Exclusive Prescription Drug Benefits

Effective January 1 , 2020

Learn how to use your Rx benefits, including lists of drugs with certain requirements for coverage. See the Exclusive formulary for the full list of drugs covered under your plan.


Drugs that are denoted with a “+” in the Prescription Drug List indicate group specific coverage. Please refer to your benefit booklet for coverage details.

Key:

UPPERCASE names = Brand

lowercase names = Generic

Guide to Prescription Drug Benefits

Your prescription drug coverage is one of the most important parts of your health plan.

Use this guide to understand how your benefits work.

Drug Name(s)

Tier

abiraterone acetate GN
ACTEMRA BP
ACTEMRA ACTPEN BP
ACTHAR BN
ADAPALENE BN+
adapalene cream GN+
adapalene gel GN+
ADDYI BN
ADEMPAS BN
ADVATE BP
ADYNOVATE BP
AFINITOR BP
AFINITOR DISPERZ BP
AFSTYLA BP
AIMOVIG BP
ALECENSA BP
ALPHANINE SD BP
ALPROLIX BP
ALUNBRIG BP
ambrisentan GN
ANADROL-50 BN
ARANESP ALBUMIN FREE BP
ARCALYST BN
ARIKAYCE BN
AUBAGIO BP
AUSTEDO BN
AVONEX BP
AYVAKIT BP
BALVERSA BN
BELBUCA BP
BENEFIX BP
BENLYSTA BN
BERINERT BN
BETASERON BP
bexarotene GN
bosentan GN
bosentan GN
BOSULIF BP
BRAFTOVI BN
BRUKINSA BN
CABOMETYX BP
CALQUENCE BN
capecitabine GN
CAPRELSA BP
CARBAGLU BN
CEQUA BN+
CERDELGA BN
CHORIONIC GONADOTROPIN BP
CIMZIA BN
COAGADEX BP
COMETRIQ BP
CONTRAVE BN
COPIKTRA BN
CORLANOR BN
COSENTYX BP
COTELLIC BP
CRESEMBA BN
dalfampridine GN
danazol GN
DAURISMO BN
diclofenac sodium (actinic keratoses) GN
DIFFERIN BN+
DOPTELET BP
DUPIXENT BN
ELMIRON BN
ELOCTATE BP
EMGALITY BP
ENBREL BP
ENDARI BN
EPIDIOLEX BP
EPOGEN BN
ERIVEDGE BP
ERLEADA BP
erlotinib hcl GN
ESBRIET BN
everolimus GN
FARYDAK BP
FASENRA PEN BN
fentanyl citrate lozenge GN
fentanyl td patch GN
FIBRYGA BP
FIRDAPSE BN
FOLLISTIM AQ BP
GALAFOLD BN
ganirelix acetate soln GN
GATTEX BN
GILENYA BP
GILOTRIF BP
glatiramer acetate soln GN
GRASTEK BN
HAEGARDA BP
HARVONI BP
HEMLIBRA BP
HEMOFIL M BP
HETLIOZ BN
HUMIRA BP
HYCAMTIN BP
IBRANCE BP
icatibant acetate inj GN
ICLUSIG BP
IDELVION BP
IDHIFA BN
imatinib mesylate tab GN
IMBRUVICA BP
INGREZZA BN
INLYTA BP
INREBIC BN
IRESSA BP
itraconazole oral soln GN
IXINITY BP
JAKAFI BP
JUXTAPID BN
JYNARQUE BN
KALYDECO BP
KEVZARA BN
KISQALI BP
KOATE BP
KOATE-DVI BP
KOGENATE FS BP
KORLYM BN
KOVALTRY BP
KUVAN BN
LEDIPASVIR/SOFOSBUVIR BP
LENVIMA 10 MG DAILY DOSE BP
lidocaine hcl GN
LIDOCAINE HCL JELLY GN+
lidocaine hcl urethral/mucosal gel prefilled syringe GN+
lidocaine patch GN
lidocaine-prilocaine cream GN
LOMAIRA BN
LONSURF BP
LORBRENA BN
LUCEMYRA BN
LYNPARZA BP
LYSODREN BP
MATULANE BP
MAVENCLAD BP
MAVYRET BP
MAYZENT BP
MEKINIST BP
MEKTOVI BN
MENOPUR BP
METHITEST BN
METHYLTESTOSTERONE BN
miglustat cap GN
MIRCERA BN
MONONINE BP
morphine sulfate cap er GN
MULPLETA BP
MYALEPT BN
NATPARA BN
NERLYNX BN
NEXAVAR BP
NINLARO BP
NORDITROPIN FLEXPRO BP
NOVAREL BP
NOVOEIGHT BP
NOXAFIL BP
NUBEQA BP
NUCALA BN
NUEDEXTA BN
NUWIQ BP
OCALIVA BN
ODACTRA BN
ODOMZO BP
OFEV BN
OPSUMIT BP
ORALAIR BN
ORENITRAM BN
ORILISSA BP
ORKAMBI BN
OTEZLA BP
oxandrolone tab GN
OXBRYTA BN
OXERVATE BN
OXYCONTIN BP
OXYMORPHONE HYDROCHLORIDE BN
PALYNZIQ BN
PEGASYS BP
PEGASYS PROCLICK BP
PEGINTRON BN
phentermine hcl cap GP
PIQRAY BP
PLEGRIDY BP
POMALYST BP
posaconazole tab delayed release GN
PREGNYL W/DILUENT BENZYL BP
PROCRIT BP
PROCYSBI BN
PROFILNINE BP
PROMACTA BN
QSYMIA BN
QUDEXY XR BN
RAGWITEK BN
RAVICTI BN
REBIF BP
REBINYN BP
RECOMBINATE BP
REPATHA BP
RESTASIS BN+
RETACRIT BP
REVLIMID BP
RIASTAP BP
RINVOQ BP
RIXUBIS BP
ROZLYTREK BP
RUBRACA BP
RUCONEST BN
RUZURGI BN
RYDAPT BP
SAXENDA BN
sildenafil citrate for suspension GN
SIMPONI BP
SKYRIZI BP
sodium phenylbutyrate oral powder GN
sodium phenylbutyrate tab GN
SOFOSBUVIR/VELPATASVIR BP
SOVALDI BP
SPRYCEL BP
STELARA BP
STIVARGA BP
STRENSIQ BP
SUNOSI BP
SUTENT BP
SYLATRON BP
SYMDEKO BP
SYMPROIC BP
tadalafil tab 20 mg (pah) GN
TAFINLAR BP
TAGRISSO BP
TALZENNA BN
TASIGNA BP
TAVALISSE BN
tazarotene cream GN
TAZVERIK BN
TECFIDERA BP
TEGSEDI BN
temozolomide cap GN
testosterone cypionate im inj in oil GN
TESTOSTERONE ENANTHATE GN
testosterone td gel GN
tetrabenazine GN
THALOMID BP
TIBSOVO BN
TOPIRAMATE ER BN
TRACLEER BP
tramadol hcl tab er GN
TREMFYA BP
tretinoin cap GN
TRIKAFTA BP
TROKENDI XR BN
TRULANCE BP
TURALIO BN
TYKERB BP
TYMLOS BP
TYVASO BN
UPTRAVI BP
VASCEPA BP
VENCLEXTA BP
VENTAVIS BN
VERZENIO BP
VITRAKVI BP
VIZIMPRO BN
voriconazole susp GN
voriconazole tab GN
VOSEVI BP
VOTRIENT BP
VUMERITY BP
VYLEESI BN
VYNDAMAX BP
VYNDAQEL BP
XALKORI BP
XELJANZ BP
XELJANZ XR BP
XENICAL BN
XERMELO BN
XIIDRA BN+
XOSPATA BN
XPOVIO BN
XTAMPZA ER BN
XTANDI BP
XYNTHA BP
XYNTHA SOLOFUSE BP
XYREM BN
YONSA BP
ZEJULA BN
ZELBORAF BP
ZOLINZA BP
ZYDELIG BP
ZYKADIA BP
ZYTIGA BP

