Elite and Exclusive Value-Based Design Drug list

Effective January 1, 2021

Your employer has chosen a Value-Based Benefit Design (VBD) for your prescription benefit plan. This means you may have lower out-of-pocket costs for drugs in value drug categories included in your VBD. Value drug categories include drugs that treat certain chronic or long-term conditions.

Below is a list of medications that may be available under your VBD benefit. Please verify with your plan if a generic drug must be tried before filling a brand version of a drug. Please refer to your benefit materials for coverage details and the plan website for current information as this publication is subject to change.

Key:

lowercase = generic  
UPPERCASE = BRAND  

Anti-coagulants/anti-platelets

Drug name

Dosage

anagrelide hcl cap

0.5 mg (Agrylin)

anagrelide hcl cap

1 mg

aspirin-dipyridamole cap er 12hr

25-200 mg (Aggrenox)

cilostazol tab

50 mg

cilostazol tab

100 mg

clopidogrel bisulfate tab

75 mg (base equiv) (Plavix)

clopidogrel bisulfate tab

300 mg (base equiv) dipyridamole tab 25 mg

dipyridamole tab

50 mg

dipyridamole tab

75 mg

prasugrel hcl tab

5 mg (base equiv) (Effient)

prasugrel hcl tab

10 mg (base equiv) (Effient)

warfarin sodium tab

1 mg (Coumadin)

warfarin sodium tab

2 mg (Coumadin)

warfarin sodium tab

2.5 mg (Coumadin)

warfarin sodium tab

3 mg (Coumadin)

warfarin sodium tab

4 mg (Coumadin)

warfarin sodium tab

5 mg (Coumadin)

warfarin sodium tab

6 mg (Coumadin)

warfarin sodium tab

7.5 mg (Coumadin)

warfarin sodium tab

10 mg (Coumadin)

Diabetes medications

Insulin

Drug name

Dosage

FIASP – insulin aspart (with niacinamide) injection

100 unit/ml

FIASP FLEXTOUCH – insulin aspart (with niacinamide) sol pen-injector

100 unit/ml

FIASP PENFILL – insulin aspart (with niacinamide) solution cartridge

100 unit/ml

HUMULIN R U-500 (CONCENTRATED) – insulin regular (human) injection

500 unit/ml

HUMULIN R U-500 KWIKPEN – insulin regular (human) solution pen-injector

500 unit/ml

INSULIN ASPART – insulin aspart injection

100 unit/ml

INSULIN ASPART FLEXPEN – insulin aspart solution pen-injector

100 unit/ml

INSULIN ASPART PENFILL – insulin aspart solution cartridge

100 unit/ml

INSULIN ASPART PROTAMINE/ – insulin aspart prot and aspart (human) injection

100 unit/ml (70-30)

INSULIN ASPART PROTAMINE/ – insulin aspart prot and aspart sus pen-injector

100 unit/ml (70-30)

LANTUS – insulin glargine injection

100 unit/ml

LANTUS SOLOSTAR – insulin glargine solution pen- injector

100 unit/ml

LEVEMIR – insulin detemir injection

100 unit/ml

LEVEMIR FLEXTOUCH – insulin detemir solution pen- injector

100 unit/ml

NOVOLIN N – insulin nph (human) (isophane) injection

100 unit/ml

NOVOLIN N FLEXPEN – insulin nph (human) (isophane) suspension pen-injector

100 unit/ml

NOVOLIN N FLEXPEN RELION – insulin nph (human) (isophane) suspension pen-injector

100 unit/ml

NOVOLIN N RELION – insulin nph (human) (isophane) injection

100 unit/ml

NOVOLIN R – insulin regular (human) injection

100 unit/ml

NOVOLIN R FLEXPEN – insulin regular (human) solution pen-injector

100 unit/ml

NOVOLIN R FLEXPEN RELION – insulin regular (human) solution pen-injector

100 unit/ml

NOVOLIN R RELION – insulin regular (human) injection

100 unit/ml

NOVOLIN 70/30 – insulin nph isophane and regular human injection

100 unit/ml (70-30)

NOVOLIN 70/30 FLEXPEN – insulin nph and regular suspension pen-injector

100 unit/ml (70-30)

NOVOLIN 70/30 FLEXPEN RELION – insulin nph and regular suspension pen-injector

100 unit/ml (70-30)

NOVOLIN 70/30 RELION – insulin nph isophane and regular human injection

100 unit/ml (70-30)

