                         3              pttw
                        VESICARE                        2              tabs
GI Drugs, Miscellaneous
       GI Drugs, Miscellaneous
                        LOTRONEX                        2              tabs
Gold Compounds
       Gold Compounds
                          RIDAURA                       2              caps
Gonadotropins
      Gonadotropins
gonadotropin, chorionic   (Pregnyl W/diluent Benzyl)    1              solr
                          SYNAREL                       2              soln
Heavy Metal Antagonists
       Heavy Metal Antagonists
                       CHEMET                           2              caps
                       CUPRIMINE                        2              caps
                       DEPEN TITRATABS                  2              tabs
                       EXJADE                           3              tbso
                       SYPRINE                          2              caps
Hematopoietic Agents
       Hematopoietic Agents
                       ARANESP ALBUMIN FREE             4     PA, QL   soln; 40mcg/0.4ml,
                                                                       40mcg/ml, 60mcg/
                                                                       ml, 100mcg/ml,
                                                                       150mcg/0.3ml,
                                                                       150mcg/0.75ml,
                                                                       200mcg/0.4ml, 200
                                                                       mc
                          ARANESP ALBUMIN FREE          2     PA, QL   soln; 25mcg/
                                                                       0.42ml, 25mcg/ml
                          ARANESP ALBUMIN FREE          4     PA, QL   soln; 60mcg/0.3ml,
                          SURE                                         100mcg/0.5ml,
                                                                       300mcg/0.6ml



                                             45
                   Drug Name                    Drug            Notes
                                                Tier

                        EPOGEN                   2     PA, QL   soln; 2000 unit/ml,
                                                                3000 unit/ml, 4000
                                                                unit/ml
                        EPOGEN                   4     PA, QL   soln; 10000 unit/
                                                                ml, 20000 unit/ml,
                                                                40000 unit/ml
                        LEUKINE                  4              soln, solr
                        NEULASTA                 4              soln
                        NEUPOGEN                 4              soln
                        PROCRIT                  2     PA, QL   soln; 2000 unit/ml,
                                                                3000 unit/ml, 4000
                                                                unit/ml
                        PROCRIT                  4     PA, QL   soln; 10000 unit/
                                                                ml, 20000 unit/ml,
                                                                40000 unit/ml
Hemorrheologic Agents
       Hemorrheologic Agents
pentoxifylline         (Trental)                 1              tbcr
Hypotensive Agents
       Central Alpha-Agonists
                         CATAPRES-TTS-1          3              ptwk; 0.1mg/24hr
                         CATAPRES-TTS-2          3              ptwk; 0.2mg/24hr
                         CATAPRES-TTS-3          3              ptwk; 0.3mg/24hr
clonidine hydrochloride (Catapres)               1              tabs
guanabenz acetate        (Wytensin)              1              tabs
guanfacine hcl           (Tenex)                 1              tabs
       Direct Vasodilators
hydralazine              (Apresoline)            1              tabs
hydrochloride
hydralazine              (Apresoline)            1     HI       soln
hydrochloride
minoxidil                (Loniten)               1              tabs
                         PROGLYCEM               2              susp
       Hypotensive Agents, Miscellaneous
                         INVERSINE               2              tabs
       Peripheral Adrenergic Inhibitors
reserpine                (Serpasil)              1              tabs
Ion-Removing Agents
      Phosphate-Removing Agents
                     FOSRENOL                    3              chew
                     PHOSLO                      2              caps
                     RENAGEL                     2              tabs
                     RENVELA                     2              tabs


                                           46
                    Drug Name                            Drug             Notes
                                                         Tier

       Potassium-Removing Agents
sodium polystyrene    (Kayexalate)                        1              powd, susp
sulfonate
Irrigating Solutions
        Irrigating Solutions
acetate and chloride ion (Acetate and Chloride Ion and    1              soln
and gluconate anion and Gluconate Anion and
magnesium (+2) and         Magnesium (+2) and
potassium (+1)             Potassium (+1))
calcium (+2) and           (Calcium (+2) and Chloride     1              soln
chloride ion and           Ion and Potassium (+1) and
potassium (+1) and         Sodium (+1))
sodium (+1)
                           LACTATED RINGER'S              3              soln
                           IRRIGATION
sodium chloride            (Sodium Chloride 0.9%)         1              soln
water, sterile             (Water, Sterile)               1              soln
Local Anesthetics (EENT)
       Local Anesthetics (EENT)
lidocaine hydrochloride (Xylocaine Jelly)                 1              gel, soln
proparacaine             (Proparacaine Hydrochloride)     1              soln
hydrochloride
Local Anesthetics (Parenteral)
       Local Anesthetics (Parenteral)
lidocaine hydrochloride (Xylocaine)                       1              soln
Miscellaneous Therapeutic Agents
       Miscellaneous Therapeutic Agents
                        ACTIMMUNE                         4              soln
                        ACTONEL                           2     QL, ST   tabs
                        ACTONEL WITH CALCIUM              2     QL, ST   tabs
alendronate sodium      (Fosamax)                         1              tabs
allopurinol             (Zyloprim)                        1              tabs
allopurinol sodium      (Aloprim)                         1              solr
amifostine              (Ethyol)                          1              solr
anagrelide              (Agrylin)                         1              caps
hydrochloride
                        ANTABUSE                          2              tabs
                        ARCALYST                          4              solr
                        ATGAM                             2     HI       inj
                        AVODART                           2              caps
                        AVONEX                            4              kit
azathioprine            (Imuran)                          1     PA       tabs
azathioprine sodium     (Imuran)                          1     PA       solr
                        BETASERON                         4              solr

                                            47
                      Drug Name                 Drug             Notes
                                                Tier

                         BONIVA                  3     ST, HI   kit
                         BONIVA                  3     QL, ST   tabs
                         BOTOX                   3              solr
                         CELLCEPT                3     PA       caps, susr, tabs
                         CELLCEPT INTRAVENOUS    3     PA       solr
                         CIMZIA                  4              kit
colchicine               (Colchicine)            1              tabs
                         COPAXONE                4              kit
cyclosporine             (Neoral)                1     PA       caps, soln
                         CYCLOSPORINE            3     PA       caps
                         MODIFIED
                         CYSTADANE               3              powd
                         CYSTAGON                2              caps
dexrazoxane              (Zinecard)              1              solr
                         ELMIRON                 2              caps
                         ENBREL                  4              kit, soln
                         ENBREL SURECLICK        4              soln
                         ETHYOL                  4              solr
etidronate disodium      (Didronel)              1              tabs
finasteride              (Proscar)               1              tabs
                         FLOMAX                  2              cp24
fomepizole (4-           (Antizol)               4              soln
methylpyrazole)
                         FOSAMAX                 2     QL       soln
                         FOSAMAX PLUS D          2     QL       tabs
                         HUMIRA                  4              kit; 40mg/0.8ml
                         HUMIRA PEN              4              kit; 40mg/0.8ml
                         HUMIRA PEN-CROHNS       4              kit; 40mg/0.8ml
                         DISEASE
                         KINERET                 4              soln
                         KUVAN                   4     PA       tbso
leflunomide              (Arava)                 1              tabs
leucovorin calcium       (Leucovorin Calcium)    1     HI       soln, solr
leucovorin calcium       (Leucovorin Calcium)    2     HI       solr
leucovorin calcium       (Leucovorin Calcium)    1              tabs; 5mg, 15mg,
                                                                25mg
leucovorin calcium       (Leucovorin Calcium)    2              tabs; 10mg
levocarnitine            (Carnitor)              1              soln, tabs
levocarnitine            (Carnitor)              1     HI       soln
mesna                    (Mesnex)                1     HI       soln
                         MESNEX                  2              tabs
                         MYFORTIC                2     PA       tbec
                         MYOBLOC                 3              soln
                         NEUMEGA                 4              solr

                                           48
                     Drug Name                       Drug            Notes
                                                     Tier

octreotide acetate       (Sandostatin)                4              soln
                         ORENCIA                      4              solr
                         ORFADIN                      2              caps
                         ORTHOCLONE OKT3              2     PA       inj
pamidronate disodium     (Aredia)                     1     HI       soln, solr
                         PROGRAF                      3     PA       caps, soln
                         RAPAMUNE                     3     PA       soln, tabs
                         REBIF                        4              soln; 22mcg/0.5ml,
                                                                     44mcg/0.5ml
                         REBIF TITRATION PACK         4              soln; 8.8mcg/
                                                                     0.2ml-22mcg/
                                                                     0.5ml
                         REMICADE                     4     PA, HI   solr
                         REVLIMID                     4     LA       caps
                         SANDOSTATIN LAR              4              kit
                         DEPOT
                         SENSIPAR                     2              tabs
                         SIMULECT                     2     PA       solr
                         SKELID                       3              tabs
                         SOMATULINE DEPOT             4              soln
                         THALOMID                     4              caps
                         THIOLA                       2              tabs
                         THYMOGLOBULIN                2     HI       solr
                         TYSABRI                      4     HI, LA   conc
                         UROXATRAL                    3              tb24
                         VITAMIN/MINERAL, MISC        3              n/a, (sodium
                                                                     fluoride)
                         ZAVESCA                      4              caps
                         ZENAPAX                      2     PA       conc
                         ZOMETA                       2     HI       conc
Mucolytic Agents
       Mucolytic Agents
acetylcysteine          (Mucomyst)                    1              soln
Multivitamin Preparations
       Multivitamin Preparations
prenatal with folic acid (Prenatal With Folic Acid    2
(greater than .8mg)      (Greater than .8mg))
Mydriatics
        Mydriatics
dipivefrin hydrochloride (Propine)                    1              soln
tropicamide              (Mydriacyl)                  1              soln
Opiate Antagonists
       Opiate Antagonists
                        NALOXONE HCL                  2              soln
                                            49
                       Drug Name                    Drug         Notes
                                                    Tier

naltrexone hydrochloride (Revia)                     1          tabs
Oxytocics
      Oxytocics
                          METHERGINE                 3          tabs
Parasympathomimetics (Cholinergic Agents)
       Parasympathomimetics (Cholinergic Agents)
                        ARICEPT                      2          tabs
                        ARICEPT ODT                  2          tbdp
bethanechol chloride    (Urecholine)                 1          tabs
                        COGNEX                       3     QL   caps
                        EVOXAC                       2          caps
                        EXELON                       3          pt24
                        EXELON                       3          caps, soln
galantamine             (Razadyne)                   1          tabs
hydrobromide
guanidine hydrochloride (Guanidine Hydrochloride)    1          tabs
                        MESTINON                     2          syrp
                        MESTINON TIMESPAN            2          tbcr
                        MYTELASE                     2          tabs
pilocarpine             (Salagen)                    1          tabs
hydrochloride
pyridostigmine bromide (Mestinon)                    1          tabs
                        RAZADYNE                     3          soln, tabs
                        RAZADYNE ER                  3          cp24
                        REGONOL                      2          soln
Parathyroid
      Parathyroid
                          FORTEO                     4          soln
                          FORTICAL                   2          soln
                          MIACALCIN                  2          soln
Pharmaceutical Aids
      Pharmaceutical Aids
                      DIABETIC SUPPLIES, MISC        2          pads
Pituitary
      Pituitary
desmopressin acetate      (DDAVP)                    1          soln, tabs
                          GENOTROPIN                 4     PA   solr; 5.8mg,
                                                                13.8mg
                          GENOTROPIN MINIQUICK       2     PA   solr; various
                                                                strengths are
                                                                available
                          HUMATROPE                  4     PA   solr; 6mg
                          HUMATROPE                  4     PA   solr; 12mg, 24mg

                                          50
                    Drug Name                    Drug         Notes
                                                 Tier

                         HUMATROPE COMBO          4     PA   solr; 5mg
                         PACK
                         NORDITROPIN              4     PA   soln; 5mg/1.5ml,
                         CARTRIDGE                           15mg/1.5ml
                         NORDITROPIN              4     PA   soln; 5mg/1.5ml,
                         NORDIFLEX PEN                       15mg/1.5ml
                         NUTROPIN                 4     PA   solr; 5mg, 10mg
                         NUTROPIN AQ              4     PA   soln; 10mg/2ml
                         NUTROPIN AQ PEN          4     PA   soln; 10mg/2ml,
                                                             20mg/2ml
                         OMNITROPE                4     PA   solr; 5.8mg
                         SAIZEN                   4     PA   solr; 5mg, 8.8mg
                         SAIZEN CLICK.EASY        4     PA   solr; 8.8mg
                         SEROSTIM                 4     PA   solr; 4mg, 5mg,
                                                             6mg
                         STIMATE                  2          soln
                         TEV-TROPIN               4     PA   solr; 5mg
                         ZORBTIVE                 4     PA   solr; 8.8mg
Progestins
       Progestins
                         DEPO-PROVERA             2          susp; 400mg/ml
                         DEPO-SUBQ PROVERA 104    2          susp; 104mg/
                                                             0.65ml
medroxyprogesterone      (Provera)                1          susp, tabs
acetate
norethindrone acetate    (Aygestin)               1          tabs
                         PROCHIEVE                3          gel
                         PROMETRIUM               2          caps
Prokinetic Agents
       Prokinetic Agents
metoclopramide           (Reglan)                 1          soln, tabs
hydrochloride
Psychotherapeutic Agents
       Antidepressants
amitriptyline            (Elavil)                 1          tabs
hydrochloride
amitriptyline            (Limbitrol)              1          tabs
hydrochloride and
chlordiazepoxide
amitriptyline            (Triavil)                1          tabs
hydrochloride and
perphenazine
amoxapine                (Asendin)                2          tabs; 150mg


                                       51
                      Drug Name               Drug         Notes
                                              Tier

amoxapine                (Asendin)             1          tabs; 25mg, 50mg,
                                                          100mg
bupropion hcl            (Wellbutrin)          1          tabs, tb12, tb24
citalopram               (Celexa)              1          soln, tabs
hydrobromide
clomipramine hcl         (Anafranil)           1          caps
                         CYMBALTA              2          cpep
desipramine              (Norpramin)           1          tabs
hydrochloride
doxepin hydrochloride    (Sinequan)            1          caps, conc
                         EFFEXOR XR            2          cp24
fluoxetine hcl           (Prozac)              1          caps, soln, tabs
fluvoxamine maleate      (Luvox)               1          tabs
imipramine               (Tofranil)            1          tabs
hydrochloride
imipramine pamoate       (Tofranil-PM)         1          caps
                         LEXAPRO               2          soln, tabs
                         LUVOX CR              3          cp24
maprotiline              (Ludiomil)            1          tabs
hydrochloride
                         MARPLAN               3          tabs
mirtazapine              (Remeron)             1          tabs, tbdp
                         NARDIL                2          tabs
nefazodone               (Serzone)             1          tabs
hydrochloride
nortriptyline            (Pamelor)             1          caps, soln
hydrochloride
paroxetine hydrochloride (Paxil)               1          susp, tabs, tb24
                         PAXIL CR              3          tb24
                         PRISTIQ               3          tb24
sertraline hydrochloride (Zoloft)              1          conc, tabs
                         SURMONTIL             3          caps; 100mg
                         SYMBYAX               3          caps
tranylcypromine sulfate (Parnate)              1          tabs
trazodone hydrochloride (Desyrel)              1          tabs
trimipramine maleate     (Surmontil)           1          caps; 25mg, 50mg
venlafaxine hcl          (Effexor)             1          tabs
                         VIVACTIL              3          tabs
                         WELLBUTRIN XL         2          tb24
        Antipsychotic Agents
                         ABILIFY               2     QL   soln, tabs
                         ABILIFY DISCMELT      2     QL   tbdp
chlorpromazine           (Thorazine)           1          soln, tabs
hydrochloride