Drug Name(s)

Tier

ACIPHEX SPRINKLE BN+
BEPREVE BN+
CLOZAPINE ODT GN
CLOZAPINE ODT BN
DEXCOM G5 MOBILE RECEIVER BP
DEXCOM G5 MOBILE TRANSMIT BP
DEXCOM G5 MOBILE/G4 PLATI BP
DEXCOM G5 RECEIVER KIT BP
DEXCOM G6 RECEIVER BP
DEXCOM G6 SENSOR BP
DEXCOM G6 TRANSMITTER BP
DEXILANT BN+
ERYTHROCIN GN
FANAPT BN
FANAPT TITRATION PACK BN
FETZIMA BN
FLUOXETINE DR BN
KETOPROFEN BN
LASTACAFT BN+
LATUDA BN
NEXIUM BP
OTREXUP BP
PAZEO BN+
PRILOSEC BN+
PROTONIX BN+
RABEPRAZOLE SODIUM DR SPR BN+
REXULTI BN
RISPERIDONE ODT BN
SAPHRIS BN
SECUADO BN
SUMATRIPTAN SUCCINATE BP
tacrolimus oint GN
tacrolimus oint GN
TOLMETIN SODIUM BN
TRINTELLIX BN
VERSACLOZ BN
VIIBRYD BN
VRAYLAR BN