NOVOLOG – insulin aspart injection

100 unit/ml

NOVOLOG FLEXPEN – insulin aspart solution pen-injector

100 unit/ml

NOVOLOG MIX 70/30 – insulin aspart prot and aspart (human) injection

100 unit/ml (70-30)

NOVOLOG MIX 70/30 PREFILL – insulin aspart prot and aspart sus pen-injector

100 unit/ml (70-30)

NOVOLOG PENFILL – insulin aspart solution cartridge

100 unit/ml

TOUJEO MAX SOLOSTAR – insulin glargine solution pen-injector

300 unit/ml (2 unit dial)

TOUJEO SOLOSTAR – insulin glargine solution pen-injector

300 unit/ml (1 unit dial)

TRESIBA – insulin degludec injection

100 unit/ml

TRESIBA FLEXTOUCH – insulin degludec solution pen-injector

100 unit/ml

TRESIBA FLEXTOUCH – insulin degludec solution pen-injector

200 unit/ml

Oral

Drug name

Dosage

acarbose tab

25 mg (Precose)

acarbose tab

50 mg (Precose)

acarbose tab

100 mg (Precose)

glimepiride tab

1 mg (Amaryl)

glimepiride tab

2 mg (Amaryl)

glimepiride tab

4 mg (Amaryl)

glipizide tab

5 mg (Glucotrol)

glipizide tab

10 mg (Glucotrol)

glipizide tab er 24hr

2.5 mg (Glucotrol xl)

glipizide tab er 24hr

5 mg (Glucotrol xl)

glipizide tab er 24hr

10 mg (Glucotrol xl)

glipizide-metformin hcl tab

2.5-250 mg

glipizide-metformin hcl tab

2.5-500 mg

glipizide-metformin hcl tab

5-500 mg

glyburide micronized tab

1.5 mg (Glynase)

glyburide micronized tab

3 mg (Glynase)

glyburide micronized tab

6 mg (Glynase)

glyburide tab

1.25 mg

glyburide tab

2.5 mg

glyburide tab

5 mg

glyburide-metformin tab

1.25-250 mg

glyburide-metformin tab

2.5-500 mg

glyburide-metformin tab

5-500 mg

metformin hcl tab

500 mg

metformin hcl tab

850 mg

metformin hcl tab

1000 mg

metformin hcl tab er 24hr

500 mg

metformin hcl tab er 24hr

750 mg

miglitol tab

25 mg (Glyset)

miglitol tab

50 mg (Glyset)

miglitol tab

100 mg (Glyset)

nateglinide tab

60 mg (Starlix)

nateglinide tab

120 mg (Starlix)

pioglitazone hcl tab

15 mg (base equiv) (Actos)

pioglitazone hcl tab

30 mg (base equiv) (Actos)

pioglitazone hcl tab

45 mg (base equiv) (Actos)

pioglitazone hcl-metformin hcl tab

15-500 mg (Actoplus met)

pioglitazone hcl-metformin hcl tab

15-850 mg (Actoplus met)

repaglinide tab

0.5 mg

repaglinide tab

1 mg

repaglinide tab

2 mg

Diabetic supplies

Basic

Drug name

Brand

Calibration Liquid

BAYER CONTOUR

BAYER CONTOUR NEXT

Insulin Syringes

 

Lancets

 

Lancet Devices

 

Pen Needles

 

Test Strips and Discs

BAYER CONTOUR

BAYER CONTOUR NEXT

High blood pressure

Drug name

Dosage

acebutolol hcl cap

200 mg

acebutolol hcl cap

400 mg

amiloride hcl tab

5 mg

amiloride and hydrochlorothiazide tab

5-50 mg amlodipine besylate tab 2.5 mg (base equivalent) (Norvasc)

amlodipine besylate tab

5 mg (base equivalent) (Norvasc)

amlodipine besylate tab

10 mg (base equivalent) (Norvasc)

amlodipine besylate-benazepril hcl cap

2.5-10 m

amlodipine besylate-benazepril hcl cap

5-10 mg (Lotrel)

amlodipine besylate-benazepril hcl cap

5-20 mg (Lotrel)

amlodipine besylate-benazepril hcl cap

5-40 mg

amlodipine besylate-benazepril hcl cap

10-20 mg (Lotrel)

amlodipine besylate-benazepril hcl cap

10-40 mg (Lotrel)

amlodipine besylate-olmesartan medoxomil tab

5­20 mg (Azor)