                                         52
                      Drug Name                   Drug             Notes
                                                  Tier

                         CLOZAPINE                 2     QL       tabs; 200mg
clozapine                (Clozaril)                1     QL       tabs; 25mg, 50mg,
                                                                  100mg
                         FAZACLO                   2     QL       tbdp
fluphenazine decanoate   (Prolixin Decanoate)      1              soln
fluphenazine             (Prolixin)                1              conc, elix, soln,
hydrochloride                                                     tabs
                         GEODON                    2     QL       caps
                         GEODON                    2     QL       solr
                         HALDOL                    3              soln
                         HALDOL DECANOATE-100      3              soln; 100mg/ml
                         HALDOL DECANOATE-50       3              soln; 50mg/ml
haloperidol              (Haldol)                  1              tabs
haloperidol decanoate    (Haldol Decanoate)        1              soln; 50mg/ml,
                                                                  100mg/ml
haloperidol lactate      (Haloperidol Lactate)     1              conc, soln
                         INVEGA                    3     QL, ST   tb24
loxapine succinate       (Loxitane)                1              caps
                         MOBAN                     3              tabs
                         NAVANE                    3              caps; 20mg
                         ORAP                      3              tabs
perphenazine             (Trilafon)                1              tabs
                         RISPERDAL                 2     QL       soln
                         RISPERDAL CONSTA          2              susr
                         RISPERDAL M-TAB           2     QL       tbdp
risperidone              (Risperdal)               1     QL       tabs
                         SEROQUEL                  2     QL       tabs
                         SEROQUEL XR               2     QL       tb24
thioridazine             (Mellaril)                1              tabs
hydrochloride
thiothixene              (Navane)                  1              caps; 1mg, 2mg,
                                                                  5mg, 10mg
trifluoperazine          (Stelazine)               1              tabs
hydrochloride
                         ZYPREXA                   2     QL       solr, tabs
                         ZYPREXA ZYDIS             2     QL       tbdp
Renin-Angiotensin-Aldosterone System Inhibitors
       Angiotensin II Receptor Antagonists
                         ATACAND                   3              tabs
                         ATACAND HCT               3              tabs
                         AVALIDE                   3              tabs
                         AVAPRO                    3              tabs
                         BENICAR                   3              tabs
                         BENICAR HCT               3              tabs

                                             53
                    Drug Name                         Drug        Notes
                                                      Tier

                         COZAAR                        2          tabs
                         DIOVAN                        2          tabs
                         DIOVAN HCT                    2          tabs
                         HYZAAR                        2          tabs
                         MICARDIS                      3          tabs
                         MICARDIS HCT                  3          tabs
                         TEVETEN                       3          tabs
                         TEVETEN HCT                   3          tabs
        Angiotensin-Converting Enzyme Inhibitors
benazepril hcl           (Lotensin)                    1          tabs
benazepril hcl and       (Lotensin HCT)                1          tabs
hydrochlorothiazide
captopril                (Capoten)                     1          tabs
captopril and            (Capozide)                    1          tabs
hydrochlorothiazide
enalapril maleate        (Vasotec)                     1          tabs
enalapril maleate and    (Vaseretic)                   1          tabs
hydrochlorothiazide
fosinopril sodium        (Monopril)                    1          tabs
fosinopril sodium and    (Monopril HCT)                1          tabs
hydrochlorothiazide
hydrochlorothiazide and (Zestoretic)                   1          tabs
lisinopril
hydrochlorothiazide and (Uniretic)                     1          tabs
moexipril hydrochloride
hydrochlorothiazide and (Accuretic)                    1          tabs
quinapril hcl
                         LEXXEL                        3          tbcr
lisinopril               (Zestril)                     1          tabs
moexipril hydrochloride (Univasc)                      1          tabs
quinapril hcl            (Accupril)                    1          tabs
ramipril                 (Altace)                      1          caps
                         TARKA                         3          tbcr
trandolapril             (Mavik)                       1          tabs
        Mineralocorticoid (Aldosterone) Antagonists
eplerenone               (Inspra)                      1          tabs
hydrochlorothiazide and (Aldactazide)                  1          tabs
spironolactone
                         INSPRA                        2          tabs
spironolactone           (Aldactone)                   1          tabs
        Renin Inhibitors
                         TEKTURNA                      2     ST   tabs
                         TEKTURNA HCT                  2     ST   tabs



                                           54
                    Drug Name                            Drug        Notes
                                                         Tier

Replacement Preparations
       Replacement Preparations
acetate and chloride ion (Acetate and Chloride Ion and    1     HI   soln; 16 meq/l, 40
and dextrose             Dextrose (anhydrous) and                    meq/l, 5 %, 3 meq/
(anhydrous) and          Magnesium (+2) and                          l, 13 meq/l
magnesium (+2) and       Potassium (+1))
potassium (+1)
acetate and chloride ion (Acetate and Chloride Ion and    1     HI   soln
and gluconate anion and Gluconate Anion and
magnesium (+2) and       Magnesium (+2) and
potassium (+1)           Potassium (+1))
calcium (+2) and         (Dextrose 2.5%)                  1     HI   soln
chloride ion and
dextrose (anhydrous)
and lactate anion and
potassium (+1)
calcium (+2) and         (Calcium (+2) and Chloride       1     HI   soln
chloride ion and         Ion and Potassium (+1) and
potassium (+1) and       Sodium (+1))
sodium (+1)
                         DEXTROSE 5%/                     2     HI   soln; 24 meq/l, 5
                         ELECTROLYTE #48                             %, 23 meq/l, 3
                         VIAFLEX                                     meq/l, 3 meq/l
                         DEXTROSE 5%/                     2     HI   soln; 48 meq/l, 5
                         ELECTROLYTE #75                             %, 20 meq/l, 15
                         VIAFLEX                                     meq/l, 35 meq/l
dextrose (anhydrous)     (Dextrose (anhydrous) and        1     HI   soln
and potassium chloride Potassium Chloride)
dextrose (anhydrous)     (Kcl 0.075%/d5w/nacl 0.45%)      1     HI   soln
and potassium chloride
and sodium chloride
                         IONOSOL-B/DEXTROSE 5%            2     HI   soln; 49 meq/l, 5
                                                                     %, 25 meq/l, 5
                                                                     meq/l, 13 meq/l
                         IONOSOL-MB/DEXTROSE              2     HI   soln; 22 meq/l, 5
                         5%                                          %, 23 meq/l, 3
                                                                     meq/l, 3 meq/l
                         IONOSOL-T/DEXTROSE 5%            2     HI   soln; 40 meq/l, 5
                                                                     %, 20 meq/l, 15
                                                                     meq/l, 35 meq/l
                         ISOLYTE-H/DEXTROSE 5%            2     HI   soln; 17 meq/l, 39
                                                                     meq/l, 5 %, 3 meq/
                                                                     l, 13 meq/l
                         ISOLYTE-P/DEXTROSE 5%            2     HI   soln
                         ISOLYTE-S                        2     HI   soln

                                            55
                     Drug Name                         Drug             Notes
                                                       Tier

                         ISOLYTE-S PH 7.4               2     HI       soln
                         ISOLYTE-S/DEXTROSE 5%          2     HI       soln; 30 meq/l, 98
                                                                       meq/l, 5 %, 23
                                                                       meq/l, 3 meq/l
                         NORMOSOL-R                     2     HI       soln
                         PLASMA-LYTE 56                 2     HI       soln
                         PLASMA-LYTE A                  2     HI       soln
                         PLASMA-LYTE-148                2     HI       soln
                         PLASMA-LYTE-148/D5W            2     HI       soln; 27 meq/l, 98
                                                                       meq/l, 5 %, 23
                                                                       meq/l, 3 meq/l
                         PLASMA-LYTE-56/D5W             2     HI       soln; 16 meq/l, 40
                                                                       meq/l, 5 %, 3 meq/
                                                                       l, 13 meq/l
potassium chloride       (K-Dur)                        1     HI       soln
potassium chloride       (K-Dur)                        1              cpcr, tbcr
potassium chloride and   (Potassium Chloride 0.3%/n)    1     HI       soln
sodium chloride
sodium chloride          (Sodium Chloride)              1     HI       soln
Respiratory Smooth Muscle Relaxants
       Respiratory Smooth Muscle Relaxants
aminophylline          (Aminophylline)                  1              tabs
theophylline           (Uniphyl)                        1              elix, tb12, tb24
Respiratory Tract Agents, Miscellaneous
       Respiratory Tract Agents, Miscellaneous
                        XOLAIR                          4     PA, QL   solr
Second Generation Antihistamines
        Second Generation Antihistamines
                        ALLEGRA-D 12 HOUR               2              tb12
                        ALLEGRA-D 24 HOUR               2              tb24
cetirizine hcl          (Zyrtec)                                       chew, soln,
                                                                       solution, syrp,
                                                                       tablet, tabs (OTC)
cetirizine hcl and       (Zyrtec-D)                                    tb12 (OTC)
pseudoephedrine
hydrochloride
                         CLARINEX                       3              syrp, tabs
                         CLARINEX REDITABS              3              tbdp
                         CLARINEX-D 12 HOUR             3              tb12
                         CLARINEX-D 24 HOUR             3              tb24
loratadine               (Claritin)                                    soln, solution,
                                                                       syrp, tablet, tabs,
                                                                       tbdp (OTC)


                                             56
                      Drug Name                      Drug            Notes
                                                     Tier

loratadine and               (Claritin-D)                            tb24 (OTC)
pseudoephedrine
hydrochloride
loratadine and               (Claritin-D)                            tb12, tb24 (OTC)
pseudoephedrine sulfate
p-ephed hcl/cetirizine hcl   (Zyrtec-D)                              tab.sr 12h (OTC)
p-ephed sul/loratadine       (Claritin-D)                            tab.sr 24h (OTC)
                             XYZAL                    2              soln, tabs
Serums
       Serums
                             CARIMUNE                 4     PA, HI   solr; 1gm, 3gm,
                             NANOFILTERED                            6gm
                             CARIMUNE                 4     PA, HI   solr
                             NANOFILTERED
                             FLEBOGAMMA               4     PA, HI   soln
                             GAMASTAN S/D             4     PA       inj
                             GAMMAGARD LIQUID         4     PA, HI   soln
                             GAMUNEX                  4     PA, HI   soln
                             IVEEGAM EN               4     PA, HI   solr; 5gm
                             OCTAGAM                  4     PA, HI   soln
                             PANGLOBULIN NF           4     PA, HI   solr
                             PANGLOBULIN NF           4     PA, HI   solr; 6gm
                             POLYGAM S/D              2     PA, HI   solr; 0.5gm
                             POLYGAM S/D              4     PA, HI   solr; 2.5gm, 5gm,
                                                                     10gm
                             VIVAGLOBIN               4     PA       soln
Skeletal Muscle Relaxants
        Centrally-Acting Skeletal Muscle Relaxants
aspirin and carisoprodol (Soma Compound)              1              tabs
aspirin and carisoprodol (Soma Compound/codeine)      1              tabs
and codeine phosphate
carisoprodol              (Soma)                      1              tabs; 350mg
chlorzoxazone             (Parafon Forte DSC)         1              tabs
cyclobenzaprine           (Flexeril)                  1              tabs
hydrochloride
methocarbamol             (Robaxin)                   1              tabs
                          ROBAXIN                     3              soln
                          SKELAXIN                    2              tabs
                          SOMA                        3              tabs; 250mg
tizanidine hydrochloride (Zanaflex)                   1              tabs
        Direct-Acting Skeletal Muscle Relaxants
dantrolene sodium         (Dantrium)                  1              caps
        Gaba-Derivative Skeletal Muscle Relaxants
baclofen                  (Lioresal)                  1              tabs

                                            57
                   Drug Name                        Drug             Notes
                                                    Tier

Skin and Mucous Membrane Agents, Miscellaneous
        Skin and Mucous Membrane Agents, Miscellaneous
                        ALDARA                         2   PA, QL   crea
                        AMEVIVE                        4            solr
                        AZELEX                         3            crea
calcipotriene           (Dovonex)                      1            soln
                        CARAC                          2            crea; 0.5 %
                        DIFFERIN                       3            crea, gel
                        DOVONEX                        2            crea
                        EFUDEX OCCLUSION               2            kit
                        PACK
                        ELIDEL                         2            crea
                        FLECTOR                        3            ptch
                        FLUOROPLEX                     2            crea; 1 %
fluorouracil            (Efudex)                       1            crea, soln
isotretinoin            (Accutane)                     1            caps
                        PANRETIN                       2            gel
podofilox               (Condylox)                     1            soln
                        PROTOPIC                       3   PA       oint
                        RAPTIVA                        4            kit
                        REGRANEX                       2   PA       gel
                        SANTYL                         2            oint
                        SOLARAZE                       2            gel
                        SORIATANE CK                   3            kit
                        TARGRETIN                      2            gel
                        TAZORAC                        2            crea, gel
Somatotropin Agonists and Antagonists
      Somatotropin Agonists
                      INCRELEX                        4             soln
                      IPLEX                           4             soln
      Somatotropin Antagonists
                      SOMAVERT                        4             solr
Sympatholytic Adrenergic Blocking Agents
        Sympatholytic Adrenergic Blocking Agents
caffeine and ergotamine (Cafergot)                    1             supp, tabs
tartrate
                        DIBENZYLINE                   2             caps
dihydroergotamine       (D.H.E. 45)                   1             soln; 1mg/ml
mesylate
                        ERGOMAR                       2             subl
ergot alkaloids,        (Ergot Alkaloids,             1             tabs
hydrogenated (mesylate) Hydrogenated (mesylate))
                        MIGRANAL                      2             soln; 4mg/ml


                                          58
                      Drug Name                    Drug    Notes
                                                   Tier

Sympathomimetic (Adrenergic) Agents
       Alpha- and Beta-Adrenergic Agonists
epinephrine             (Adrenalin)                 1     soln
hydrochloride
                        EPIPEN 2-PAK                2     devi; 1 :1000
                        EPIPEN-JR 2-PAK             2     devi; 1 :2000
                        TWINJECT                    2     devi
       Alpha-Adrenergic Agonists
midodrine hcl           (Proamatine)                1     tabs
       Beta-Adrenergic Agonists
                        ADVAIR DISKUS               2     misc
                        ADVAIR HFA                  2     aero
albuterol sulfate       (Proventil)                 1     nebu, syrp, tabs,
                                                          tb12
                         BRETHINE                   2     soln
                         COMBIVENT                  2     aero
                         FORADIL AEROLIZER          2     caps
                         MAXAIR AUTOHALER           3     aerb
metaproterenol sulfate   (Alupent)                  1     nebu, syrp, tabs
                         PROAIR HFA                 2     aers
                         PROVENTIL HFA              2     aers
                         SEREVENT DISKUS            2     aepb
terbutaline sulfate      (Brethine)                 1     soln, tabs
                         VENTOLIN HFA               2     aers
                         VOSPIRE ER                 3     tb12
Thyroid and Antithyroid Agents
        Antithyroid Agents
methimazole              (Tapazole)                 1     tabs
propylthiouracil         (Propylthiouracil)         1     tabs
        Thyroid Agents
                         CYTOMEL                    2     tabs
levothyroxine sodium     (Synthroid)                1     tabs
liothyronine sodium      (Triostat)                 1     soln
Toxoids
       Toxoids
                         ADACEL                     2     susp; 15.5mcg/
                                                          0.5ml, 2 lf/0.5ml, 5
                                                          lf/0.5ml
                         BOOSTRIX                   2     susp; 18.5mcg/
                                                          0.5ml, 2.5 lf/0.5ml,
                                                          5 lf/0.5ml
                         DAPTACEL                   2     susp; 10mcg/
                                                          0.5ml, 15 lf/0.5ml,
                                                          5 lf/0.5ml