Quantity Level Limit Program Summary

Drug Class

Drug Name

Adult Quantity Level Limit

Child Quantity Level Limit

Actinic Keratosis ALDARA CREAM 5% 48 Packets Per 60 Days N/A
Actinic Keratosis EFUDEX CREAM 5% 240 Grams Per 90 Days N/A
Actinic Keratosis fluorouracil cream 5% 240 Grams Per 90 Days N/A
Actinic Keratosis imiquimod cream 5% 48 Packets Per 60 Days N/A
Acute Migraine 5HT AMERGE TAB 1MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT AMERGE TAB 2.5MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT AXERT TAB 12.MG 12 Tablets Per 30 Days N/A
Acute Migraine 5HT AXERT TAB 6.2MG 12 Tablets Per 30 Days N/A
Acute Migraine 5HT FROVA TAB 2.5MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT IMITREX SPRY 20MG/ACT 12 Inhalers Per 30 Days N/A
Acute Migraine 5HT IMITREX SPRY 5MG/ACT 12 Inhalers Per 30 Days N/A
Acute Migraine 5HT IMITREX INJ 6MG/0.5ML 10 Vials Per 30 Days N/A
Acute Migraine 5HT IMITREX TAB 100MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT IMITREX TAB 25MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT IMITREX TAB 50MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT IMITREX STATDOSE REFILL CARTRIDGE 4MG.0.5ML 12 CARTS Per 30 Days N/A
Acute Migraine 5HT IMITREX STATDOSE REFILL CARTRIDGE 6MG.0.5ML 12 CARTS Per 30 Days N/A
Acute Migraine 5HT IMITREX STATDOSE SYSTEM AUTI-INJECTOR 4MG.0.5ML 12 Syringes Per 30 Days N/A
Acute Migraine 5HT IMITREX STATDOSE SYSTEM AUTO-INJECTOR 6MG.0.5ML 12 Syringes Per 30 Days N/A
Acute Migraine 5HT MAXALT TAB 10MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT MAXALT-MLT TAB 10MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT MAXALT-MLT TAB 5MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT ONZETRA XSAIL 11/MG 2 Kits Per 30 Days N/A
Acute Migraine 5HT RELPAX TAB 20MG 12 Tablets Per 30 Days N/A
Acute Migraine 5HT RELPAX TAB 40MG 12 Tablets Per 30 Days N/A
Acute Migraine 5HT SUMATRIPTAN SUCCINATE SYRINE 6MG/0.5ML 12 Syringes Per 30 Days N/A
Acute Migraine 5HT TOSYMRA SPRAY 10MG 18 Doses Per 30 Days N/A
Acute Migraine 5HT TREXIMET TAB -60MG 9 Tablets Per 30 Days N/A
Acute Migraine 5HT TREXIMET TAB -500MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT ZEMBRACE SYMTOUCH AUTO-INJECTOR 5MG/0.5ML 24 Pens Per 30 Days N/A
Acute Migraine 5HT ZOMIG SPRAY 5 MG/SPRAY 2 SPRAYS Per 30 Days N/A
Acute Migraine 5HT ZOMIG SPRAY 5 MG/SPRAY 2 SPRAYS Per 30 Days N/A
Acute Migraine 5HT ZOMIG TAB 2.5MG 12 Tablets Per 30 Days N/A
Acute Migraine 5HT ZOMIG TAB 5 MG 12 Tablets Per 30 Days N/A
Acute Migraine 5HT ZOMIG ZMT TAB 2.5MG 12 Tablets Per 30 Days N/A
Acute Migraine 5HT ZOMIG ZMT TAB 5MG 12 Tablets Per 30 Days N/A
Acute Migraine 5HT almotriptan tab 12.mg 12 Tablets Per 30 Days N/A
Acute Migraine 5HT almotriptan tab 6.2mg 12 Tablets Per 30 Days N/A
Acute Migraine 5HT almotriptan malate tab 12.mg 12 Tablets Per 30 Days N/A
Acute Migraine 5HT almotriptan malate tab 6.2mg 12 Tablets Per 30 Days N/A
Acute Migraine 5HT eletriptan hydrobromide tab 20mg 12 Tablets Per 30 Days N/A
Acute Migraine 5HT eletriptan hydrobromide tab 40mg 12 Tablets Per 30 Days N/A
Acute Migraine 5HT frovatriptan succinate tab 2.5mg 18 Tablets Per 30 Days N/A
Acute Migraine 5HT naratriptan hcl TAB 5 MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT naratriptan hcl tab 2.5mg 18 Tablets Per 30 Days N/A
Acute Migraine 5HT rizatriptan benzoate tab 10mg 18 Tablets Per 30 Days N/A
Acute Migraine 5HT rizatriptan benzoate TAB 5 MG 18 Tablets Per 30 Days N/A
Acute Migraine 5HT rizatriptan benzoate odt tab 10mg 18 Tablets Per 30 Days N/A
Acute Migraine 5HT rizatriptan benzoate odt tab 5mg 18 Tablets Per 30 Days N/A
Acute Migraine 5HT sumatriptan spray 20mg 12 Inhalers Per 30 Days N/A
Acute Migraine 5HT sumatriptan spray 5mg 12 Inhalers Per 30 Days N/A
Acute Migraine 5HT sumatriptan succinate inj 6mg/0.5ml 10 Vials Per 30 Days N/A
Acute Migraine 5HT sumatriptan succinate auto-injector 4mg/0.5ml 12 Syringes Per 30 Days N/A