amlodipine besylate-olmesartan medoxomil tab

5­40 mg (Azor)

amlodipine besylate-olmesartan medoxomil tab

10­20 mg (Azor)

amlodipine besylate-olmesartan medoxomil tab

10­40 mg (Azor)

amlodipine besylate-valsartan tab

5-160 mg (Exforge)

amlodipine besylate-valsartan tab

5-320 mg (Exforge)

amlodipine besylate-valsartan tab

10-160 mg (Exforge)

amlodipine besylate-valsartan tab

10-320 mg (Exforge)

amlodipine-valsartan-hydrochlorothiazide

tab 5-160-12.5 mg (Exforge hct)

amlodipine-valsartan-hydrochlorothiazide

tab 5-160-25 mg (Exforge hct)

amlodipine-valsartan-hydrochlorothiazide tab

10-160-12.5 mg (Exforge hct)

amlodipine-valsartan-hydrochlorothiazide tab

10-160-25 mg (Exforge hct)

amlodipine-valsartan-hydrochlorothiazide tab

10-320-25 mg (Exforge hct)

atenolol tab

25 mg (Tenormin)

atenolol tab

50 mg (Tenormin)

atenolol tab

100 mg (Tenormin)

atenolol and chlorthalidone tab

50-25 mg (Tenoretic 50)

atenolol and chlorthalidone tab

100-25 mg (Tenoretic 100)

benazepril hcl tab

5 mg

benazepril hcl tab

10 mg (Lotensin)

benazepril hcl tab

20 mg (Lotensin)

benazepril hcl tab

40 mg (Lotensin)

benazepril and hydrochlorothiazide tab

5-6.25 mg

benazepril and hydrochlorothiazide tab

10-12.5 mg (Lotensin hct)

benazepril and hydrochlorothiazide tab

20-12.5 mg (Lotensin hct)

benazepril and hydrochlorothiazide tab

20-25 mg (Lotensin hct)

betaxolol hcl tab

10 mg

betaxolol hcl tab

20 mg

bisoprolol fumarate tab

5 mg

bisoprolol fumarate tab

10 mg

bisoprolol and hydrochlorothiazide tab

2.5-6.25 mg (Ziac)

bisoprolol and hydrochlorothiazide tab

5-6.25 mg (Ziac)

bisoprolol and hydrochlorothiazide tab

10-6.25 mg (Ziac)

bumetanide tab

0.5 mg (Bumex)

bumetanide tab

1 mg (Bumex)

bumetanide tab

2 mg (Bumex)

candesartan cilexetil tab

4 mg (Atacand)

candesartan cilexetil tab

8 mg (Atacand)

candesartan cilexetil tab

16 mg (Atacand)

candesartan cilexetil tab

32 mg (Atacand)

candesartan cilexetil-hydrochlorothiazide tab

16-12.5 mg (Atacand hct)

candesartan cilexetil-hydrochlorothiazide tab

32-12.5 mg (Atacand hct)

candesartan cilexetil-hydrochlorothiazide tab

32-25 mg (Atacand hct)

captopril tab

12.5 mg

captopril tab

25 mg

captopril tab

50 mg

captopril tab

100 mg

carvedilol tab

3.125 mg (Coreg)

carvedilol tab

6.25 mg (Coreg)

carvedilol tab

12.5 mg (Coreg)

carvedilol tab

25 mg (Coreg)

chlorthalidone tab

25 mg

chlorthalidone tab

50 mg

clonidine hcl tab

0.1 mg (Catapres)

clonidine hcl tab

0.2 mg (Catapres)

clonidine hcl tab

0.3 mg (Catapres)

clonidine td patch

weekly 0.1 mg/24hr (Catapres-tts-1)

clonidine td patch

weekly 0.2 mg/24hr (Catapres-tts-2)

clonidine td patch

weekly 0.3 mg/24hr (Catapres-tts-3)

diltiazem hcl tab

30 mg (Cardizem)

diltiazem hcl tab

60 mg (Cardizem)

diltiazem hcl tab

90 mg

diltiazem hcl tab

120 mg (Cardizem)

diltiazem hcl cap er

12hr 60 mg

diltiazem hcl cap er

12hr 90 mg

diltiazem hcl cap er

12hr 120 mg

diltiazem hcl coated beads cap er

24hr 120 mg (Cardizem cd)

diltiazem hcl coated beads cap er

24hr 180 mg (Cardizem cd)