                                              59
                     Drug Name                         Drug         Notes
                                                       Tier

                          DECAVAC                       2          inj; 2 lfu, 5 lfu
                          DIPTHERIA/TETANUS             2          inj; 6.7 lfu/0.5ml, 5
                          TOXOIDPEDIATRIC                          lfu/0.5ml
                          INFANRIX                      2          susp; 58mcg/
                                                                   0.5ml, 25 lfu/
                                                                   0.5ml, 10 lfu/0.5ml
tetanus toxoid adsorbed   (Tetanus Toxoid, Adsorbed)    1     PA   soln
                          TETANUS/DIPHTHERIA            2          susp
                          TOXOIDS-ADSORBED
                          ADULT
                          TRIHIBIT                      2          kit
                          TRIPEDIA                      2          susp; 46.8mcg/
                                                                   0.5ml, 6.7 lfu/
                                                                   0.5ml, 5 lfu/0.5ml
Uricosuric Agents
       Uricosuric Agents
colchicine and           (Col-Benemid)                  1          tabs
probenecid
probenecid               (Benemid)                      1          tabs
Urinary Anti-infectives
        Urinary Anti-infectives
                          FURADANTIN                    2          susp
methenamine hippurate (Hiprex)                          1          tabs
                          MONUROL                       2          pack
nitrofurantoin            (Macrodantin)                 1          caps
macrocrystalline
nitrofurantoin            (Macrobid)                    1          caps
monohydrate
macrocrystals
                          PRIMSOL                       2          soln
trimethoprim              (Proloprim)                   1          tabs
Vaccines
       Vaccines
                          ACTHIB                        2          solr
                          ATTENUVAX                     2     PA   inj
                          COMVAX                        2          susp
                          ENGERIX-B                     2     PA   inj, susp; 10mcg/
                                                                   0.5ml, 20mcg/ml
                          GARDASIL                      3          susp
                          HAVRIX                        2     PA   susp
                          HIBTITER                      2          soln
                          IMOVAX RABIES                 2     PA   inj
                          (H.D.C.V.)
                          IPOL INACTIVATED IPV          2          inj

                                            60
                       Drug Name                   Drug             Notes
                                                   Tier

                          JE-VAX                    2              solr
                          MENACTRA                  2              inj; 4mcg/0.5ml
                          MENOMUNE-A/C/Y/W-135      2              inj; 50mcg/0.5ml
                          MERUVAX II W/DILUENT      2              inj
                          10 DOSE
                          M-M-R II W/DILUENT 10     2              inj
                          DOS
                          PEDIARIX                  2              susp
                          PEDVAX HIB                2              soln
                          PROQUAD                   3              inj
                          RABAVERT                  2     PA       susr
                          RECOMBIVAX HB             2     PA       inj, susp; 5mcg/
                                                                   0.5ml, 10mcg/ml,
                                                                   40mcg/ml
                          ROTATEQ                   2              susp
                          TWINRIX                   2              susp
                          TYPHIM VI                 2              soln
                          VAQTA                     2     PA       inj
                          VARIVAX                   2              inj
                          VIVOTIF BERNA             2              cpdr
yellow fever vaccine      (Yellow Fever Vaccine)    1              inj
                          ZOSTAVAX                  2              solr
Vasoconstrictors
      Vasoconstrictors
naphazoline            (Albalon)                    1              soln
hydrochloride
                       TYZINE                       2              soln; 0.1 %
                       TYZINE PEDIATRIC             2              soln; 0.05 %
                       NASAL DROPS
Vasodilating Agents
        Nitrates and Nitrites
isosorbide dinitrate       (Isordil)                1              subl, tabs, tbcr
isosorbide mononitrate (Imdur)                      1              tabs, tb24
nitroglycerin              (Nitro-dur)              1              pt24, soln
                           NITROLINGUAL             2              soln
                           PUMPSPRAY
                           NITROSTAT                3              subl
        Phosphodiesterase Inhibitors
                           REVATIO                  4              tabs
        Vasodilating Agents, Miscellaneous
                           AGGRENOX                 3              cp12
dipyridamole               (Persantine)             1              tabs
                           LETAIRIS                 4              tabs
                           REMODULIN                4     PA, HI   soln

                                             61
                    Drug Name             Drug        Notes
                                          Tier

                       TRACLEER            4     LA   tabs
Vitamin D
        Vitamin D
                       CALCITRIOL          2          soln
calcitriol             (Rocaltrol)         1          caps, soln
                       HECTOROL            2          caps, soln
                       ZEMPLAR             3          caps, soln




                                     62
                                                                    INDEX

8-MOP....................................................... 41              acetylcysteine ............................................ 49
ABELCET................................................. 19                  Aclovate .................................................... 24
ABILIFY ................................................... 52               ACTHIB .................................................... 60
ABILIFY DISCMELT .............................. 52                           Actigall ...................................................... 40
ABRAXANE ............................................ 26                     ACTIMMUNE .......................................... 47
acarbose .................................................... 16             Actiq ............................................................ 8
ACCOLATE ............................................. 23                    Activella .................................................... 43
Accupril..................................................... 54             ACTIVELLA ............................................ 43
Accuretic ................................................... 54             ACTONEL ................................................ 47
Accutane ................................................... 58              ACTONEL WITH CALCIUM ................. 47
acebutolol hydrochloride .......................... 34                       ACTOPLUS MET .................................... 17
acetaminophen and butalbital and caffeine                                    ACTOS ..................................................... 17
  and codeine phosphate ............................ 8                       ACULAR .................................................. 23
acetaminophen and caffeine and                                               ACULAR LS ............................................ 23
  dihydrocodeine bitartrate ....................... 8                        ACULAR PF ............................................. 23
acetaminophen and codeine phosphate ...... 8                                 acyclovir .................................................... 33
acetaminophen and hydrocodone bitartrate 8                                   acyclovir sodium ....................................... 33
acetaminophen and oxycodone                                                  ADACEL .................................................. 59
  hydrochloride .......................................... 8                 ADAGEN .................................................. 43
acetaminophen and propoxyphene                                               Adderall..................................................... 10
  hydrochloride .......................................... 8                 ADDERALL XR ........................................ 9
Acetaminophen and Propoxyphene                                               Adoxa ........................................................ 14
  Hydrochloride ......................................... 8                  Adrenalin................................................... 59
acetaminophen and propoxyphene napsylate                                     Adriamycin ............................................... 27
  ................................................................. 8        Adrucil ...................................................... 27
acetaminophen and tramadol hcl................ 8                             ADVAIR DISKUS.................................... 59
acetate and chloride ion and dextrose                                        ADVAIR HFA .......................................... 59
  (anhydrous) and magnesium (+2) and                                         ADVICOR ................................................ 25
  potassium (+1) ...................................... 55                   AEROBID ................................................... 6
Acetate and Chloride Ion and Dextrose                                        AEROBID-M .............................................. 6
  anhydrous and Magnesium +2 and                                             AGGRENOX ............................................ 61
  Potassium +1 ......................................... 55                  Agrylin ...................................................... 47
acetate and chloride ion and gluconate                                       ALAMAST ............................................... 10
  anion and magnesium (+2) and potassium                                     alanine and arginine and dextrose
  (+1) ................................................. 47, 55                (anhydrous) and glycine and histidine.. 35
Acetate and Chloride Ion and Gluconate                                       Alanine and Arginine and Dextrose
  Anion and Magnesium +2 and Potassium                                         anhydrous and Glycine and Histidine ... 35
  +1 .................................................... 47, 55             Albalon ...................................................... 61
acetazolamide ........................................... 19                 ALBENZA ................................................ 10
ACETAZOLAMIDE SODIUM................ 19                                      albuterol sulfate ........................................ 59
acetic acid ................................................. 21             alclometasone dipropionate ...................... 24
acetic acid and aluminum acetate............. 21                             alcohol, usp and dextrose (anhydrous) ..... 35
acetic acid and hydrocortisone ................. 21                          Alcohol, USP and Dextrose anhydrous .... 35



                                                                        63
Aldactazide ............................................... 54            AMINOSYN II 3.5%/DEXTROSE 5%.... 36
Aldactone .................................................. 54           AMINOSYN II 4.25%/DEXTROSE 20% 36
ALDARA .................................................. 58              AMINOSYN II 5%/DEXTROSE 25%..... 36
ALDURAZYME....................................... 43                      AMINOSYN II 8.5%/ELECTROLYTES 36
alendronate sodium................................... 47                  AMINOSYN II M 3.5%/DEXTROSE 5% 36
ALFERON N ............................................ 33                 AMINOSYN M ........................................ 36
ALIMTA ................................................... 26             AMINOSYN-HBC ................................... 36
ALINIA ..................................................... 30           AMINOSYN-HF....................................... 36
ALKERAN ............................................... 26                AMINOSYN-PF 7% ................................. 36
ALLEGRA-D 12 HOUR .......................... 56                           amiodarone hcl ......................................... 39
ALLEGRA-D 24 HOUR .......................... 56                           AMITIZA .................................................. 39
allopurinol................................................. 47           amitriptyline hydrochloride ...................... 51
allopurinol sodium .................................... 47                amitriptyline hydrochloride and
ALOCRIL ................................................. 24                chlordiazepoxide ................................... 51
ALOMIDE ................................................ 10               amitriptyline hydrochloride and
Aloprim ..................................................... 47            perphenazine ......................................... 51
ALORA ..................................................... 43            amlodipine besylate .................................. 35
ALOXI ...................................................... 18           amlodipine besylate and benazepril hcl.... 35
ALPHAGAN P ......................................... 19                   AMMONIUM CHLORIDE ........................ 6
Alphatrex................................................... 24           ammonium lactate ..................................... 42
ALREX ..................................................... 23            Ammonium Lactate .................................. 42
ALTABAX ............................................... 21                amoxapine ........................................... 51, 52
Altace ........................................................ 54        amoxicillin................................................. 13
ALTOPREV.............................................. 25                 amoxicillin and clavulanic acid ................ 13
Alupent ...................................................... 59         amoxicillin and potassium clavulanate ..... 13
amantadine hydrochloride ........................ 29                      Amoxil ...................................................... 13
Amaryl ...................................................... 17          amphetamine aspartate and amphetamine
Ambien ...................................................... 33            sulfate and dextroamphetamine
AMBISOME ............................................. 19                   saccharate and dextroamphetamine ..... 10
amcinonide ................................................ 24            Amphocin .................................................. 19
AMERGE.................................................. 25               AMPHOTEC............................................. 19
AMEVIVE ................................................ 58               amphotericin b .......................................... 19
amifostine .................................................. 47          ampicillin .................................................. 13
amikacin sulfate ........................................ 10              ampicillin sodium ...................................... 13
Amikin ...................................................... 10          Ampicillin Sodium .................................... 13
amiloride hydrochloride (anhydrous) ....... 42                            ampicillin sodium and sulbactam sodium . 13
amiloride hydrochloride (anhydrous) and                                   amylase (diastase) and lipase (as
   hydrochlorothiazide .............................. 42                    pancrelipase) and protease ................... 41
aminophylline............................................ 56              Anafranil ................................................... 52
Aminophylline .......................................... 56               anagrelide hydrochloride.......................... 47
AMINOSYN ............................................. 35                 Anaprox....................................................... 7
AMINOSYN 7%/ELECTROLYTES ....... 35                                       Ancef ......................................................... 11
AMINOSYN 8.5%/ELECTROLYTES .... 35                                        ANCOBON ............................................... 19
AMINOSYN II ......................................... 36                  ANDRODERM ........................................... 9
AMINOSYN II 3.5%/DEXTROSE 25%. 35,                                        ANDROGEL............................................... 9
   36                                                                     ANDROGEL PUMP ................................... 9



                                                                     64
ANDROID .................................................. 9              Atropine Sulfate ........................................ 15
ANGELIQ ................................................. 43              atropine sulfate and diphenoxylate
Ansaid ......................................................... 7           hydrochloride ........................................ 18
ANTABUSE ............................................. 47                 Atrovent .................................................... 42
ANTARA .................................................. 25              ATROVENT HFA .................................... 15
Antivert ..................................................... 18         ATTENUVAX .......................................... 60
ANTIVERT............................................... 18                augmented betamethasone dipropionate .. 24
Antizol....................................................... 48         Augmentin................................................. 13
APOKYN .................................................. 29              Augmentin ES-600.................................... 13
Apresoline ................................................. 46           AVALIDE ................................................. 53
APTIVUS .................................................. 32             AVANDAMET ......................................... 17
ARALAST ................................................ 43               AVANDARYL ......................................... 17
Aralen ........................................................ 30        AVANDIA ................................................ 18
ARANESP ALBUMIN FREE .................. 45                                AVAPRO .................................................. 53
ARANESP ALBUMIN FREE SURE....... 45                                       AVASTIN ................................................. 26
Arava ......................................................... 48        AVELOX .................................................. 14
ARCALYST ............................................. 47                 AVELOX ABC PACK ............................. 14
Aredia ........................................................ 49        AVINZA ..................................................... 8
ARICEPT .................................................. 50             AVODART ............................................... 47
ARICEPT ODT ......................................... 50                  AVONEX .................................................. 47
ARIMIDEX............................................... 26                AXERT ..................................................... 25
ARIXTRA ................................................. 30              Axid........................................................... 31
AROMASIN ............................................. 26                 Aygestin .................................................... 51
ARRANON ............................................... 26                AZACTAM ............................................... 12
Artane ........................................................ 29        AZACTAM IN DEXTROSE.................... 12
ASACOL................................................... 23              AZASITE .................................................. 20
Asendin ............................................... 51, 52            azathioprine .............................................. 47
ASMANEX 120 METERED DOSES ........ 6                                      azathioprine sodium .................................. 47
ASMANEX 14 METERED DOSES .......... 6                                     AZELEX ................................................... 58
ASMANEX 30 METERED DOSES .......... 6                                     AZILECT .................................................. 29
ASMANEX 60 METERED DOSES .......... 6                                     azithromycin.............................................. 12
aspirin and butalbital and caffeine and                                   Azithromycin ............................................ 12
   codeine phosphate ................................... 8                AZMACORT .............................................. 6
aspirin and carisoprodol........................... 57                    AZOPT...................................................... 19
aspirin and carisoprodol and codeine                                      AZOR ........................................................ 35
   phosphate .............................................. 57            Azulfidine ................................................. 14
ASTELIN .................................................. 10             bacitracin ............................................ 11, 20
ATACAND ............................................... 53                Bacitracin ............................................ 11, 20
ATACAND HCT ...................................... 53                     bacitracin zinc and hydrocortisone acetate
Atarax ........................................................ 33           and neomycin sulfate and polymyxin b
atenolol ..................................................... 34            sulfate .................................................... 20
atenolol and chlorthalidone ...................... 34                     Bacitracin Zinc and Hydrocortisone Acetate
ATGAM .................................................... 47                and Neomycin Sulfate and Polymyxin B
ATRALIN ................................................. 39                 Sulfate ................................................... 20
ATRIPLA .................................................. 32             bacitracin zinc and neomycin sulfate and
atropine sulfate ......................................... 15                polymyxin b sulfate ............................... 20