Acute Migraine 5HT sumatriptan succinate auto-injector 6mg/0.5ml 12 Syringes Per 30 Days N/A
Acute Migraine 5HT sumatriptan succinate tab 100mg 18 Tablets Per 30 Days N/A
Acute Migraine 5HT sumatriptan succinate tab 25mg 18 Tablets Per 30 Days N/A
Acute Migraine 5HT sumatriptan succinate tab 50mg 18 Tablets Per 30 Days N/A
Acute Migraine 5HT sumatriptan succinate refill cartridge 4 mg/0 5ml 12 CARTS Per 30 Days N/A
Acute Migraine 5HT sumatriptan succinate refill cartridge 6 mg/0 5ml 12 CARTS Per 30 Days N/A
Acute Migraine 5HT sumatriptan/naproxen sodium tab -500mg 18 Tablets Per 30 Days N/A
Acute Migraine 5HT zolmitriptan tab 2.5mg 12 Tablets Per 30 Days N/A
Acute Migraine 5HT zolmitriptan tab 5mg 12 Tablets Per 30 Days N/A
Acute Migraine 5HT zolmitriptan odt tab 2.5mg 12 Tablets Per 30 Days N/A
Acute Migraine 5HT zolmitriptan odt tab 5mg 12 Tablets Per 30 Days N/A
ADHD Agents ADDERALL TAB 10MG 60 Tablets Per 30 Days N/A
ADHD Agents ADDERALL TAB 12.MG 60 Tablets Per 30 Days N/A
ADHD Agents ADDERALL TAB 15MG 60 Tablets Per 30 Days N/A
ADHD Agents ADDERALL TAB 20MG 90 Tablets Per 30 Days N/A
ADHD Agents ADDERALL TAB 30MG 60 Tablets Per 30 Days N/A
ADHD Agents ADDERALL TAB 5MG 60 Tablets Per 30 Days N/A
ADHD Agents ADDERALL TAB 7.5MG 60 Tablets Per 30 Days N/A
ADHD Agents ADDERALL XR CAP 10MG 30 Capsules Per 30 Days N/A
ADHD Agents ADDERALL XR CAP 15MG 30 Capsules Per 30 Days N/A
ADHD Agents ADDERALL XR CAP 20MG 30 Capsules Per 30 Days N/A
ADHD Agents ADDERALL XR CAP 25MG 30 Capsules Per 30 Days N/A
ADHD Agents ADDERALL XR CAP 30MG 30 Capsules Per 30 Days N/A
ADHD Agents ADDERALL XR CAP 5MG 30 Capsules Per 30 Days N/A
ADHD Agents ADHANSIA XR CAP 25MG 30 Capsules Per 30 Days N/A
ADHD Agents ADHANSIA XR CAP 35MG 30 Capsules Per 30 Days N/A
ADHD Agents ADHANSIA XR CAP 45MG 30 Capsules Per 30 Days N/A
ADHD Agents ADHANSIA XR CAP 55MG 30 Capsules Per 30 Days N/A
ADHD Agents ADHANSIA XR CAP 70MG 30 Capsules Per 30 Days N/A
ADHD Agents ADHANSIA XR CAP 85MG 30 Capsules Per 30 Days N/A
ADHD Agents ADZENYS ER SUSP 1.25 MG/ML 450 mLs Per 30 Days N/A
ADHD Agents ADZENYS XR-ODT TAB 12.MG 30 Tablets Per 30 Days N/A
ADHD Agents ADZENYS XR-ODT TAB 15.MG 30 Tablets Per 30 Days N/A
ADHD Agents ADZENYS XR-ODT TAB 18.MG 30 Tablets Per 30 Days N/A
ADHD Agents ADZENYS XR-ODT TAB 3.1MG 60 Tablets Per 30 Days N/A
ADHD Agents ADZENYS XR-ODT TAB 6.3MG 60 Tablets Per 30 Days N/A
ADHD Agents ADZENYS XR-ODT TAB 9.4MG 30 Tablets Per 30 Days N/A
ADHD Agents AMPHETAMINE ER SUSP 1.25 MG/ML 450 mLs Per 30 Days N/A
ADHD Agents APTENSIO XR CAP 10MG 30 Capsules Per 30 Days N/A
ADHD Agents APTENSIO XR CAP 15MG 30 Capsules Per 30 Days N/A
ADHD Agents APTENSIO XR CAP 20MG 30 Capsules Per 30 Days N/A
ADHD Agents APTENSIO XR CAP 30MG 30 Capsules Per 30 Days N/A
ADHD Agents APTENSIO XR CAP 40MG 30 Capsules Per 30 Days N/A
ADHD Agents APTENSIO XR CAP 50MG 30 Capsules Per 30 Days N/A
ADHD Agents APTENSIO XR CAP 60MG 30 Capsules Per 30 Days N/A
ADHD Agents CONCERTA TAB 18MG 30 Tablets Per 30 Days N/A
ADHD Agents CONCERTA TAB 27MG 30 Tablets Per 30 Days N/A
ADHD Agents CONCERTA TAB 36MG 60 Tablets Per 30 Days N/A
ADHD Agents CONCERTA TAB 54MG 30 Tablets Per 30 Days N/A
ADHD Agents COTEMPLA XR-ODT TAB 17.MG 60 Tablets Per 30 Days N/A
ADHD Agents COTEMPLA XR-ODT TAB 25.MG 60 Tablets Per 30 Days N/A
ADHD Agents COTEMPLA XR-ODT TAB 8.6MG 30 Tablets Per 30 Days N/A
ADHD Agents DAYTRANA PATCH 10MG 30 Patches Per 30 Days N/A
ADHD Agents DAYTRANA PATCH 15MG 30 Patches Per 30 Days N/A
ADHD Agents DAYTRANA PATCH 20MG 30 Patches Per 30 Days N/A
ADHD Agents DAYTRANA PATCH 30MG 30 Patches Per 30 Days N/A
ADHD Agents DESOXYN TAB 5 MG 150 Tablets Per 30 Days N/A
ADHD Agents DEXEDRINE CAP 10MG 120 Capsules Per 30 Days N/A
ADHD Agents DEXEDRINE CAP 15MG 120 Capsules Per 30 Days N/A
ADHD Agents DEXEDRINE CAP 5MG 90 Capsules Per 30 Days N/A
ADHD Agents DYANAVEL XR SUSP 2.5 MG/ML 240 mLs Per 30 Days N/A
ADHD Agents EVEKEO TAB 10MG 180 Tablets Per 30 Days N/A