diltiazem hcl coated beads cap er

24hr 240 mg (Cardizem cd)

diltiazem hcl coated beads cap er

24hr 300 mg (Cardizem cd)

diltiazem hcl coated beads cap er

24hr 360 mg (Cardizem cd)

diltiazem hcl coated beads tab er

24hr 180 mg (Cardizem la)

diltiazem hcl coated beads tab er

24hr 240 mg (Cardizem la)

diltiazem hcl coated beads tab er

24hr 300 mg (Cardizem la)

diltiazem hcl coated beads tab er

24hr 360 mg (Cardizem la)

diltiazem hcl coated beads tab er

24hr 420 mg (Cardizem la)

diltiazem hcl extended release beads cap er

24hr 120 mg (Tiazac)

diltiazem hcl extended release beads cap er

24hr 180 mg (Tiazac)

diltiazem hcl extended release beads cap er

24hr 240 mg (Tiazac)

diltiazem hcl extended release beads cap er

24hr 300 mg (Tiazac)

diltiazem hcl extended release beads cap er

24hr 360 mg (Tiazac)

diltiazem hcl extended release beads cap er

24hr 420 mg (Tiazac)

doxazosin mesylate tab

1 mg (Cardura)

doxazosin mesylate tab

2 mg (Cardura)

doxazosin mesylate tab

4 mg (Cardura)

doxazosin mesylate tab

8 mg (Cardura)

enalapril maleate tab

2.5 mg (Vasotec)

enalapril maleate tab

5 mg (Vasotec)

enalapril maleate tab

10 mg (Vasotec)

enalapril maleate tab

20 mg (Vasotec)

enalapril maleate and hydrochlorothiazide tab

5-12.5 mg

enalapril maleate and hydrochlorothiazide tab

10-25 mg (Vaseretic)

eplerenone tab

25 mg (Inspra)

eplerenone tab

50 mg (Inspra)

felodipine tab er

24hr 2.5 mg

felodipine tab er

24hr 5 mg

felodipine tab er

24hr 10 mg

fosinopril sodium and hydrochlorothiazide tab

10- 12.5 mg

fosinopril sodium and hydrochlorothiazide tab

20- 12.5 mg

fosinopril sodium tab

10 mg

fosinopril sodium tab

20 mg

fosinopril sodium tab

40 mg

furosemide oral solution

10 mg/ml

furosemide tab

20 mg (Lasix)

furosemide tab

40 mg (Lasix)

furosemide tab

80 mg (Lasix)

guanfacine hcl tab

1 mg

guanfacine hcl tab

2 mg

hydralazine hcl tab

10 mg

hydralazine hcl tab

25 mg

hydralazine hcl tab

50 mg

hydralazine hcl tab

100 mg

hydrochlorothiazide cap

12.5 mg

hydrochlorothiazide tab

12.5 mg

hydrochlorothiazide tab

25 mg

hydrochlorothiazide tab

50 mg

indapamide tab

1.25 mg

indapamide tab

2.5 mg

irbesartan tab

75 mg (Avapro)

irbesartan tab

150 mg (Avapro)

irbesartan tab

300 mg (Avapro)

irbesartan-hydrochlorothiazide

tab 150-12.5 mg (Avalide)

irbesartan-hydrochlorothiazide tab

300-12.5 mg (Avalide)

isradipine cap

2.5 mg

isradipine cap

5 mg

labetalol hcl tab

100 mg

labetalol hcl tab

200 mg

labetalol hcl tab

300 mg

lisinopril tab

2.5 mg (Zestril)

lisinopril tab

5 mg (Zestril)

lisinopril tab

10 mg (Prinivil)

lisinopril tab

20 mg (Prinivil)

lisinopril tab

30 mg (Zestril)

lisinopril tab

40 mg (Zestril)

lisinopril and hydrochlorothiazide tab

10-12.5 mg (Zestoretic)

lisinopril and hydrochlorothiazide tab

20-12.5 mg (Zestoretic)

lisinopril and hydrochlorothiazide tab

20-25 mg (Zestoretic)

losartan potassium tab

25 mg (Cozaar)

losartan potassium tab

50 mg (Cozaar)

losartan potassium tab

100 mg (Cozaar)

losartan potassium and hydrochlorothiazide tab

50- 12.5 mg (Hyzaar)

losartan potassium and hydrochlorothiazide tab

100- 12.5 mg (Hyzaar)