                                                                     65
bacitracin zinc and polymyxin b sulfate.... 20                            BLEPHAMIDE ......................................... 20
Bacitracin Zinc and Polymyxin B Sulfate 20                                BLEPHAMIDE S.O.P. ............................. 20
baclofen ..................................................... 57         Blocadren .................................................. 34
BACTOCILL IN DEXTROSE ................. 13                                BONIVA ................................................... 48
Bactrim ...................................................... 14         BOOSTRIX............................................... 59
Bactroban .................................................. 22           BOTOX ..................................................... 48
BACTROBAN NASAL............................ 20                            Brethine ..................................................... 59
balsalazide disodium................................. 23                  BRETHINE ............................................... 59
BARACLUDE .......................................... 33                   brimonidine tartrate .................................. 19
BECONASE AQ ....................................... 23                    Brimonidine Tartrate ................................. 19
Benadryl .................................................... 44          bromocriptine mesylate ............................. 29
benazepril hcl ............................................ 54            bumetanide ................................................ 42
benazepril hcl and hydrochlorothiazide ... 54                             Bumex ....................................................... 42
bendroflumethiazide and nadolol ............. 34                          BUPHENYL ............................................... 7
Benemid .................................................... 60           BUPRENEX ............................................... 9
BENICAR ................................................. 53              BUPRENORPHINE HCL .......................... 9
BENICAR HCT ........................................ 53                   bupropion hcl ............................................ 52
BENOQUIN .............................................. 40                Buspar ....................................................... 33
BENZACLIN ............................................ 21                 buspirone hydrochloride ........................... 33
Benzamycin............................................... 21              BUSULFEX .............................................. 26
benzoyl peroxide and erythromycin .......... 21                           butorphanol tartrate.................................... 9
benztropine mesylate ................................. 29                 BYETTA ................................................... 16
Betagan ..................................................... 19          BYSTOLIC ............................................... 34
betamethasone dipropionate ..................... 24                       cabergoline ............................................... 29
betamethasone dipropionate and                                            CADUET .................................................. 25
   clotrimazole........................................... 22             Cafergot..................................................... 58
betamethasone valerate ............................ 24                    caffeine and ergotamine tartrate .............. 58
Betamethasone Valerate............................ 24                     Calan SR ................................................... 34
Betapace .................................................... 34          calcipotriene ............................................. 58
BETASERON ........................................... 47                  calcitriol .................................................... 62
betaxolol hydrochloride ...................... 19, 34                     CALCITRIOL ........................................... 62
Betaxolol Hydrochloride ........................... 19                    calcium (+2) and chloride ion and dextrose
bethanechol chloride ................................. 50                   (anhydrous) and lactate anion and
BETIMOL ................................................. 19                potassium (+1) ...................................... 55
BETOPTIC-S ............................................ 19                calcium (+2) and chloride ion and
Biaxin ........................................................ 12          potassium (+1) and sodium (+1) .... 47, 55
BICILLIN C-R .......................................... 13                Calcium +2 and Chloride Ion and Potassium
BICILLIN L-A .......................................... 13                  +1 and Sodium +1 ........................... 47, 55
BICNU W/DILUENT                                                           CAMPATH ............................................... 26
   ABSOLUTEETHANOL ....................... 26                             CAMPRAL ............................................... 40
BILTRICIDE ............................................ 10                Camptosar ................................................. 27
bisoprolol fumarate................................... 34                 CANASA .................................................. 23
bisoprolol fumarate and                                                   CANCIDAS .............................................. 19
   hydrochlorothiazide .............................. 34                  CANTIL .................................................... 15
Blenoxane ................................................. 26            CAPASTAT SULFATE ........................... 26
bleomycin sulfate ...................................... 26               Capoten ..................................................... 54



                                                                     66
Capozide ................................................... 54           cefoxitin sodium ........................................ 12
captopril .................................................... 54         cefpodoxime proxetil ................................. 11
captopril and hydrochlorothiazide ........... 54                          cefprozil..................................................... 11
CARAC ..................................................... 58            ceftazidime ................................................ 11
Carafate ..................................................... 31         Ceftin......................................................... 12
CARAFATE ............................................. 31                 ceftriaxone sodium .................................... 12
carbamazepine .......................................... 15               ceftriaxone sodium and dextrose
CARBATROL .......................................... 15                      (anhydrous) ........................................... 12
carbidopa anhydrous and levodopa.......... 29                             Ceftriaxone Sodium and Dextrose
carbinoxamine maleate ............................. 44                       anhydrous .............................................. 12
carboplatin ................................................ 26           CEFTRIAXONE/DEXTROSE ................. 12
Cardene ..................................................... 35          cefuroxime axetil ....................................... 12
CARDENE I.V. ........................................ 35                  cefuroxime sodium .................................... 12
CARDENE SR .......................................... 35                  Cefzil ......................................................... 11
Cardizem ................................................... 34           CELEBREX ................................................ 7
Cardizem CD ............................................ 34               Celexa ....................................................... 52
CARDIZEM CD ....................................... 34                    CELLCEPT ............................................... 48
Cardura ........................................................ 7        CELLCEPT INTRAVENOUS ................. 48
CARIMUNE NANOFILTERED .............. 57                                   CELONTIN............................................... 16
carisoprodol .............................................. 57            CENESTIN ............................................... 43
Carmol-HC ................................................ 24             cephalexin ................................................. 12
Carnitor ..................................................... 48         cephalexin monohydrate ........................... 12
carteolol hcl .............................................. 42           Cephalexin Monohydrate .......................... 12
carvedilol .................................................. 34          Cerebyx ..................................................... 16
CASODEX................................................ 26                CEREDASE .............................................. 43
Cataflam ...................................................... 7         CEREZYME ............................................. 43
Catapres..................................................... 46          Cerubidine ................................................. 27
CATAPRES-TTS-1 .................................. 46                      CESAMET ................................................ 18
CATAPRES-TTS-2 .................................. 46                      cetirizine hcl .............................................. 56
CATAPRES-TTS-3 .................................. 46                      cetirizine hcl and pseudoephedrine
Ceclor ........................................................ 11           hydrochloride ........................................ 56
CEDAX ..................................................... 11            CHANTIX................................................. 33
CEENU ..................................................... 26            CHEMET .................................................. 45
cefaclor ..................................................... 11         CHLORAMPHENICOL SODIUM
cefaclor monohydrate ............................... 11                      SUCCINATE ........................................ 12
cefadroxil hemihydrate ............................. 11                   chlorhexidine gluconate ............................ 21
Cefadroxil Hemihydrate............................ 11                     chloroquine phosphate .............................. 30
cefadroxil monohydrate ............................ 11                    chlorothiazide ........................................... 42
cefazolin sodium........................................ 11               chlorpromazine hydrochloride.................. 52
cefdinir ...................................................... 11        chlorthalidone ........................................... 42
cefepime hydrochloride ............................. 11                   chlorzoxazone ........................................... 57
CEFIZOX IN DEXTROSE 5% ................ 11                                cholestyramine .......................................... 25
cefotaxime sodium ..................................... 11                ciclopirox .................................................. 22
Cefotetan ................................................... 12          ciclopirox olamine .................................... 22
CEFOTETAN ........................................... 12                  cilostazol ................................................... 31
cefotetan disodium .................................... 12                Ciloxan ...................................................... 20



                                                                     67
CILOXAN................................................. 20               Clinoril ........................................................ 7
cimetidine .................................................. 31          clobetasol propionate................................ 24
cimetidine hydrochloride .......................... 31                    CLODERM ............................................... 24
CIMZIA .................................................... 48            CLOLAR................................................... 26
Cipro ......................................................... 14        clomipramine hcl ...................................... 52
CIPRO HC ................................................ 20              clonidine hydrochloride ............................ 46
Cipro I.V. .................................................. 14          clotrimazole............................................... 22
Cipro I.V. in D5W .................................... 14                 clozapine ................................................... 53
Cipro XR ................................................... 14           CLOZAPINE ............................................ 53
CIPRODEX............................................... 20                Clozaril...................................................... 53
ciprofloxacin ............................................. 14            Cogentin .................................................... 29
ciprofloxacin and ciprofloxacin hcl .......... 14                         COGENTIN .............................................. 29
ciprofloxacin and dextrose (anhydrous) ... 14                             COGNEX .................................................. 50
ciprofloxacin hcl ................................. 14, 20                Colazal ...................................................... 23
cisplatin ..................................................... 26        Col-Benemid ............................................. 60
citalopram hydrobromide ......................... 52                      colchicine .................................................. 48
cladribine .................................................. 26          Colchicine ................................................. 48
Claforan..................................................... 11          colchicine and probenecid ........................ 60
CLAFORAN ............................................. 12                 Colestid ..................................................... 25
CLARINEX .............................................. 56                COLESTID FLAVORED ......................... 25
CLARINEX REDITABS .......................... 56                           colestipol hydrochloride ........................... 25
CLARINEX-D 12 HOUR ......................... 56                           colistimethate sodium................................ 11
CLARINEX-D 24 HOUR ......................... 56                           Coly-mycin-m ........................................... 11
clarithromycin ........................................... 12             COLY-MYCIN-S ..................................... 20
Claritin ...................................................... 56        Colyte ........................................................ 39
Claritin-D .................................................. 57          COMBIGAN ............................................. 19
clemastine fumarate .................................. 44                 COMBIPATCH ........................................ 43
Cleocin ................................................ 11, 21           COMBIVENT ........................................... 59
Cleocin Phosphate..................................... 11                 COMBIVIR............................................... 32
Climara...................................................... 43          Combunox ................................................... 8
CLIMARA ................................................ 43               Compazine ................................................ 18
CLIMARA PRO ....................................... 43                    COMTAN ................................................. 29
CLIMIMIX E 4.25%/DEXTROSE 5% .... 36                                      COMVAX ................................................. 60
clindamycin hydrochloride ....................... 11                      CONCERTA ............................................. 10
clindamycin phosphate........................ 11, 21                      Condylox ................................................... 58
CLINIMIX 2.75%/DEXTROSE 5% ........ 36                                    COPAXONE ............................................. 48
CLINIMIX 4.25%/DEXTROSE 5% ........ 36                                    Copegus..................................................... 33
CLINIMIX 5%/DEXTROSE 15% ........... 36                                   Cordarone .................................................. 39
CLINIMIX 5%/DEXTROSE 20% ........... 37                                   CORDRAN ............................................... 24
CLINIMIX 5%/DEXTROSE 25% ........... 37                                   CORDRAN SP.......................................... 24
CLINIMIX E 2.75%/DEXTROSE 10% ... 37                                      CORDRAN TAPE .................................... 24
CLINIMIX E 2.75%/DEXTROSE 5% ..... 37                                     Coreg ......................................................... 34
CLINIMIX E 5%/DEXTROSE 15% ........ 37                                    COREG CR............................................... 34
CLINIMIX E 5%/DEXTROSE 20% ........ 37                                    Corgard ..................................................... 34
CLINIMIX E 5%/DEXTROSE 25% ........ 37                                    Cortef .......................................................... 6
CLINIMIX E 5%/DEXTROSE 35% ........ 37                                    cortisone acetate ......................................... 6



                                                                     68
Cortisone Acetate ........................................ 6              DAPTACEL.............................................. 59
Cortisporin ................................................ 21           DARAPRIM ............................................. 30
CORTISPORIN-TC .................................. 20                      Darvocet-n 100............................................ 8
Corzide ...................................................... 34         Darvon......................................................... 9
COSMEGEN............................................. 26                  daunorubicin hydrochloride ..................... 27
COSOPT ................................................... 19             DAUNOXOME ........................................ 27
Coumadin .................................................. 31            Daypro......................................................... 7
COUMADIN............................................. 30                  DDAVP ..................................................... 50
COZAAR .................................................. 54              Decadron ..................................................... 6
CREON 5 ................................................. 41              DECAVAC ............................................... 60
CREON 10 ................................................ 41              Declomycin ............................................... 14
CREON 20 ................................................ 41              Delatestryl ................................................... 9
CRESTOR................................................. 25               Delestrogen ............................................... 43
CRIXIVAN ............................................... 32               DELESTROGEN ...................................... 43
cromolyn sodium ....................................... 24                Demadex ................................................... 42
Cromolyn Sodium ..................................... 24                  demeclocycline hydrochloride .................. 14
CUBICIN .................................................. 11             Demerol....................................................... 9
CUPRIMINE............................................. 45                 DEMEROL ................................................. 8
Cutivate ..................................................... 24         Demulen 1/35-28 ...................................... 40
CUTIVATE............................................... 24                DENAVIR................................................. 22
cyclobenzaprine hydrochloride................. 57                         Depacon .................................................... 15
Cyclocort ................................................... 24          Depakene................................................... 15
cyclophosphamide ..................................... 26                 Depakote ................................................... 15
cyclosporine .............................................. 48            DEPAKOTE ............................................. 15
CYCLOSPORINE MODIFIED ................ 48                                 DEPAKOTE ER ....................................... 15
CYKLOKAPRON .................................... 20                       DEPAKOTE SPRINKLES ....................... 15
CYMBALTA ............................................ 52                  DEPEN TITRATABS ............................... 45
cyproheptadine hydrochloride .................. 44                        DEPO-ESTRADIOL................................. 43
CYSTADANE .......................................... 48                   Depo-medrol ............................................... 6
CYSTAGON ............................................. 48                 DEPO-MEDROL ........................................ 6
cytarabine ................................................. 27           DEPO-PROVERA .................................... 51
CYTOMEL ............................................... 59                DEPO-SUBQ PROVERA 104 ................. 51
Cytosar-U .................................................. 27           Depo-testosterone ....................................... 9
Cytotec ...................................................... 31         Dermatop................................................... 24
Cytovene ................................................... 33           DERMOTIC .............................................. 23
CYTOVENE ............................................. 33                 desipramine hydrochloride ....................... 52
Cytoxan ..................................................... 26          desmopressin acetate ................................ 50
D.H.E. 45 .................................................. 58           desogestrel and ethinyl estradiol .............. 40
dacarbazine ............................................... 27            desonide .................................................... 24
DACARBAZINE ...................................... 27                     Desowen .................................................... 24
DACOGEN ............................................... 27                desoximetasone ......................................... 24
danazol ........................................................ 9        Desyrel ...................................................... 52
Danocrine .................................................... 9          DETROL ................................................... 45
Dantrium ................................................... 57           DETROL LA ............................................ 45
dantrolene sodium..................................... 57                 dexamethasone ............................................ 6
DAPSONE ................................................ 26