ADHD Agents EVEKEO TAB 5MG 90 Tablets Per 30 Days N/A
ADHD Agents EVEKEO ODT TAB 10MG 60 Tablets Per 30 Days N/A
ADHD Agents EVEKEO ODT TAB 15MG 60 Tablets Per 30 Days N/A
ADHD Agents EVEKEO ODT TAB 20MG 60 Tablets Per 30 Days N/A
ADHD Agents EVEKEO ODT TAB 5MG 60 Tablets Per 30 Days N/A
ADHD Agents FOCALIN TAB 10MG 60 Tablets Per 30 Days N/A
ADHD Agents FOCALIN TAB 2.5MG 60 Tablets Per 30 Days N/A
ADHD Agents FOCALIN TAB 5MG 60 Tablets Per 30 Days N/A
ADHD Agents FOCALIN XR CAP 10MG 30 Capsules Per 30 Days N/A
ADHD Agents FOCALIN XR CAP 15MG 30 Capsules Per 30 Days N/A
ADHD Agents FOCALIN XR CAP 20MG 30 Capsules Per 30 Days N/A
ADHD Agents FOCALIN XR CAP 25MG 30 Capsules Per 30 Days N/A
ADHD Agents FOCALIN XR CAP 30MG 30 Capsules Per 30 Days N/A
ADHD Agents FOCALIN XR CAP 35MG 30 Capsules Per 30 Days N/A
ADHD Agents FOCALIN XR CAP 40MG 30 Capsules Per 30 Days N/A
ADHD Agents FOCALIN XR CAP 5MG 30 Capsules Per 30 Days N/A
ADHD Agents INTUNIV TAB 1MG 30 Tablets Per 30 Days N/A
ADHD Agents INTUNIV TAB 2MG 30 Tablets Per 30 Days N/A
ADHD Agents INTUNIV TAB 3MG 30 Tablets Per 30 Days N/A
ADHD Agents INTUNIV TAB 4MG 30 Tablets Per 30 Days N/A
ADHD Agents JORNAY PM CAP 100MG 30 Capsules Per 30 Days N/A
ADHD Agents JORNAY PM CAP 20MG 30 Capsules Per 30 Days N/A
ADHD Agents JORNAY PM CAP 40MG 30 Capsules Per 30 Days N/A
ADHD Agents JORNAY PM CAP 60MG 30 Capsules Per 30 Days N/A
ADHD Agents JORNAY PM CAP 80MG 30 Capsules Per 30 Days N/A
ADHD Agents KAPVAY TAB 0.1MG 120 Tablets Per 30 Days N/A
ADHD Agents METHYLIN 10MG/5ML 900 mLs Per 30 Days N/A
ADHD Agents METHYLIN 5MG/5ML 450 mLs Per 30 Days N/A
ADHD Agents METHYLPHENIDATE HYDROCHLORIDE ER TAB 18MG 30 Tablets Per 30 Days N/A
ADHD Agents METHYLPHENIDATE HYDROCHLORIDE ER TAB 72MG 30 Tablets Per 30 Days N/A
ADHD Agents MYDAYIS CAP 12.MG 30 Capsules Per 30 Days N/A
ADHD Agents MYDAYIS CAP 25MG 30 Capsules Per 30 Days N/A
ADHD Agents MYDAYIS CAP 37.MG 30 Capsules Per 30 Days N/A
ADHD Agents MYDAYIS CAP 50MG 30 Capsules Per 30 Days N/A
ADHD Agents QUILLICHEW ER TAB 20MG 30 Tablets Per 30 Days N/A
ADHD Agents QUILLICHEW ER TAB 30MG 60 Tablets Per 30 Days N/A
ADHD Agents QUILLICHEW ER TAB 40MG 30 Tablets Per 30 Days N/A
ADHD Agents QUILLIVANT XR SUSP 25 MG/5ML 360 mLs Per 30 Days N/A
ADHD Agents RELEXXII TAB 72MG 30 Tablets Per 30 Days N/A
ADHD Agents RITALIN TAB 10MG 90 Tablets Per 30 Days N/A
ADHD Agents RITALIN TAB 20MG 90 Tablets Per 30 Days N/A
ADHD Agents RITALIN TAB 5MG 90 Tablets Per 30 Days N/A
ADHD Agents RITALIN LA CAP 10MG 30 Capsules Per 30 Days N/A
ADHD Agents RITALIN LA CAP 20MG 30 Capsules Per 30 Days N/A
ADHD Agents RITALIN LA CAP 30MG 30 Capsules Per 30 Days N/A
ADHD Agents RITALIN LA CAP 40MG 30 Capsules Per 30 Days N/A
ADHD Agents STRATTERA CAP 10MG 60 Capsules Per 30 Days N/A
ADHD Agents STRATTERA CAP 100MG 30 Capsules Per 30 Days N/A
ADHD Agents STRATTERA CAP 18MG 60 Capsules Per 30 Days N/A
ADHD Agents STRATTERA CAP 25MG 60 Capsules Per 30 Days N/A
ADHD Agents STRATTERA CAP 40MG 60 Capsules Per 30 Days N/A
ADHD Agents STRATTERA CAP 60MG 30 Capsules Per 30 Days N/A
ADHD Agents STRATTERA CAP 80MG 30 Capsules Per 30 Days N/A
ADHD Agents VYVANSE CAP 10MG 30 Capsules Per 30 Days N/A
ADHD Agents VYVANSE CAP 20MG 30 Capsules Per 30 Days N/A
ADHD Agents VYVANSE CAP 30MG 30 Capsules Per 30 Days N/A
ADHD Agents VYVANSE CAP 40MG 30 Capsules Per 30 Days N/A
ADHD Agents VYVANSE CAP 50MG 30 Capsules Per 30 Days N/A
ADHD Agents VYVANSE CAP 60MG 30 Capsules Per 30 Days N/A
ADHD Agents VYVANSE CAP 70MG 30 Capsules Per 30 Days N/A
ADHD Agents VYVANSE TAB 10MG 30 Tablets Per 30 Days N/A
ADHD Agents VYVANSE TAB 20MG 30 Tablets Per 30 Days N/A
ADHD Agents VYVANSE TAB 30MG 30 Tablets Per 30 Days N/A
ADHD Agents VYVANSE TAB 40MG 30 Tablets Per 30 Days N/A
ADHD Agents VYVANSE TAB 50MG 30 Tablets Per 30 Days N/A
ADHD Agents VYVANSE TAB 60MG 30 Tablets Per 30 Days N/A
ADHD Agents ZENZEDI TAB 15MG 90 Tablets Per 30 Days N/A