losartan potassium and hydrochlorothiazide tab

100- 25 mg (Hyzaar)

methyldopa tab

250 mg

methyldopa tab

500 mg

metolazone tab

2.5 mg

metolazone tab

5 mg

metolazone tab

10 mg

metoprolol and hydrochlorothiazide tab

50-25 mg (Lopressor hct)

metoprolol and hydrochlorothiazide tab

100-25 mg

metoprolol succinate tab er

24hr 25 mg (tartrate equiv) (Toprol xl)

metoprolol succinate tab er

24hr 50 mg (tartrate equiv) (Toprol xl)

metoprolol succinate tab er

24hr 100 mg (tartrate equiv) (Toprol xl)

metoprolol succinate tab er

24hr 200 mg (tartrate equiv) (Toprol xl)

metoprolol tartrate tab

25 mg

metoprolol tartrate tab

37.5 mg

metoprolol tartrate tab

50 mg (Lopressor)

metoprolol tartrate tab

75 mg

metoprolol tartrate tab

100 mg (Lopressor)

minoxidil tab

2.5 mg

minoxidil tab

10 mg

moexipril hcl tab

7.5 mg

moexipril hcl tab

15 mg

nadolol tab

20 mg (Corgard)

nadolol tab

40 mg (Corgard)

nadolol tab

80 mg (Corgard)

nicardipine hcl cap

20 mg

nicardipine hcl cap

30 mg

nifedipine cap

10 mg (Procardia)

nifedipine cap

20 mg

nifedipine tab er

24hr 30 mg

nifedipine tab er

24hr 60 mg

nifedipine tab er

24hr 90 mg

nifedipine tab er

24hr osmotic release 30 mg (Procardia xl)

nifedipine tab er

24hr osmotic release 60 mg (Procardia xl)

nifedipine tab er

24hr osmotic release 90 mg (Procardia xl)

olmesartan medoxomil tab

5 mg (Benicar)

olmesartan medoxomil tab

20 mg (Benicar)

olmesartan medoxomil tab

40 mg (Benicar)

olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg (Benicar hct)

olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg (Benicar hct)

olmesartan medoxomil-hydrochlorothiazide tab

40-25 mg (Benicar hct)

olmesartan-amlodipine-hydrochlorothiazide tab

20-5-12.5 mg (Tribenzor)

olmesartan-amlodipine-hydrochlorothiazide tab

40-5-12.5 mg (Tribenzor)

olmesartan-amlodipine-hydrochlorothiazide tab

40-5-25 mg (Tribenzor)

olmesartan-amlodipine-hydrochlorothiazide tab

40-10-12.5 mg (Tribenzor)

olmesartan-amlodipine-hydrochlorothiazide tab

40-10-25 mg (Tribenzor)

perindopril erbumine tab

2 mg

perindopril erbumine tab

4 mg

perindopril erbumine tab

8 mg

phenoxybenzamine hcl cap

10 mg (Dibenzyline)

pindolol tab

5 mg

pindolol tab

10 mg

prazosin hcl cap

1 mg (Minipress)

prazosin hcl cap

2 mg (Minipress)

prazosin hcl cap

5 mg (Minipress)

propranolol hcl cap er

24hr 60 mg (Inderal la)

propranolol hcl cap er

24hr 80 mg (Inderal la)

propranolol hcl cap er

24hr 120 mg (Inderal la)

propranolol hcl cap er

24hr 160 mg (Inderal la)

propranolol hcl tab

10 mg

propranolol hcl tab

20 mg

propranolol hcl tab

40 mg

propranolol hcl tab

60 mg

propranolol hcl tab

80 mg

quinapril hcl tab

5 mg (Accupril)

quinapril hcl tab

10 mg (Accupril)

quinapril hcl tab

20 mg (Accupril)

quinapril hcl tab

40 mg (Accupril)

quinapril-hydrochlorothiazide tab

10-12.5 mg (Accuretic)

quinapril-hydrochlorothiazide tab

20-12.5 mg (Accuretic)

quinapril-hydrochlorothiazide tab

20-25 mg (Accuretic)

ramipril cap

1.25 mg (Altace)

ramipril cap

2.5 mg (Altace)

ramipril cap

5 mg (Altace)

ramipril cap

10 mg (Altace)

spironolactone tab

25 mg (Aldactone)

spironolactone tab

50 mg (Aldactone)

spironolactone tab

100 mg (Aldactone)