                                                                     69
dexamethasone and neomycin sulfate and                                       DILANTIN ............................................... 16
   polymyxin b sulfate ............................... 20                    DILANTIN INFATABS ........................... 16
dexamethasone sodium phosphate ............ 23                               Dilaudid....................................................... 8
Dexamethasone Sodium Phosphate .......... 23                                 DILAUDID-HP........................................... 8
dexchlorpheniramine maleate................... 45                            DILTIAZEM HCL .................................... 34
Dexchlorpheniramine Maleate .................. 45                            diltiazem hydrochloride ............................ 34
Dexedrine .................................................. 10              DIOVAN ................................................... 54
dexmethylphenidate hydrochloride ........... 10                              DIOVAN HCT .......................................... 54
dexrazoxane .............................................. 48                DIPENTUM .............................................. 23
dextroamphetamine sulfate ....................... 10                         diphenhydramine hydrochloride ............... 44
DEXTROSE 5%/ELECTROLYTE #48                                                  dipivefrin hydrochloride ........................... 49
   VIAFLEX ............................................. 55                  Diprolene................................................... 24
DEXTROSE 5%/ELECTROLYTE #75                                                  DIPTHERIA/TETANUS
   VIAFLEX ............................................. 55                     TOXOIDPEDIATRIC .......................... 60
dextrose (anhydrous) ................................ 37                     dipyridamole ............................................. 61
dextrose (anhydrous) and fluconazole ...... 18                               disopyramide phosphate ........................... 39
dextrose (anhydrous) and heparin sodium                                      Ditropan .................................................... 45
   (porcine)................................................ 30              Diuril ......................................................... 42
dextrose (anhydrous) and potassium                                           divalproex sodium ..................................... 15
   chloride ................................................. 55             DIVIGEL .................................................. 43
dextrose (anhydrous) and potassium                                           Dolobid ....................................................... 7
   chloride and sodium chloride ............... 55                           Dolophine.................................................... 9
dextrose (anhydrous) and sodium chloride37                                   Domeboro ................................................. 21
Dextrose 2.5% ........................................... 55                 DORIBAX ................................................ 12
Dextrose 25% ............................................ 37                 DORYX .................................................... 14
Dextrose 5%/sodium Chlori ...................... 37                          Dostinex .................................................... 29
Dextrose anhydrous and Potassium Chloride                                    Dovonex .................................................... 58
   ............................................................... 55        DOVONEX ............................................... 58
DIABETIC SUPPLIES, MISC ........... 41, 50                                   doxazosin mesylate...................................... 7
Diamox ...................................................... 19             doxepin hydrochloride .............................. 52
DIBENZYLINE ........................................ 58                      DOXIL ...................................................... 27
diclofenac potassium................................... 7                    doxorubicin hydrochloride........................ 27
diclofenac sodium ................................. 7, 23                    doxycycline hyclate ............................. 14, 21
dicloxacillin sodium .................................. 13                   Doxycycline Hyclate ................................. 14
didanosine ................................................. 32              doxycycline monohydrate.......................... 14
Didronel .................................................... 48             dronabinol ................................................. 18
DIFFERIN................................................. 58                 drospirenone and ethinyl estradiol ........... 40
diflorasone diacetate................................. 24                    DROXIA ................................................... 27
Diflucan..................................................... 19             DTIC-Dome .............................................. 27
Diflucan in Iso-osmotic D......................... 18                        DUETACT ................................................ 18
Diflucan in NaCl ....................................... 19                  Duragesic .................................................... 8
diflunisal ..................................................... 7           Duricef ...................................................... 11
digoxin....................................................... 39            Dyazide ..................................................... 42
DIGOXIN ................................................. 39                 Dynacirc .................................................... 35
dihydroergotamine mesylate ..................... 58                          DYNACIRC CR ....................................... 35
Dilantin ..................................................... 16            DYNACIRC-CR ....................................... 35



                                                                        70
Dynapen .................................................... 13             ERAXIS .................................................... 19
DYRENIUM ............................................. 42                   ERBITUX ................................................. 27
E.E.S. 400 ................................................. 12             ERGOMAR............................................... 58
econazole nitrate ....................................... 22                ergot alkaloids, hydrogenated (mesylate) . 58
Effexor ...................................................... 52           Ergot Alkaloids, Hydrogenated mesylate . 58
EFFEXOR XR .......................................... 52                    Eryc ........................................................... 12
Efudex ....................................................... 58           Erygel ........................................................ 22
EFUDEX OCCLUSION PACK ............... 58                                    ERYTHROCIN ......................................... 12
ELAPRASE .............................................. 43                  ERYTHROCIN LACTOBIONATE ......... 12
Elavil ......................................................... 51         ERYTHROCIN STEARATE ................... 12
Eldepryl ..................................................... 30           erythromycin ................................. 12, 21, 22
ELESTRIN ................................................ 43                erythromycin and sulfisoxazole................. 12
ELIDEL..................................................... 58              ERYTHROMYCIN ETHYLSUCCINATE
ELIGARD ................................................. 27                   ............................................................... 12
Elimite ....................................................... 23          ERYTHROMYCIN LACTOBIONATE .. 12
ELITEK..................................................... 43              ESTRACE ................................................. 43
Ellence....................................................... 27           ESTRADERM .......................................... 43
ELMIRON ................................................ 48                 estradiol .................................................... 43
Elocon ....................................................... 24           estradiol and norethindrone acetate ......... 43
ELOXATIN .............................................. 27                  estradiol valerate ...................................... 43
ELSPAR .................................................... 27              ESTRASORB ........................................... 44
EMCYT..................................................... 27               ESTRING .................................................. 44
EMEND .................................................... 18               ESTROGEL .............................................. 44
EMLA ....................................................... 30             estropipate................................................. 44
EMSAM .................................................... 30               ethambutol hydrochloride ......................... 26
EMTRIVA ................................................ 32                 ethinyl estradiol and ethynodiol diacetate 40
enalapril maleate ...................................... 54                 ethinyl estradiol and ferrous fumarate and
enalapril maleate and hydrochlorothiazide                                      norethindrone acetate ........................... 40
  ............................................................... 54        ethinyl estradiol and levonorgestrel ......... 40
ENBREL ................................................... 48               ethinyl estradiol and norethindrone.......... 40
ENBREL SURECLICK ............................ 48                            ethinyl estradiol and norethindrone acetate
Enduron ..................................................... 42               ............................................................... 40
ENGERIX-B ............................................. 60                  ethinyl estradiol and norgestimate............ 40
ENTOCORT EC ......................................... 6                     ethinyl estradiol and norgestrel ................ 40
Enulose........................................................ 7           ethosuximide ............................................. 16
ENZYMAX............................................... 41                   Ethyol ........................................................ 47
epinephrine hydrochloride ........................ 59                       ETHYOL................................................... 48
EPIPEN 2-PAK ......................................... 59                   etidronate disodium .................................. 48
EPIPEN-JR 2-PAK ................................... 59                      etodolac ....................................................... 7
epirubicin hcl ............................................ 27              ETOPOPHOS ........................................... 27
EPIVIR ...................................................... 32            etoposide ................................................... 27
EPIVIR HBV ............................................ 32                  Eulexin ...................................................... 27
eplerenone ................................................. 54             EURAX ..................................................... 22
EPOGEN ................................................... 46               EVAMIST ................................................. 44
EPZICOM ................................................. 32                EVISTA .................................................... 43
EQUAGESIC .............................................. 7                  EVOXAC .................................................. 50



                                                                       71
EXELDERM ............................................. 22                  fludarabine phosphate .............................. 27
EXELON................................................... 50               fludrocortisone acetate ............................... 6
EXFORGE ................................................ 35                Flumadine ................................................. 32
EXJADE ................................................... 45              FLUMADINE ........................................... 32
EXTINA .................................................... 22             flunisolide.................................................. 23
FABRAZYME .......................................... 43                    fluocinolone acetonide .............................. 24
FACTIVE .................................................. 14              fluocinonide............................................... 24
famciclovir ................................................ 33            fluorometholone ........................................ 23
famotidine ................................................. 31            FLUOROPLEX......................................... 58
famotidine and sodium chloride................ 31                          fluorouracil ......................................... 27, 58
Famvir ....................................................... 33          fluoxetine hcl ............................................. 52
FANSIDAR............................................... 30                 fluoxymesterone .......................................... 9
FARESTON .............................................. 27                 fluphenazine decanoate ............................. 53
FASLODEX .............................................. 27                 fluphenazine hydrochloride ...................... 53
FAZACLO ................................................ 53                flurbiprofen ................................................. 7
FELBATOL .............................................. 15                 flurbiprofen sodium................................... 23
Feldene ........................................................ 7         flutamide ................................................... 27
felodipine................................................... 35           fluticasone propionate ........................ 23, 24
FEMARA .................................................. 27               fluvoxamine maleate ................................. 52
FEMHRT 1/5 ............................................ 44                 FML Liquifilm .......................................... 23
FEMHRT LOW DOSE ............................. 44                           Focalin....................................................... 10
FEMRING................................................. 44                FOCALIN XR ........................................... 10
FEMTRACE ............................................. 44                  fomepizole (4-methylpyrazole) .................. 48
fenofibrate ................................................. 25           FORADIL AEROLIZER .......................... 59
fenoprofen calcium...................................... 7                 Fortaz ........................................................ 11
fentanyl ........................................................ 8        FORTAZ ................................................... 12
fentanyl citrate ............................................ 8            FORTEO ................................................... 50
FENTORA .................................................. 8               FORTICAL ............................................... 50
finasteride ................................................. 48           Fosamax .................................................... 47
Fioricet/codeine........................................... 8              FOSAMAX ............................................... 48
Fiorinal/codeine #3 ..................................... 8                FOSAMAX PLUS D ................................ 48
Flagyl ........................................................ 30         foscarnet sodium ....................................... 32
Flagyl IV ................................................... 30           Foscavir ..................................................... 32
flavoxate hydrochloride ............................ 45                    fosinopril sodium ...................................... 54
FLEBOGAMMA ...................................... 57                       fosinopril sodium and hydrochlorothiazide
flecainide acetate ...................................... 39                  ............................................................... 54
FLECTOR ................................................. 58               fosphenytoin sodium.................................. 16
Flexeril ...................................................... 57         FOSRENOL .............................................. 46
FLOMAX .................................................. 48               FRAGMIN ................................................ 30
Flonase ...................................................... 23          FREAMINE HBC 6.9%............................ 37
Florinef ........................................................ 6        FREAMINE III 3% ................................... 37
FLOVENT HFA ......................................... 6                    FROVA ..................................................... 25
Floxin ........................................................ 14         FURADANTIN......................................... 60
fluconazole ................................................ 19            furosemide ................................................. 42
fluconazole and sodium chloride .............. 19                          FUZEON ................................................... 32
Fludara ...................................................... 27          gabapentin................................................. 15



                                                                      72
GABITRIL ................................................ 15                 GYNODIOL ............................................. 44
galantamine hydrobromide ....................... 50                          Haldol ........................................................ 53
GAMASTAN S/D..................................... 57                         HALDOL .................................................. 53
GAMMAGARD LIQUID......................... 57                                 Haldol Decanoate ...................................... 53
GAMUNEX .............................................. 57                    HALDOL DECANOATE-100 ................. 53
ganciclovir ................................................ 33              HALDOL DECANOATE-50 ................... 53
GANTRISIN PEDIATRIC ....................... 14                               halobetasol propionate ............................. 24
Garamycin ................................................. 21               haloperidol ................................................ 53
GARDASIL .............................................. 60                   haloperidol decanoate .............................. 53
GASTROCROM ....................................... 24                        haloperidol lactate .................................... 53
gemfibrozil ................................................ 25              Haloperidol Lactate ................................... 53
GEMZAR .................................................. 27                 Halotestin .................................................... 9
GENOTROPIN ......................................... 50                      HAVRIX ................................................... 60
GENOTROPIN MINIQUICK .................. 50                                   HECTOROL ............................................. 62
gentamicin sulfate ............................... 21, 22                    HEPARIN SODIUM ................................ 31
Gentamicin Sulfate.................................... 22                    heparin sodium (porcine).......................... 30
gentamicin sulfate and sodium chloride ... 10                                heparin sodium (porcine) and sodium
Gentamicin Sulfate/sodium ....................... 10                           chloride ................................................. 30
GEODON .................................................. 53                 Heparin Sodium porcine ........................... 30
GLEEVEC ................................................ 27                  Heparin Sodium porcine and Sodium
glimepiride ................................................ 17                Chloride................................................. 30
glipizide ..................................................... 17           Heparin Sodium/D5W .............................. 30
glipizide and metformin hydrochloride..... 17                                HEPARIN SODIUM/NACL 0.45% ......... 31
GLUCAGEN HYPOKIT .......................... 20                               HEPATASOL ........................................... 37
GLUCAGON EMERGENCY KIT........... 20                                         HEPSERA ................................................. 33
Glucophage ............................................... 16                HERCEPTIN............................................. 27
Glucotrol ................................................... 17             HEXALEN ................................................ 27
Glucovance ............................................... 17                HIBTITER ................................................ 60
glyburide ................................................... 17             Hiprex ....................................................... 60
glyburide and metformin hydrochloride ... 17                                 HUMALOG .............................................. 16
glycerin and phospholipids and soybean oil                                   HUMALOG MIX 50/50 ........................... 16
   ............................................................... 37        HUMALOG MIX 50/50 PEN................... 16
glycopyrrolate ........................................... 15                HUMALOG MIX 75/25 ........................... 16
GLYSET ................................................... 16                HUMALOG MIX 75/25 PEN................... 16
gonadotropin, chorionic ........................... 45                       HUMALOG PEN...................................... 16
gramicidin and neomycin sulfate and                                          Humatin..................................................... 30
   polymyxin b sulfate ............................... 21                    HUMATROPE.......................................... 50
granisetron hcl .......................................... 18                HUMATROPE COMBO PACK .............. 51
Grifulvin V ................................................ 18              HUMIRA .................................................. 48
griseofulvin ............................................... 18              HUMIRA PEN .......................................... 48
GRIS-PEG................................................. 18                 HUMIRA PEN-CROHNS DISEASE ....... 48
guanabenz acetate ..................................... 46                   HUMULIN 50/50...................................... 16
guanfacine hcl ........................................... 46                HUMULIN 70/30...................................... 16
guanidine hydrochloride ........................... 50                       HUMULIN 70/30 PEN ............................. 16
Guanidine Hydrochloride.......................... 50                         HUMULIN N ............................................ 16
GYNAZOLE-1 ......................................... 22                      HUMULIN N U-100 PEN ........................ 16