ADHD Agents ZENZEDI TAB 2.5MG 90 Tablets Per 30 Days N/A
ADHD Agents ZENZEDI TAB 20MG 90 Tablets Per 30 Days N/A
ADHD Agents ZENZEDI TAB 30MG 60 Tablets Per 30 Days N/A
ADHD Agents ZENZEDI TAB 7.5MG 90 Tablets Per 30 Days N/A
ADHD Agents amphetamine sulfate tab 10mg 180 Tablets Per 30 Days N/A
ADHD Agents amphetamine sulfate tab 5mg 90 Tablets Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine cap 10mg 30 Capsules Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine cap 15mg 30 Capsules Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine cap 20mg 30 Capsules Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine cap 25mg 30 Capsules Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine cap 30mg 30 Capsules Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine cap 5mg 30 Capsules Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine tab 10mg 60 Tablets Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine tab 12.mg 60 Tablets Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine tab 15mg 60 Tablets Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine tab 20mg 90 Tablets Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine tab 30mg 60 Tablets Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine tab 5mg 60 Tablets Per 30 Days N/A
ADHD Agents amphetamine/dextroamphetamine tab 7.5mg 60 Tablets Per 30 Days N/A
ADHD Agents atomoxetine cap 10mg 60 Capsules Per 30 Days N/A
ADHD Agents atomoxetine cap 100mg 30 Capsules Per 30 Days N/A
ADHD Agents atomoxetine cap 18mg 60 Capsules Per 30 Days N/A
ADHD Agents atomoxetine cap 25mg 60 Capsules Per 30 Days N/A
ADHD Agents atomoxetine cap 40mg 60 Capsules Per 30 Days N/A
ADHD Agents atomoxetine cap 60mg 30 Capsules Per 30 Days N/A
ADHD Agents atomoxetine cap 80mg 30 Capsules Per 30 Days N/A
ADHD Agents atomoxetine hydrochloride cap 10mg 60 Capsules Per 30 Days N/A
ADHD Agents atomoxetine hydrochloride cap 100mg 30 Capsules Per 30 Days N/A
ADHD Agents atomoxetine hydrochloride cap 18mg 60 Capsules Per 30 Days N/A
ADHD Agents atomoxetine hydrochloride cap 25mg 60 Capsules Per 30 Days N/A
ADHD Agents atomoxetine hydrochloride cap 40mg 60 Capsules Per 30 Days N/A
ADHD Agents atomoxetine hydrochloride cap 60mg 30 Capsules Per 30 Days N/A
ADHD Agents atomoxetine hydrochloride cap 80mg 30 Capsules Per 30 Days N/A
ADHD Agents clonidine hcl er tab 0.1mg 120 Tablets Per 30 Days N/A
ADHD Agents clonidine hydrochloride tab 0.1mg 120 Tablets Per 30 Days N/A
ADHD Agents clonidine hydrochloride er tab 0.1mg 120 Tablets Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl tab 10mg 60 Tablets Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl tab 2.5mg 60 Tablets Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl tab 5mg 60 Tablets Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl er cap 10mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl er cap 15mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl er cap 20mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl er cap 25mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl er cap 30mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl er cap 35mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl er cap 40mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hcl er cap 5mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride cap 25mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride tab 10mg 60 Tablets Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride tab 2.5mg 60 Tablets Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride tab 5mg 60 Tablets Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride er cap 10mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride er cap 15mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride er cap 20mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride er cap 30mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride er cap 35mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride er cap 40mg 30 Capsules Per 30 Days N/A