spironolactone and hydrochlorothiazide tab

25-25 mg (Aldactazide)

telmisartan tab

20 mg (Micardis)

telmisartan tab

40 mg (Micardis)

telmisartan tab

80 mg (Micardis)

telmisartan-amlodipine tab

40-5 mg (Twynsta)

telmisartan-amlodipine tab

40-10 mg (Twynsta)

telmisartan-amlodipine tab

80-5 mg (Twynsta)

telmisartan-amlodipine tab

80-10 mg (Twynsta)

telmisartan-hydrochlorothiazide tab

40-12.5 mg (Micardis hct)

telmisartan-hydrochlorothiazide tab

80-12.5 mg (Micardis hct)

telmisartan-hydrochlorothiazide tab

80-25 mg (Micardis hct)

terazosin hcl cap

1 mg (base equivalent)

terazosin hcl cap

2 mg (base equivalent)

terazosin hcl cap

5 mg (base equivalent)

terazosin hcl cap

10 mg (base equivalent)

torsemide tab

5 mg

torsemide tab

10 mg

torsemide tab

20 mg

torsemide tab

100 mg

trandolapril tab

1 mg

trandolapril tab

2 mg

trandolapril tab

4 mg

trandolapril-verapamil hcl tab er

2-180 mg (Tarka)

trandolapril-verapamil hcl tab er

2-240 mg (Tarka)

trandolapril-verapamil hcl tab er

4-240 mg (Tarka)

triamterene cap

50 mg (Dyrenium)

triamterene cap

100 mg (Dyrenium)

triamterene and hydrochlorothiazide cap

37.5-25 mg (Dyazide)

triamterene and hydrochlorothiazide tab

37.5-25 mg (Maxzide-25)

triamterene and hydrochlorothiazide tab

75-50 mg (Maxzide)

valsartan tab

40 mg (Diovan)

valsartan tab

80 mg (Diovan)

valsartan tab

160 mg (Diovan)

valsartan tab

320 mg (Diovan)

valsartan-hydrochlorothiazide tab

80-12.5 mg (Diovan hct)

valsartan-hydrochlorothiazide tab

160-12.5 mg (Diovan hct)

valsartan-hydrochlorothiazide tab

160-25 mg (Diovan hct)

valsartan-hydrochlorothiazide tab

320-12.5 mg (Diovan hct)

valsartan-hydrochlorothiazide tab

320-25 mg (Diovan hct)

verapamil hcl cap er

24hr 120 mg (Verelan)

verapamil hcl cap er

24hr 180 mg (Verelan)

verapamil hcl cap er

24hr 240 mg (Verelan)

verapamil hcl tab

40 mg

verapamil hcl tab

80 mg

verapamil hcl tab

120 mg

verapamil hcl tab er

120 mg (Calan sr)

verapamil hcl tab er

180 mg (Calan sr)

verapamil hcl tab er

240 mg (Calan sr)

High cholesterol

Drug name

Dosage

atorvastatin calcium tab

10 mg (base equivalent) (Lipitor)

atorvastatin calcium tab

20 mg (base equivalent) (Lipitor)

atorvastatin calcium tab

40 mg (base equivalent) (Lipitor)

atorvastatin calcium tab

80 mg (base equivalent) (Lipitor)

cholestyramine light powder

4 gm/dose (Questran light)

cholestyramine light powder packets

4 gm

cholestyramine powder

4 gm/dose (Questran)

cholestyramine powder packets

4 gm (Questran)

choline fenofibrate cap dr

45 mg (fenofibric acid equiv) (Trilipix)

colesevelam hcl packet for suspension

3.75 gm (Welchol)

colesevelam hcl tab

625 mg (Welchol)

colestipol hcl granules

5 gm (Colestid)

colestipol hcl granule packets

5 gm (Colestid)

colestipol hcl tab

1 gm (Colestid)

ezetimibe tab 10 mg (Zetia)

ezetimibe-simvastatin tab

10-10 mg (Vytorin)

ezetimibe-simvastatin tab

10-20 mg (Vytorin)

ezetimibe-simvastatin tab

10-40 mg (Vytorin)

ezetimibe-simvastatin tab

10-80 mg (Vytorin)

fenofibrate micronized cap

43 mg

fenofibrate micronized cap

67 mg

fenofibrate micronized cap

134 mg

fenofibrate micronized cap

200 mg

fenofibrate tab

48 mg (Tricor)

fenofibrate tab

54 mg

fenofibrate tab

145 mg (Tricor)