                                                                        73
HUMULIN R ............................................ 16                    IMITREX STATDOSE REFILL .............. 25
HYCAMTIN ............................................. 27                    Imodium .................................................... 18
hydralazine hydrochloride ........................ 46                        IMOVAX RABIES H.D.C.V.................... 60
Hydrea ....................................................... 27            Imuran ....................................................... 47
hydrochlorothiazide .................................. 42                    INCRELEX ............................................... 58
hydrochlorothiazide and lisinopril ........... 54                            indapamide................................................ 42
hydrochlorothiazide and metoprolol tartrate                                  Inderal LA ................................................. 34
   ............................................................... 34        Inderide ..................................................... 34
hydrochlorothiazide and moexipril                                            Indocin ........................................................ 7
   hydrochloride ........................................ 54                 indomethacin ............................................... 7
hydrochlorothiazide and propranolol                                          INFANRIX ............................................... 60
   hydrochloride ........................................ 34                 INFERGEN ............................................... 33
hydrochlorothiazide and quinapril hcl ..... 54                               INNOHEP ................................................. 31
hydrochlorothiazide and spironolactone .. 54                                 INNOPRAN XL........................................ 34
hydrochlorothiazide and triamterene ....... 42                               Inspra......................................................... 54
hydrocodone bitartrate and ibuprofen ........ 8                              INSPRA .................................................... 54
hydrocortisone ...................................... 6, 24                  INTAL INHALER .................................... 24
hydrocortisone acetate and urea                                              INTELENCE............................................. 32
   (carbamide) ........................................... 24                INTRON-A ............................................... 33
hydrocortisone and neomycin sulfate and                                      INTRON-A W/DILUENT ........................ 33
   polymyxin b sulfate ............................... 21                    INVANZ ................................................... 13
hydrocortisone butyrate ............................ 24                      INVEGA ................................................... 53
hydrocortisone sodium succinate ................ 6                           INVERSINE ............................................. 46
hydrocortisone valerate ............................ 24                      INVIRASE ................................................ 32
hydromorphone hydrochloride ................... 8                            IONOSOL-B/DEXTROSE 5%................. 55
hydroxychloroquine sulfate....................... 30                         IONOSOL-MB/DEXTROSE 5% ............. 55
hydroxyurea .............................................. 27                IONOSOL-T/DEXTROSE 5% ................. 55
hydroxyzine hydrochloride........................ 33                         IOPIDINE ................................................. 42
hydroxyzine pamoate ................................ 33                      IPLEX ....................................................... 58
Hygroton ................................................... 42              IPOL INACTIVATED IPV ...................... 60
Hytone ....................................................... 24            ipratropium bromide ................................. 42
Hytrin .......................................................... 7          IQUIX ....................................................... 21
HYZAAR .................................................. 54                 IRESSA ..................................................... 27
ibuprofen ..................................................... 7            irinotecan hydrochloride .......................... 27
ibuprofen and oxycodone hydrochloride .... 8                                 ISENTRESS .............................................. 32
Idamycin ................................................... 27              ISOLYTE-H/DEXTROSE 5% ................. 55
idarubicin hcl ............................................ 27               ISOLYTE-P/DEXTROSE 5% .................. 55
Ifex ............................................................ 27         ISOLYTE-S .............................................. 55
Ifex/mesnex Combo Pack ......................... 27                          ISOLYTE-S PH 7.4 .................................. 56
ifosfamide .................................................. 27             ISOLYTE-S/DEXTROSE 5% .................. 56
IFOSFAMIDE........................................... 27                     isoniazid .................................................... 26
ifosfamide and mesna................................ 27                      Isoniazid .................................................... 26
Imdur ......................................................... 61           isoniazid and rifampin .............................. 26
imipramine hydrochloride ........................ 52                         isopropyl alcohol pad ............................... 22
imipramine pamoate ................................. 52                      Isopropyl Alcohol Pad .............................. 22
IMITREX .................................................. 25                Isordil ........................................................ 61



                                                                        74
isosorbide dinitrate ................................... 61                LAMICTAL STARTER/TAKING
isosorbide mononitrate ............................. 61                       CARBAMAZEPINE/NOT TAKING
isotretinoin ................................................ 58              VALPROATE ....................................... 15
isradipine .................................................. 35           LAMICTAL STARTER/TAKING
ISTALOL .................................................. 19                 VALPROATE ....................................... 15
itraconazole............................................... 19             Lamisil ...................................................... 18
IVEEGAM EN .......................................... 57                   LAMISIL .................................................. 22
IXEMPRA KIT ......................................... 27                   lamotrigine ................................................ 15
JANUMET ................................................ 16                Lanoxin ..................................................... 39
JANUVIA ................................................. 16               LANOXIN ................................................ 39
JE-VAX..................................................... 61             LANTUS ................................................... 17
KADIAN ..................................................... 8             LANTUS SOLOSTAR ............................. 17
KALETRA ................................................ 32                Lariam ....................................................... 30
kanamycin sulfate...................................... 10                 Lasix .......................................................... 42
Kantrex ...................................................... 10          leflunomide................................................ 48
Kayexalate................................................. 47             LESCOL ................................................... 25
Kcl 0.075%/d5w/nacl 0.45% .................... 55                          LESCOL XL ............................................. 25
K-Dur ........................................................ 56          LETAIRIS ................................................. 61
Keflex ........................................................ 12         leucovorin calcium .................................... 48
KEMADRIN ............................................. 29                  Leucovorin Calcium.................................. 48
Kenalog ..................................................... 24           LEUKERAN ............................................. 27
KENALOG ............................................... 24                 LEUKINE ................................................. 46
KEPIVANCE ............................................ 39                  leuprolide acetate...................................... 27
KEPPRA ................................................... 15              Leustatin .................................................... 26
Kerlone ...................................................... 34          LEVAQUIN .............................................. 14
KETEK ..................................................... 12             LEVAQUIN LEVA-PAK ......................... 14
ketoconazole ........................................ 19, 22               LEVAQUIN PREMIX .............................. 14
ketoprofen ................................................... 7           LEVEMIR ................................................. 17
ketorolac tromethamine .............................. 7                    LEVEMIR FLEXPEN .............................. 17
ketotifen fumarate ..................................... 10                levobunolol hydrochloride ........................ 19
KINERET ................................................. 48               levocarnitine ............................................. 48
Klaron ....................................................... 22          levorphanol tartrate .................................... 8
KUVAN .................................................... 48              Levorphanol Tartrate .................................. 8
KU-ZYME HP .......................................... 41                   levothyroxine sodium ................................ 59
Kytril ......................................................... 18        LEXAPRO ................................................ 52
labetalol hydrochloride............................. 34                    LEXIVA .................................................... 32
Lac-hydrin ................................................. 42            LEXXEL ................................................... 54
LACRISERT ............................................. 42                 LIALDA .................................................... 23
LACTATED RINGER'S IRRIGATION .. 47                                         Lidex ......................................................... 24
lactic acid .................................................. 42          lidocaine and prilocaine ........................... 30
lactulose ...................................................... 7         Lidocaine HCl ........................................... 39
Lamictal .................................................... 15           lidocaine hydrochloride ................ 30, 39, 47
LAMICTAL STARTER/NOT TAKING                                                LIDODERM ............................................. 30
   CARBAMAZEPINE............................. 15                           Limbitrol ................................................... 51
                                                                           lindane....................................................... 22
                                                                           Lindane ..................................................... 22



                                                                      75
Lioresal ..................................................... 57          LUPRON DEPOT ..................................... 28
liothyronine sodium .................................. 59                  LUPRON DEPOT-PED ............................ 28
LIPITOR ................................................... 25             Luvox ........................................................ 52
Liposyn III ................................................ 37            LUVOX CR .............................................. 52
LIQUADD ................................................ 10                LYRICA .................................................... 15
lisinopril .................................................... 54         LYSODREN ............................................. 28
lithium carbonate ...................................... 25                Macrobid ................................................... 60
lithium citrate ............................................ 25            Macrodantin .............................................. 60
Lithium Citrate .......................................... 25              Magnesium Sulfate Abbojec ..................... 15
Lithobid ..................................................... 25          magnesium sulfate, heptahydrate.............. 15
LITHOSTAT............................................... 7                 MALARONE ............................................ 30
Locoid ....................................................... 24          maprotiline hydrochloride ........................ 52
Lodine ......................................................... 7         Marinol ...................................................... 18
LODOSYN ............................................... 29                 MARPLAN ............................................... 52
Loestrin 1/20-21 ........................................ 40               MATULANE ............................................ 28
Loestrin Fe 1/20 ........................................ 40               Mavik ........................................................ 54
Lofibra....................................................... 25          MAXAIR AUTOHALER ......................... 59
Lomotil ...................................................... 18          MAXALT ................................................. 25
Loniten ...................................................... 46          MAXALT-MLT ........................................ 25
loperamide hydrochloride......................... 18                       Maxipime .................................................. 11
Lopid ......................................................... 25         MAXIPIME .............................................. 12
Lopressor................................................... 34            Maxitrol..................................................... 20
Lopressor HCT.......................................... 34                 mebendazole .............................................. 10
Loprox ....................................................... 22          meclizine hydrochloride ............................ 18
LOPROX SHAMPOO .............................. 22                           meclofenamate sodium ................................ 7
loratadine .................................................. 56           Meclomen ................................................... 7
loratadine and pseudoephedrine                                             Medrol ......................................................... 6
   hydrochloride ........................................ 57               medroxyprogesterone acetate ................... 51
loratadine and pseudoephedrine sulfate ... 57                              mefloquine hcl ........................................... 30
LOTEMAX ............................................... 23                 Mefoxin ..................................................... 12
Lotensin..................................................... 54           Megace ...................................................... 28
Lotensin HCT............................................ 54                MEGACE ES ............................................ 28
Lotrel ......................................................... 35        megestrol acetate ...................................... 28
LOTREL ................................................... 35              Mellaril ...................................................... 53
Lotrisone ................................................... 22           meloxicam ................................................... 7
LOTRONEX ............................................. 45                  MENACTRA ............................................ 61
lovastatin ................................................... 25          MENEST................................................... 44
LOVAZA .................................................. 25               MENOMUNE-A/C/Y/W-135 ................... 61
LOVENOX ............................................... 31                 MENOSTAR............................................. 44
loxapine succinate ..................................... 53                MEPERIDINE HCL ................................... 9
Loxitane .................................................... 53           meperidine hydrochloride ........................... 9
Lozol ......................................................... 42         meprobamate............................................. 33
Ludiomil .................................................... 52           MEPRON .................................................. 30
LUMIGAN ................................................ 42                mercaptopurine ......................................... 28
LUNESTA ................................................ 33                MERREM ................................................. 13
Lupron ....................................................... 27          MERUVAX II W/DILUENT 10 DOSE ... 61



                                                                      76
mesalamine (5-asa) ................................... 23                 Micronase .................................................. 17
mesna ........................................................ 48         Microzide .................................................. 42
Mesnex ...................................................... 48          Midamor.................................................... 42
MESNEX .................................................. 48              midodrine hcl ............................................ 59
Mestinon ................................................... 50           MIGRANAL ............................................. 58
MESTINON .............................................. 50                Miltown ..................................................... 33
MESTINON TIMESPAN ......................... 50                            Minipress..................................................... 7
mestranol and norethindrone.................... 40                        Minocin ..................................................... 14
METADATE CD ...................................... 10                     minocycline hydrochloride........................ 14
Metaglip .................................................... 17          minoxidil ................................................... 46
metaproterenol sulfate .............................. 59                  MINTEZOL .............................................. 10
metformin hydrochloride .......................... 16                     Miralax ...................................................... 39
methadone hydrochloride ........................... 9                     MIRAPEX................................................. 29
Methadone Hydrochloride .......................... 9                      mirtazapine ............................................... 52
methazolamide .......................................... 19               misoprostol................................................ 31
methenamine hippurate ............................. 60                    mitomycin c ............................................... 28
METHERGINE......................................... 50                    mitoxantrone hydrochloride...................... 28
methimazole .............................................. 59             M-M-R II W/DILUENT 10 DOS ............. 61
METHITEST .............................................. 9                MOBAN .................................................... 53
methocarbamol ......................................... 57                Mobic .......................................................... 7
methotrexate .............................................. 28            Moduretic 5-50.......................................... 42
Methotrexate ............................................. 28             moexipril hydrochloride............................ 54
methotrexate sodium ................................. 28                  mometasone furoate .................................. 24
methscopolamine bromide ........................ 15                       Monistat 3 ................................................. 22
methyclothiazide ....................................... 42               Monopril ................................................... 54
METHYLIN .............................................. 10                Monopril HCT .......................................... 54
methylphenidate hydrochloride ................ 10                         MONUROL .............................................. 60
methylprednisolone ..................................... 6                morphine sulfate.......................................... 9
methylprednisolone acetate ........................ 6                     MORPHINE SULFATE ............................. 9
methylprednisolone sodium succinate ........ 6                            MOTOFEN ............................................... 18
metipranolol .............................................. 19            Motrin ......................................................... 7
metoclopramide hydrochloride ................. 51                         MS Contin ................................................... 9
metolazone ................................................ 42            Mucomyst ................................................. 49
metoprolol succinate ................................. 34                 mupirocin .................................................. 22
metoprolol tartrate .................................... 34               MUSTARGEN.......................................... 28
Metrogel .................................................... 22          Mutamycin ................................................ 28
Metrogel Vaginal ...................................... 22                Myambutol ................................................ 26
metronidazole...................................... 22, 30                Mycelex..................................................... 22
metronidazole and sodium chloride .......... 30                           MYCOBUTIN .......................................... 26
Mevacor .................................................... 25           Mycolog II ................................................ 22
mexiletine hydrochloride .......................... 39                    Mycostatin........................................... 19, 22
Mexitil ....................................................... 39        Mydriacyl .................................................. 49
MIACALCIN ............................................ 50                 MYFORTIC .............................................. 48
MICARDIS ............................................... 54               MYLOTARG ............................................ 28
MICARDIS HCT ...................................... 54                    MYOBLOC............................................... 48
miconazole nitrate..................................... 22                MYOZYME .............................................. 43