ADHD Agents dexmethylphenidate hydrochloride er cap 5mg 30 Capsules Per 30 Days N/A
ADHD Agents dextroamphetamine sulfate soln 5mg/5ml 1800 mLs Per 30 Days N/A
ADHD Agents dextroamphetamine sulfate tab 10mg 180 Tablets Per 30 Days N/A
ADHD Agents dextroamphetamine sulfate tab 5mg 90 Tablets Per 30 Days N/A
ADHD Agents dextroamphetamine sulfate er cap 10mg 120 Capsules Per 30 Days N/A
ADHD Agents dextroamphetamine sulfate er cap 15mg 120 Capsules Per 30 Days N/A
ADHD Agents dextroamphetamine sulfate er cap 5mg 90 Capsules Per 30 Days N/A
ADHD Agents guanfacine er tab 1MG 30 Tablets Per 30 Days N/A
ADHD Agents guanfacine er tab 2MG 30 Tablets Per 30 Days N/A
ADHD Agents guanfacine er tab 3MG 30 Tablets Per 30 Days N/A
ADHD Agents guanfacine er tab 4MG 30 Tablets Per 30 Days N/A
ADHD Agents guanfacine hydrochloride tab 1MG 30 Tablets Per 30 Days N/A
ADHD Agents guanfacine hydrochloride tab 2MG 30 Tablets Per 30 Days N/A
ADHD Agents guanfacine hydrochloride tab 3MG 30 Tablets Per 30 Days N/A
ADHD Agents guanfacine hydrochloride tab 4MG 30 Tablets Per 30 Days N/A
ADHD Agents metadate er tab 20mg 90 Tablets Per 30 Days N/A
ADHD Agents methamphetamine hcl tab 5 mg 150 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride tab 10mg 180 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride tab 2.5mg 90 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride tab 5mg 90 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride soln 10mg/5ml 900 mLs Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride soln 5mg/5ml 450 mLs Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride tab 10mg 90 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride tab 20mg 90 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride tab 5mg 90 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride cd cap 10mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride cd cap 20mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride cd cap 30mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride cd cap 40mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride cd cap 50mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride cd cap 60mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 10mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 20mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 10mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 20mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 30mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 40mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 30mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 40mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 50mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er cap 60mg 30 Capsules Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er tab 10mg 90 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er tab 20mg 90 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er tab 27mg 30 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er tab 36mg 60 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er tab 54mg 30 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er tab 18mg 30 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er tab 27mg 30 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er tab 36mg 60 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er tab 54mg 30 Tablets Per 30 Days N/A
ADHD Agents methylphenidate hydrochloride er (la) cap 60mg 30 Capsules Per 30 Days N/A
ADHD Agents procentra soln 5mg/5ml 1800 mLs Per 30 Days N/A
ADHD Agents zenzedi tab 10mg 180 Tablets Per 30 Days N/A
ADHD Agents zenzedi tab 5mg 90 Tablets Per 30 Days N/A
Alinia ALINIA SUSP 100MG/5ML 300 mLs Per 90 Days N/A
Alinia ALINIA TAB 500MG 12 Tablets Per 90 Days N/A
Amantadine ER GOCOVRI CAP 137MG 60 Capsules Per 30 Days N/A
Amantadine ER GOCOVRI CAP 68.MG 30 Capsules Per 30 Days N/A
Amantadine ER OSMOLEX ER TAB 129MG 30 Tablets Per 30 Days N/A