fenofibrate tab

160 mg

gemfibrozil tab

600 mg (Lopid)

lovastatin tab

10 mg

lovastatin tab

20 mg

lovastatin tab

40 mg

niacin tab er

500 mg (antihyperlipidemic) (Niaspan)

niacin tab er

750 mg (antihyperlipidemic) (Niaspan)

niacin tab er

1000 mg (antihyperlipidemic) (Niaspan)

pravastatin sodium tab

10 mg

pravastatin sodium tab

20 mg (Pravachol)

pravastatin sodium tab

40 mg (Pravachol)

pravastatin sodium tab

80 mg

rosuvastatin calcium tab

5 mg (Crestor)

rosuvastatin calcium tab

10 mg (Crestor)

rosuvastatin calcium tab

20 mg (Crestor)

rosuvastatin calcium tab

40 mg (Crestor)

simvastatin tab 5 mg

simvastatin tab

10 mg (Zocor)

simvastatin tab

20 mg (Zocor)

simvastatin tab

40 mg (Zocor)

simvastatin tab

80 mg (Zocor)

Osteoporosis

Drug name

Dosage

alendronate sodium tab

10 mg

alendronate sodium tab

35 mg

alendronate sodium tab

70 mg (Fosamax)

calcitonin (salmon) nasal solution

200 unit/activated

ibandronate sodium tab

150 mg (base equivalent) (Boniva)

raloxifene hcl tab

60 mg (Evista)

risedronate sodium tab

150 mg (Actonel)

risedronate sodium tab

30 mg (Actonel)

risedronate sodium tab

35 mg (Actonel)

risedronate sodium tab

5 mg (Actonel)

risedronate sodium tab delayed release

35 mg (Atelvia)

Respiratory

Medications

Drug name

Dosage

acetylcysteine inhalation solution

10%

acetylcysteine inhalation solution

20%

ADVAIR DISKUS – fluticasone-salmeterol aerosol powder base

100-50 mcg/dose

ADVAIR DISKUS – fluticasone-salmeterol aerosol powder base

250-50 mcg/dose

ADVAIR DISKUS – fluticasone-salmeterol aerosol powder base

500-50 mcg/dose

ADVAIR HFA – fluticasone-salmeterol inhalation aerosol

45-21 mcg/activated

ADVAIR HFA – fluticasone-salmeterol inhalation aerosol

115-21 mcg/activated

ADVAIR HFA – fluticasone-salmeterol inhalation aerosol

230-21 mcg/activated

albuterol sulfate inhalation aerosol

108 mcg/activated (90mcg base equiv) (Proair hfa)

albuterol sulfate solution nebu

0.083% (2.5 mg/3ml)

albuterol sulfate solution nebu

0.5% (5 mg/ml)

albuterol sulfate solution nebu

0.63 mg/3ml (base equiv)

albuterol sulfate solution nebu

1.25 mg/3ml (base equiv)

albuterol sulfate syrup

2 mg/5ml

albuterol sulfate tab

2 mg

albuterol sulfate tab

4 mg

ANORO ELLIPTA – umeclidinium-vilanterol aerosol powder base

62.5-25 mcg/inh

ARNUITY ELLIPTA – fluticasone furoate aerosol powder breath activated

50 mcg/activated

ARNUITY ELLIPTA – fluticasone furoate aerosol powder breath activated

100 mcg/activated

ARNUITY ELLIPTA – fluticasone furoate aerosolpowder breath activated

200 mcg/activated

ASMANEX HFA – mometasone furoate inhalation aerosol suspension

50 mcg/activated

ASMANEX HFA – mometasone furoate inhalation aerosol suspension

100 mcg/activated

ASMANEX HFA – mometasone furoate inhalation aerosol suspension

200 mcg/activated

ASMANEX TWISTHALER 30 MET – mometasone furoate inhalation powder

110 mcg/inh (breath activated)

ASMANEX TWISTHALER 30 MET – mometasone furoate inhalation powder

220 mcg/inh (breath activated)

ASMANEX TWISTHALER 60 MET – mometasone furoate inhalation powder

220 mcg/inh (breath activated)

ASMANEX TWISTHALER 120 ME – mometasone furoate inhalation powder

220 mcg/inh (breath activated)