                                                                     77
Mysoline ................................................... 16           NIASPAN ................................................. 25
MYTELASE ............................................. 50                 nicardipine hcl .......................................... 35
nabumetone ................................................. 7            nicotine...................................................... 34
nadolol ...................................................... 34         Nicotine Patch ........................................... 34
nafcillin sodium......................................... 13              NICOTROL INHALER ............................ 34
NAFTIN .................................................... 22            NICOTROL NS ........................................ 34
NAFTIN-MP ............................................. 22                nifedipine................................................... 35
NAGLAZYME ......................................... 43                    NILANDRON ........................................... 28
Nalfon ......................................................... 7        nimodipine................................................. 35
NALLPEN ISO-OSMOTIC IN                                                    Nimotop .................................................... 35
  DEXTROSE.......................................... 13                   Nipent ........................................................ 28
NALLPEN/DEXTROSE .......................... 13                            nisoldipine ................................................. 35
NALOXONE HCL ................................... 49                       Nitro-dur ................................................... 61
naltrexone hydrochloride .......................... 50                    nitrofurantoin macrocrystalline ................ 60
NAMENDA .............................................. 40                 nitrofurantoin monohydrate macrocrystals
NAMENDA TITRATION PAK ............... 40                                     ............................................................... 60
naphazoline hydrochloride ....................... 61                      nitroglycerin.............................................. 61
Naprosyn ..................................................... 7          NITROLINGUAL PUMPSPRAY ............ 61
naproxen ..................................................... 7          NITROSTAT ............................................ 61
naproxen sodium ......................................... 7               nizatidine ................................................... 31
NARDIL ................................................... 52             Nizoral................................................. 19, 22
NASACORT AQ ...................................... 23                     Nolvadex ................................................... 28
Nasarel ...................................................... 23         NORDITROPIN CARTRIDGE ............... 51
NASONEX ............................................... 23                NORDITROPIN NORDIFLEX PEN ....... 51
NATACYN ............................................... 21                norethindrone............................................ 40
Navane ...................................................... 53          norethindrone acetate ............................... 51
NAVANE .................................................. 53              Norinyl 1+50 ............................................. 40
Navelbine .................................................. 29           NORMOSOL-R ........................................ 56
Nebcin ....................................................... 11         NOROXIN ................................................ 14
nefazodone hydrochloride......................... 52                      Norpace ..................................................... 39
neomycin sulfate........................................ 11               Norpramin ................................................. 52
Neomycin Sulfate...................................... 11                 nortriptyline hydrochloride....................... 52
neomycin sulfate and polymyxin b sulfate 22                               Norvasc ..................................................... 35
Neoral ........................................................ 48        NORVIR ................................................... 32
Neosporin ............................................ 20, 21             Novantrone ................................................ 28
Neosporin Gu Irrigant ............................... 22                  NOVOLIN 70/30 ...................................... 17
NEPHRAMINE ........................................ 37                    NOVOLIN 70/30 INNOLET .................... 17
Neptazane .................................................. 19           NOVOLIN 70/30 PENFILL ..................... 17
NEULASTA ............................................. 46                 NOVOLIN N ............................................ 17
NEUMEGA............................................... 48                 NOVOLIN N INNOLET .......................... 17
NEUPOGEN ............................................. 46                 NOVOLIN N U-100 PENFILL ................ 17
Neurontin .................................................. 15           NOVOLIN R ............................................. 17
NEURONTIN ........................................... 15                  NOVOLIN R INNOLET .......................... 17
NEUTREXIN ............................................ 30                 NOVOLIN R U-100 PENFILL ................ 17
NEVANAC ............................................... 23                NOVOLOG ............................................... 17
NEXAVAR ............................................... 28                NOVOLOG FLEXPEN ............................ 17



                                                                     78
NOVOLOG MIX 70/30 ............................ 17                          Ovral ......................................................... 40
NOVOLOG MIX 70/30 PENFILL ........... 17                                   OXACILLIN SODIUM ............................ 13
NOVOLOG MIX 70/30 PREFILLED                                                Oxandrin ..................................................... 9
   FLEXPEN ............................................. 17                oxandrolone ................................................ 9
NOVOLOG PENFILL .............................. 17                          oxaprozin..................................................... 7
NOXAFIL ................................................. 19               oxcarbazepine ........................................... 15
Nulytely..................................................... 39           OXSORALEN .......................................... 41
NUTROPIN .............................................. 51                 OXSORALEN ULTRA ............................ 41
NUTROPIN AQ........................................ 51                     oxybutynin chloride ................................... 45
NUTROPIN AQ PEN ............................... 51                         oxycodone hydrochloride ............................ 9
NUVARING ............................................. 40                  OXYTROL ............................................... 45
Nydrazid .................................................... 26           PACERONE ............................................. 39
nystatin ................................................ 19, 22           paclitaxel ................................................... 28
nystatin and triamcinolone acetonide ....... 22                            Pamelor ..................................................... 52
OCTAGAM .............................................. 57                  pamidronate disodium .............................. 49
octreotide acetate ...................................... 49               Pamine....................................................... 15
Ocufen ....................................................... 23          Pancrease MT 10....................................... 41
Ocuflox ..................................................... 21           PANCREASE MT 4 ................................. 41
Ocupress .................................................... 42           PANCRECARB MS-16 ............................ 41
ofloxacin.............................................. 14, 21             PANCRECARB MS-4 .............................. 42
Ogen .......................................................... 44         PANCRECARB MS-8 .............................. 42
Olux........................................................... 24         PANGLOBULIN NF ................................ 57
omeprazole ................................................ 31             Panlor SS..................................................... 8
OMNARIS ................................................ 23                PANRETIN ............................................... 58
Omnicef..................................................... 11            pantoprazole sodium sesquihydrate.......... 31
OMNITROPE ........................................... 51                   Parafon Forte DSC .................................... 57
ONCASPAR ............................................. 28                  Paraplatin .................................................. 26
Oncovin ..................................................... 29           Parlodel ..................................................... 29
ondansetron............................................... 18              Parnate....................................................... 52
ondansetron hcl ......................................... 18               paromomycin sulfate ................................. 30
ONTAK..................................................... 28              paroxetine hydrochloride .......................... 52
Optipranolol .............................................. 19             PASER ...................................................... 26
OPTIVAR ................................................. 10               PATADAY ............................................... 10
ORAMORPH SR ........................................ 9                     PATANASE.............................................. 10
ORAP ........................................................ 53           PATANOL ................................................ 10
ORENCIA ................................................. 49               Paxil .......................................................... 52
ORFADIN ................................................. 49               PAXIL CR ................................................ 52
Orinase ...................................................... 17          Pediapred..................................................... 6
ORTHO EVRA ......................................... 40                    PEDIARIX ................................................ 61
Ortho Micronor ......................................... 40                Pediatex ..................................................... 44
Ortho Tri-cyclen........................................ 40                Pediazole ................................................... 12
Ortho-cept-28 ............................................ 40              PEDIOTIC ................................................ 21
ORTHOCLONE OKT3 ............................ 49                            PEDVAX HIB .......................................... 61
Orudis .......................................................... 7        PEGANONE ............................................. 16
Ovcon-35/28 ............................................. 40               PEGASYS ................................................. 33
OVIDE ...................................................... 22            PEG-INTRON........................................... 33



                                                                      79
PEG-INTRON REDIPEN......................... 33                            Plaquenil ................................................... 30
PEG-INTRON REDIPEN PAK 4 ............. 33                                 PLASMA-LYTE 56 .................................. 56
penicillin g potassium ............................... 13                 PLASMA-LYTE A ................................... 56
Penicillin G Potassium .............................. 13                  PLASMA-LYTE-148 ............................... 56
PENICILLIN G POTASSIUM IN ISO-                                            PLASMA-LYTE-148/D5W...................... 56
   OSMOTIC DEXTROSE....................... 13                             PLASMA-LYTE-56/D5W........................ 56
PENICILLIN G PROCAINE.................... 13                              Platinol AQ ............................................... 26
penicillin g sodium .................................... 13               PLAVIX .................................................... 31
Penicillin G Sodium .................................. 13                 Plendil ....................................................... 35
penicillin v potassium ............................... 13                 Pletal ......................................................... 31
Penlac Nail Lacquer .................................. 22                 podofilox ................................................... 58
PENTASA................................................. 23               polyethylene glycol.................................... 39
pentostatin ................................................. 28          polyethylene glycol and potassium chloride
pentoxifylline ............................................. 46             and sodium bicarbonate and sodium
Pen-vee K .................................................. 13             chloride ................................................. 39
Pepcid ........................................................ 31        polyethylene glycol and potassium chloride
Pepcid IV .................................................. 31             and sodium bicarbonate and sodium
p-ephed hcl/cetirizine hcl .......................... 57                    chloride and sodium sul ........................ 39
p-ephed sul/loratadine .............................. 57                  POLYGAM S/D........................................ 57
Percocet ....................................................... 8        polymyxin b sulfate and trimethoprim sulfate
Periactin .................................................... 44           ............................................................... 21
Peridex ...................................................... 21         POLY-PRED............................................. 21
Periostat..................................................... 21         Polytrim..................................................... 21
permethrin ................................................. 23           potassium chloride .................................... 56
perphenazine ............................................. 53             Potassium Chloride 0.3%/n....................... 56
Persantine .................................................. 61          potassium chloride and sodium chloride .. 56
Phenergan .................................................. 44           potassium citrate ......................................... 7
phenylephrine hydrochloride and                                           PRANDIN ................................................. 17
   promethazine hydrochloride ................. 44                        Pravachol................................................... 25
Phenylephrine Hydrochloride and                                           pravastatin sodium .................................... 25
   Promethazine Hydrochloride ................ 44                         prazosin hydrochloride ............................... 7
PHENYTEK ............................................. 16                 Precose ...................................................... 16
phenytoin ................................................... 16          Pred Forte .................................................. 23
phenytoin sodium ...................................... 16                prednicarbate ............................................ 24
PHENYTOIN SODIUM ........................... 16                           prednisolone acetate ................................. 23
PHOSLO ................................................... 46             prednisolone anhydrous .............................. 6
PHOSPHOLINE IODIDE ........................ 20                            prednisolone sodium phosphate............ 6, 23
PHOTOFRIN ............................................ 28                 Prednisolone Sodium Phosphate ............... 23
pilocarpine hydrochloride ........................ 50                     prednisolone sodium phosphate and
PILOPINE HS ........................................... 20                  sulfacetamide sodium ............................ 21
pindolol ..................................................... 34         Prednisolone Sodium Phosphate and
piperacillin sodium ................................... 13                  Sulfacetamide Sodium .......................... 21
Piperacillin Sodium................................... 13                 prednisone ................................................... 6
PIPERACILLIN SODIUM ....................... 13                            PREDNISONE ............................................ 6
piroxicam .................................................... 7          PREDNISONE INTENSOL ....................... 6
PLAN B .................................................... 40            PREFEST .................................................. 44



                                                                     80
Pregnyl W/diluent Benzyl ......................... 45                       promethazine hydrochloride ..................... 44
Prelone ........................................................ 6          PROMETRIUM ........................................ 51
PREMARIN .............................................. 44                  PRONESTYL ........................................... 39
PREMARIN W/APPLICATOR ............... 44                                    propafenone hcl ........................................ 39
PREMASOL ............................................. 37                   proparacaine hydrochloride ..................... 47
PREMPHASE ........................................... 44                    Proparacaine Hydrochloride ..................... 47
PREMPRO ................................................ 44                 Propine ...................................................... 49
prenatal with folic acid (greater than .8mg)                                propoxyphene hydrochloride ...................... 9
  ............................................................... 49        propranolol hydrochloride........................ 34
Prenatal With Folic Acid Greater than .8mg                                  propylthiouracil ........................................ 59
  ............................................................... 49        Propylthiouracil......................................... 59
PREVACID............................................... 31                  PROQUAD ............................................... 61
PREVACID NAPRAPAC .......................... 7                              Proscar....................................................... 48
PREVACID SOLUTAB ........................... 31                             PROSOL ................................................... 37
PREVPAC................................................. 31                 Protonix ..................................................... 31
PREZISTA ................................................ 32                PROTONIX .............................................. 31
PRIFTIN ................................................... 26              PROTOPIC ............................................... 58
Prilosec...................................................... 31           Proventil .................................................... 59
PRIMAQUINE PHOSPHATE ................. 30                                   PROVENTIL HFA ................................... 59
PRIMAXIN I.M. ....................................... 13                    Provera ...................................................... 51
PRIMAXIN IV.......................................... 13                    PROVIGIL ................................................ 10
PRIMAXIN IV ADD-VANTAGE ........... 13                                      Prozac........................................................ 52
primidone .................................................. 16             Psorcon ...................................................... 24
PRIMSOL ................................................. 60                PULMICORT FLEXHALER ..................... 6
Principen ................................................... 13            Purinethol .................................................. 28
PRISTIQ ................................................... 52              PYLERA ................................................... 11
PROAIR HFA ........................................... 59                   pyrazinamide ............................................. 26
Proamatine ................................................ 59              Pyrazinamide............................................. 26
probenecid................................................. 60              pyridostigmine bromide ............................ 50
procainamide hydrochloride..................... 39                          QUALAQUIN........................................... 30
Procainamide Hydrochloride .................... 39                          Questran .................................................... 25
PROCALAMINE ...................................... 37                       quinapril hcl .............................................. 54
PROCANBID ........................................... 39                    quinidine gluconate................................... 39
Procardia XL ............................................. 35               Quinidine Gluconate ................................. 39
PROCHIEVE ............................................ 51                   QUINIDINE GLUCONATE .................... 39
prochlorperazine ....................................... 18                 quinidine sulfate ........................................ 39
prochlorperazine edisylate........................ 18                       Quinidine Sulfate ...................................... 39
prochlorperazine maleate ......................... 18                       QUIXIN .................................................... 21
PROCRIT .................................................. 46               QVAR ......................................................... 6
PROGLYCEM .......................................... 46                     RABAVERT ............................................. 61
PROGRAF ................................................ 49                 ramipril ..................................................... 54
PROLASTIN............................................. 43                   RANEXA .................................................. 39
PROLEUKIN ............................................ 28                   ranitidine hydrochloride ........................... 31
Prolixin...................................................... 53           RAPAMUNE ............................................ 49
Prolixin Decanoate .................................... 53                  RAPTIVA ................................................. 58
Proloprim .................................................. 60             Razadyne ................................................... 50



                                                                       81
RAZADYNE............................................. 50                  Risperdal ................................................... 53
RAZADYNE ER ...................................... 50                     RISPERDAL ............................................. 53
REBETOL................................................. 33               RISPERDAL CONSTA ............................ 53
REBIF ....................................................... 49          RISPERDAL M-TAB ............................... 53
REBIF TITRATION PACK ..................... 49                             risperidone ................................................ 53
RECOMBIVAX HB ................................. 61                        Ritalin........................................................ 10
Reglan ....................................................... 51         RITALIN LA ............................................ 10
REGONOL ............................................... 50                RITUXAN................................................. 28
REGRANEX ............................................. 58                 Robaxin ..................................................... 57
Relafen ........................................................ 7        ROBAXIN ................................................ 57
RELENZA DISKHALER ......................... 33                            Robinul...................................................... 15
RELION 70/30 .......................................... 17                Rocaltrol .................................................... 62
RELION 70/30 INNOLET ....................... 17                           Rocephin ................................................... 12
RELION N ................................................ 17              ROCEPHIN IN ISO-OSMOTIC
RELION N INNOLET .............................. 17                           DEXTROSE.......................................... 12
RELION R ................................................ 17              Romycin .................................................... 21
RELPAX ................................................... 25             ropinirole hydrochloride........................... 29
Remeron .................................................... 52           ROTATEQ ................................................ 61
REMICADE .............................................. 49                Rowasa ...................................................... 23
REMODULIN........................................... 61                   Roxicodone ................................................. 9
RENAGEL ................................................ 46               ROZEREM ............................................... 33
RENAMIN ................................................ 37               Rythmol..................................................... 39
RENVELA ................................................ 46               RYTHMOL SR ......................................... 39
Requip ....................................................... 29         SAIZEN .................................................... 51
REQUIP XL .............................................. 29               SAIZEN CLICK.EASY ............................ 51
RESCRIPTOR .......................................... 32                  Salagen ...................................................... 50
reserpine ................................................... 46          Sandostatin ................................................ 49
RESTASIS ................................................ 23              SANDOSTATIN LAR DEPOT................ 49
Retin-A...................................................... 39          SANTYL ................................................... 58
RETIN-A MICRO .................................... 39                     Seasonale................................................... 40
Retrovir ..................................................... 32         Sectral ....................................................... 34
RETROVIR IV INFUSION...................... 32                             selegiline hcl ............................................. 30
REVATIO ................................................. 61              selenium sulfide......................................... 22
Revia ......................................................... 50        Selsun Shampoo ........................................ 22
REVLIMID ............................................... 49               SELZENTRY ............................................ 32
REYATAZ ................................................ 32               SENSIPAR ................................................ 49
RHEUMATREX ....................................... 28                     SEREVENT DISKUS ............................... 59
RHINOCORT AQUA ............................... 23                         SEROMYCIN ........................................... 26
ribavirin .................................................... 33         SEROQUEL.............................................. 53
RIDAURA ................................................ 45               SEROQUEL XR ....................................... 53
Rifadin....................................................... 26         SEROSTIM ............................................... 51
Rifamate .................................................... 26          Serpasil ...................................................... 46
rifampin ..................................................... 26         sertraline hydrochloride ........................... 52
RIFATER .................................................. 26             Serzone...................................................... 52
RILUTEK ................................................. 40              Silvadene ................................................... 22
rimantadine hydrochloride ....................... 32                      silver sulfadiazine ..................................... 22