BREO ELLIPTA – fluticasone furoate-vilanterol aerosol powder base

100-25 mcg/inh

BREO ELLIPTA – fluticasone furoate-vilanterol aerosol powder base

200-25 mcg/inh

BREZTRI aerosol SPHERE – budesonide-nterol aerosol glycopyrrolate-formoterol aerosol

160-9-4.8 mcg/activated

BROVANA – arformoterol tartrate solution nebu

15 mcg/2ml (base equiv)

budesonide inhalation suspension

0.25 mg/2ml(Pulmicort)

budesonide inhalation suspension

0.5 mg/2ml (Pulmicort)

budesonide inhalation suspension

1 mg/2ml (Pulmicort)

cromolyn sodium solution nebu

20 mg/2ml

DULERA – mometasone furoate-formoterol fumarate aerosol

50-5 mcg/activated

DULERA – mometasone furoate-formoterol fumarate aerosol

100-5 mcg/activated

DULERA – mometasone furoate-formoterol fumarate aerosol

200-5 mcg/activated

FLOVENT DISKUS – fluticasone propionate aerosol powder base

50 mcg/blister

FLOVENT DISKUS – fluticasone propionate aerosol powder base

100 mcg/blister

FLOVENT DISKUS – fluticasone propionate aerosol powder base

250 mcg/blister

FLOVENT HFA – fluticasone propionate hfa inhalation aerosol

44 mcg/activated (50/valve)

FLOVENT HFA – fluticasone propionate hfa inhalation aerosol

110 mcg/activated (125/valve)

FLOVENT HFA – fluticasone propionate hfa inhalation aerosol

220 mcg/activated (250/valve)

FLUTICASONE PROPIONATE/SA – fluticasone-l aerosol salmeterol aerosol powder base

55-14 mcg/activated

FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aerosol powder base

113-14 mcg/activated

FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aerosol powder base

232-14 mcg/activated

INCRUSE ELLIPTA – umeclidinium br aerosol powder breath activated

62.5 mcg/inh (base eq)

ipratropium bromide inhalation solution

0.02% ro powder

ipratropium-albuterol nebu solution

0.5-2.5(3) mg/3ml

levalbuterol hcl solution nebu

0.31 mg/3ml (base /3ml equiv) (Xopenex)

levalbuterol hcl solution nebu

0.63 mg/3ml (base equiv) (Xopenex)

levalbuterol hcl solution nebu

1.25 mg/3ml (base equiv) (Xopenex)

levalbuterol hcl solution nebu conc

1.25 mg/0.5ml (base equiv) (Xopenex concentrate)

montelukast sodium chew tab

4 mg (base equiv)(Singulair)

montelukast sodium chew tab

5 mg (base equiv)(Singulair)

montelukast sodium tab

10 mg (base equiv) (Singulair)

QVAR REDIHALER – beclomethasone diprop hfa breath activated inhalation aerosol

40 mcg/activated

QVAR REDIHALER – beclomethasone diprop hfa breath activated inhalation aerosol

80 mcg/activated

SEREVENT DISKUS – salmeterol xinafoate aerosol powder base

50 mcg/dose (base equiv)

SPIRIVA HANDIHALER – tiotropium bromide er powder monohydrate inhalation cap

18 mcg (base equiv)

SPIRIVA RESPIMAT – tiotropium bromide monohydrate inhalation aerosol

1.25 mcg/activated uiv)

SPIRIVA RESPIMAT – tiotropium bromide monohydrate inhalation aerosol

2.5 mcg/activated

STIOLTO RESPIMAT – tiotropium br-olodaterol inhalation aerosol solution

2.5-2.5 mcg/activated

STRIVERDI RESPIMAT – olodaterol hcl inhalation aerosol solution

2.5 mcg/activated (base equiv)

SYMBICORT – budesonide-formoterol fumarate dihyd aerosol

80-4.5 mcg/activated

SYMBICORT – budesonide-formoterol fumarate dihyd aerosol

160-4.5 mcg/activated

terbutaline sulfate tab

2.5 mg oterol fumarate dihyd

terbutaline sulfate tab

5 mg

theophylline solution

80 mg/15ml

theophylline tab er

24hr 400 mg

theophylline tab er

24hr 600 mg

TRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol aepb

100-62.5-25 mcg/inh

VENTOLIN HFA – albuterol sulfate inhalation aerosol

108 mcg/activated (90mcg base equiv) nhal aerosol

zafirlukast tab

10 mg (Accolate)

zafirlukast tab

20 mg (Accolate)

zafirlukast tab

20 mg (Accolate)