                                                                     82
SIMCOR ................................................... 25              STRATTERA ........................................... 40
SIMULECT............................................... 49                 STREPTOMYCIN SULFATE ................. 11
simvastatin ................................................ 25            STROMECTOL ........................................ 10
Sinemet ..................................................... 29           SUBOXONE ............................................... 9
Sinequan .................................................... 52           SUBUTEX .................................................. 9
SINGULAIR ............................................. 23                 SUCRAID ................................................. 43
SKELAXIN............................................... 57                 sucralfate................................................... 31
SKELID .................................................... 49             Sular .......................................................... 35
sodium bicarbonate..................................... 7                  SULAR ..................................................... 35
Sodium Bicarbonate .................................... 7                  sulfacetamide sodium .......................... 21, 22
sodium chloride................................... 47, 56                  Sulfacetamide Sodium .............................. 21
Sodium Chloride ....................................... 56                 sulfadiazine ............................................... 14
Sodium Chloride 0.9% .............................. 47                     Sulfadiazine............................................... 14
sodium lactate ............................................. 7             sulfamethoxazole and trimethoprim.......... 14
Sodium Lactate ........................................... 7               SULFAMYLON ....................................... 22
sodium polystyrene sulfonate .................... 47                       sulfasalazine.............................................. 14
SOLARAZE .............................................. 58                 sulindac ....................................................... 7
SOLTAMOX ............................................ 28                   SUPRAX ................................................... 12
Solu-cortef................................................... 6           Surmontil................................................... 52
Solu-medrol................................................. 6             SURMONTIL ........................................... 52
SOLU-MEDROL ........................................ 6                     SUSTIVA .................................................. 32
SOLU-MEDROL ACT-O-VIAL ................ 6                                  SUTENT ................................................... 28
Soma ......................................................... 57          SYMBICORT ............................................. 6
SOMA ....................................................... 57            SYMBYAX............................................... 52
Soma Compound....................................... 57                    SYMLIN ................................................... 16
Soma Compound/codeine ......................... 57                         SYMLINPEN 120 ..................................... 16
SOMATULINE DEPOT ........................... 49                            SYMLINPEN 60 ....................................... 16
SOMAVERT............................................. 58                   Symmetrel ................................................. 29
Sonata........................................................ 33          SYNAGIS ................................................. 33
SORIATANE CK ..................................... 58                      Synalar ...................................................... 24
sotalol hydrochloride ................................ 34                  SYNAREL ................................................ 45
Spectazole ................................................. 22            SYNERCID............................................... 11
SPIRIVA HANDIHALER ........................ 15                             Synthroid ................................................... 59
spironolactone........................................... 54               SYPRINE .................................................. 45
Sporanox ................................................... 19            TABLOID ................................................. 28
SPORANOX ............................................. 19                  Tagamet..................................................... 31
SPRYCEL ................................................. 28               Tambocor .................................................. 39
Stadol .......................................................... 9        TAMIFLU ................................................. 33
STALEVO 100 ......................................... 29                   tamoxifen citrate ....................................... 28
STALEVO 150 ......................................... 29                   Tapazole .................................................... 59
STALEVO 200 ......................................... 29                   TARCEVA................................................ 28
STALEVO 50 ........................................... 29                  TARGRETIN ...................................... 28, 58
STARLIX .................................................. 17              TARKA ..................................................... 54
Stelazine .................................................... 53          TASIGNA ................................................. 28
Sterapred ..................................................... 6          TASMAR .................................................. 29
STIMATE ................................................. 51               Tavist Allergy ........................................... 44



                                                                      83
Taxol ......................................................... 28         tizanidine hydrochloride ........................... 57
TAXOTERE ............................................. 28                  TOBRADEX ............................................. 21
TAZORAC ................................................ 58                tobramycin sulfate............................... 11, 21
Tegretol ..................................................... 15          TOBRAMYCIN SULFATE ADD-
TEGRETOL-XR ....................................... 15                        VANTAGE ........................................... 11
TEKTURNA ............................................. 54                  TOBRAMYCIN SULFATE/SODIUM
TEKTURNA HCT .................................... 54                          CHLORIDE .......................................... 11
Tenex......................................................... 46          Tobrex ....................................................... 21
Tenoretic ................................................... 34           Tofranil ..................................................... 52
Tenormin ................................................... 34            Tofranil-PM .............................................. 52
Terazol 3 ................................................... 22           tolazamide ................................................. 17
terazosin hcl ................................................ 7           tolbutamide ............................................... 17
terbinafine hydrochloride ......................... 18                     Tolectin ....................................................... 7
terbutaline sulfate ..................................... 59               Tolinase ..................................................... 17
terconazole ................................................ 22            tolmetin sodium ........................................... 7
TESTIM ...................................................... 9            TOPAMAX ............................................... 15
testosterone cypionate ................................. 9                 TOPAMAX SPRINKLE ........................... 15
testosterone enanthate ................................ 9                  Topicort ..................................................... 24
TESTRED ................................................... 9              Toprol XL ................................................. 34
tetanus toxoid adsorbed ............................ 60                    Toradol ........................................................ 7
Tetanus Toxoid, Adsorbed ........................ 60                       TORISEL .................................................. 28
TETANUS/DIPHTHERIA TOXOIDS-                                                torsemide ................................................... 42
   ADSORBED ADULT .......................... 60                            TRACLEER .............................................. 62
tetracycline hydrochloride ........................ 14                     tramadol hcl ................................................ 9
Tetracycline Hydrochloride ...................... 14                       Trandate .................................................... 34
TEVETEN................................................. 54                Trandate Iv ................................................ 34
TEVETEN HCT........................................ 54                     trandolapril ............................................... 54
TEV-TROPIN ........................................... 51                  TRANSDERM-SCOP............................... 18
THALOMID ............................................. 49                  tranylcypromine sulfate ............................ 52
theophylline ............................................... 56            TRAVASOL ............................................. 38
THIOLA .................................................... 49             TRAVASOL 2.75%/DEXTROSE 10%.... 38
Thioplex .................................................... 28           TRAVASOL 2.75%/DEXTROSE 5%...... 38
thioridazine hydrochloride........................ 53                      TRAVASOL 3.5%/ELECTROLYTES .... 38
thiotepa ..................................................... 28          TRAVASOL 4.25%/DEXTROSE 25%.... 38
thiothixene ................................................. 53           TRAVASOL 5.5%/DEXTROSE 10%...... 38
Thorazine .................................................. 52            TRAVASOL 5.5%/DEXTROSE 20%...... 38
THYMOGLOBULIN ............................... 49                           TRAVASOL 5.5%/ELECTROLYTES .... 38
Ticlid ......................................................... 31        TRAVASOL 8.5%/DEXTROSE 10%...... 38
ticlopidine hydrochloride .......................... 31                    TRAVASOL 8.5%/DEXTROSE 20%...... 38
Tigan ......................................................... 18         TRAVASOL 8.5%/DEXTROSE 50%...... 38
TIKOSYN ................................................. 39               TRAVASOL 8.5%/ELECTROLYTES .... 38
TIMENTIN ............................................... 13                TRAVATAN............................................. 20
timolol maleate.................................... 19, 34                 TRAVATAN Z ......................................... 20
Timoptic .................................................... 19           trazodone hydrochloride ........................... 52
TIMOPTIC OCUDOSE ............................ 19                           TREANDA ............................................... 28
TINDAMAX ............................................. 30                  TRECATOR ............................................. 26



                                                                      84
TRELSTAR DEPOT ................................ 28                         Uniphyl ..................................................... 56
TRELSTAR LA ........................................ 28                    Uniretic ..................................................... 54
Trental ....................................................... 46         Univasc ..................................................... 54
tretinoin ............................................... 28, 39           Urecholine ................................................. 50
TREXALL ................................................ 28                Urispas ...................................................... 45
triamcinolone acetonide............................ 24                     Urocit-K ...................................................... 7
TRIAMCINOLONE ACETONIDE IN                                                 UROXATRAL .......................................... 49
   ABSORBASE ....................................... 24                    ursodiol ..................................................... 40
Triavil ........................................................ 51        UVADEX .................................................. 41
TRICOR .................................................... 25             VAGIFEM ................................................ 44
trifluoperazine hydrochloride ................... 53                       VALCYTE ................................................ 33
trifluridine ................................................. 21          valproate sodium....................................... 15
trihexyphenidyl hydrochloride .................. 29                        valproic acid ............................................. 15
TRIHIBIT ................................................. 60              VALTREX ................................................ 33
Trilafon ..................................................... 53          VANCOCIN HCL .................................... 11
Trileptal ..................................................... 15         VANCOCIN HCL ISO-
TRILEPTAL ............................................. 15                   OSMOTICDEXTROSE........................ 11
trimethobenzamide hydrochloride ............ 18                            vancomycin hydrochloride ........................ 11
trimethoprim ............................................. 60              Vancomycin Hydrochloride ...................... 11
TRIMETHOPRIM/                                                              VANTAS .................................................. 29
   SULFAMETHOXAZOLE DS.............. 14                                    Vantin ........................................................ 11
trimipramine maleate ................................ 52                   VAQTA..................................................... 61
Triostat ...................................................... 59         VARIVAX ................................................ 61
TRIPEDIA ................................................ 60               Vaseretic ................................................... 54
TRISENOX ............................................... 28                Vasotec ...................................................... 54
TRIZIVIR ................................................. 32              VECTIBIX ................................................ 29
TROPHAMINE ........................................ 38                     VELCADE ................................................ 29
tropicamide ............................................... 49             venlafaxine hcl .......................................... 52
TRUSOPT ................................................. 20               VENTOLIN HFA ..................................... 59
TRUVADA ............................................... 32                 Vepesid ..................................................... 27
TWINJECT ............................................... 59                VERAMYST............................................. 23
TWINRIX ................................................. 61               verapamil hydrochloride ........................... 34
TYGACIL ................................................. 14               Verapamil Hydrochloride ......................... 34
TYKERB................................................... 29               VEREGEN ................................................ 22
Tylenol/codeine #3...................................... 8                 Vermox ..................................................... 10
TYPHIM VI .............................................. 61                Vesanoid ................................................... 28
TYSABRI ................................................. 49               VESICARE ............................................... 45
TYZEKA................................................... 33               VFEND ..................................................... 19
TYZINE .................................................... 61             VFEND IV ................................................ 19
TYZINE PEDIATRIC NASAL DROPS .. 61                                         Vibramycin ............................................... 14
Ultracet ........................................................ 8        VIBRAMYCIN ................................... 14, 15
Ultram ......................................................... 9         Vicodin ES .................................................. 8
ULTRASE................................................. 42                Vicoprofen .................................................. 8
Ultravate .................................................... 24          VIDAZA ................................................... 29
Unasyn ...................................................... 13           VIDEX ...................................................... 32
Unipen ....................................................... 13          Videx EC................................................... 32



                                                                      85
VIDEX EC ................................................ 32              zaleplon ..................................................... 33
VIGAMOX ............................................... 21                Zanaflex .................................................... 57
VINBLASTINE SULFATE...................... 29                              ZANOSAR ................................................ 29
vincristine sulfate ...................................... 29             Zantac ........................................................ 31
vinorelbine tartrate ................................... 29               Zarontin ..................................................... 16
VIOKASE ................................................. 42              Zaroxolyn .................................................. 42
VIRACEPT ............................................... 32               ZAVESCA ................................................ 49
VIRAMUNE ............................................. 32                 Zebeta ........................................................ 34
VIREAD ................................................... 32             ZEGERID ................................................. 31
Viroptic ..................................................... 21         ZELAPAR................................................. 30
Visken ....................................................... 34         ZEMAIRA ................................................ 43
Vistaril....................................................... 33        ZEMPLAR ................................................ 62
VISTIDE ................................................... 33            ZENAPAX ................................................ 49
VITAMIN/MINERAL, MISC .................. 49                               ZERIT ....................................................... 32
VIVACTIL................................................ 52               Zestoretic................................................... 54
VIVAGLOBIN ......................................... 57                   Zestril ........................................................ 54
VIVELLE-DOT ........................................ 44                   ZETIA ....................................................... 25
VIVOTIF BERNA .................................... 61                     Ziac ........................................................... 34
Voltaren................................................. 7, 23           ZIAGEN .................................................... 32
VOLTAREN ............................................... 7                zidovudine ................................................. 32
Vosol ......................................................... 21        Zinacef ...................................................... 12
Vosol HC .................................................. 21            Zinecard .................................................... 48
VOSPIRE ER ............................................ 59                Zithromax Z-pak ....................................... 12
VYVANSE ............................................... 10                ZMAX ....................................................... 12
warfarin sodium ........................................ 31               Zocor ......................................................... 25
water, sterile ............................................. 47           Zofran ........................................................ 18
Water, Sterile ............................................ 47            ZOLINZA ................................................. 29
WELCHOL ............................................... 25                Zoloft......................................................... 52
Wellbutrin ................................................. 52           zolpidem tartrate ....................................... 33
WELLBUTRIN XL .................................. 52                       ZOMETA .................................................. 49
Westcort .................................................... 24          ZOMIG ..................................................... 26
Wytensin ................................................... 46           ZOMIG ZMT ............................................ 26
XALATAN ............................................... 20                ZONALON ............................................... 30
XIBROM................................................... 23              Zonegran ................................................... 16
XIFAXAN................................................. 11               zonisamide................................................. 16
XOLAIR ................................................... 56             ZORBTIVE ............................................... 51
XOLEGEL ................................................ 22               ZOSTAVAX ............................................. 61
Xylocaine ............................................ 30, 47             ZOSYN ..................................................... 13
Xylocaine Jelly.......................................... 47              Zovirax ...................................................... 33
XYREM .................................................... 40             ZOVIRAX................................................. 22
XYZAL ..................................................... 57            ZYFLO CR ............................................... 23
Yasmin 28 ................................................. 40            ZYLET ...................................................... 21
YAZ .......................................................... 40         Zyloprim ................................................... 47
yellow fever vaccine .................................. 61                ZYMAR .................................................... 21
Yellow Fever Vaccine............................... 61                    ZYPREXA ................................................ 53
Zaditor ....................................................... 10        ZYPREXA ZYDIS ................................... 53



                                                                     86
Zyrtec ........................................................ 56        ZYVOX..................................................... 11
Zyrtec-D .............................................. 56, 57




                                                                     87
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