Amantadine ER OSMOLEX ER TAB 193MG 30 Tablets Per 30 Days N/A
Amantadine ER OSMOLEX ER TAB 258MG 30 Tablets Per 30 Days N/A
Ampyra AMPYRA TAB 10MG 60 Tablets Per 30 Days N/A
Ampyra dalfampridine er tab 10mg 60 Tablets Per 30 Days N/A
Androgen/Anabolic Steroids ANDRODERM PATCH 2MG 30 Patches Per 30 Days N/A
Androgen/Anabolic Steroids ANDRODERM PATCH 4MG 30 Patches Per 30 Days N/A
Androgen/Anabolic Steroids ANDROGEL GEL 20.25MG/1.25MG 30 Packets Per 30 Days N/A
Androgen/Anabolic Steroids ANDROGEL GEL 25MG/2.5MG 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids ANDROGEL GEL 40.25MG/2.5GM 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids ANDROGEL GEL 50MG/5GM 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids ANDROGEL PUMP GEL 20.25MG 2 Bottles Per 30 Days N/A
Androgen/Anabolic Steroids ANDROID CAP 10MG 600 Capsules Per 30 Days N/A
Androgen/Anabolic Steroids AVEED INJ 750MG/3ML 1 Vial Per 28 Days N/A
Androgen/Anabolic Steroids DEPO-TESTOSTERONE INJ 100MG/ML 1 Vial Per 28 Days N/A
Androgen/Anabolic Steroids DEPO-TESTOSTERONE INJ 200MG/ML 10 mLs Per 28 Days N/A
Androgen/Anabolic Steroids FORTESTA GEL 10MG 2 Bottles Per 30 Days N/A
Androgen/Anabolic Steroids JATENZO CAP 158MG 60 Capsules Per 30 Days N/A
Androgen/Anabolic Steroids JATENZO CAP 198MG 120 Capsules Per 30 Days N/A
Androgen/Anabolic Steroids JATENZO CAP 237MG 60 Capsules Per 30 Days N/A
Androgen/Anabolic Steroids METHITEST TAB 10MG 600 Capsules Per 30 Days N/A
Androgen/Anabolic Steroids METHYLTESTOSTERONE CAP 10MG 600 Capsules Per 30 Days N/A
Androgen/Anabolic Steroids NATESTO GEL 5.5MG 3 Pumps Per 30 Days N/A
Androgen/Anabolic Steroids STRIANT SYSTEM SteroiMG 60 Systems Per 30 Days N/A
Androgen/Anabolic Steroids TESTIM GEL 50MG/5GM 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids TESTOPEL PELLETS 75MG 6 Pellets Per 90 Days N/A
Androgen/Anabolic Steroids TESTOSTERONE GEL 25MG/2.5GM 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids TESTOSTERONE GEL 50MG/5GM 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids TESTOSTERONE CYPIONATE INJ 200/MG/ML 10 mLs Per 28 Days N/A
Androgen/Anabolic Steroids TESTOSTERONE ENANTHATE INJ 200MG/ML 1 Vial Per 28 Days N/A
Androgen/Anabolic Steroids TESTOSTERONE PUMP GEL 12.5MG/ACT(1%) 4 Pumps Per 30 Days N/A
Androgen/Anabolic Steroids TESTRED CAP 10MG 600 Capsules Per 30 Days N/A
Androgen/Anabolic Steroids VOGELXO GEL 50MG/5GM 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids VOGELXO PUMP GEL 12.5MG/ACT(1%) 4 Pumps Per 30 Days N/A
Androgen/Anabolic Steroids XYOSTED AUTO-INJECTOR 100MG/0.5ML 4 Pens Per 28 Days N/A
Androgen/Anabolic Steroids XYOSTED AUTO-INJECTOR 50MG/0.5ML 4 Pens Per 28 Days N/A
Androgen/Anabolic Steroids XYOSTED AUTO-INJECTOR 75MG/0.5ML 4 Pens Per 28 Days N/A
Androgen/Anabolic Steroids testosterone gel 10mg/act (2%) 2 Bottles Per 30 Days N/A
Androgen/Anabolic Steroids testosterone gel 20.25 mg/1.25gm (1.62%) 30 Packets Per 30 Days N/A
Androgen/Anabolic Steroids testosterone gel 20.25 mg/act (1.62%) 2 Bottles Per 30 Days N/A
Androgen/Anabolic Steroids testosterone gel 25 mg/2.5gm (1%) 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids testosterone gel 40.5 mg/2.5gm (1.62%) 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids testosterone gel 50 mg/5gm (1%) 60 Packets Per 30 Days N/A
Androgen/Anabolic Steroids testosterone soln 30mg/act 2 Bottles Per 30 Days N/A
Androgen/Anabolic Steroids testosterone cypionate inj 100/ml 1 Vial Per 28 Days N/A
Androgen/Anabolic Steroids testosterone cypionate inj oil 200/ml 10 mLs Per 28 Days N/A
Androgen/Anabolic Steroids testosterone enanthate inj 200/ml 1 Vial Per 28 Days N/A
Androgen/Anabolic Steroids TESTOSTERONE PUMP GEL 12.5MG/ACT(1%) 4 Bottles Per 30 Days N/A
Androgen/Anabolic Steroids TESTOSTERONE PUMP GEL 12.5MG/ACT(1%) 2 Bottles Per 30 Days N/A
Androgen/Anabolic Steroids testosterone topical solution 30/mg/act 2 Bottles Per 30 Days N/A
Anticoagulant BEVYXXA CAP 40MG 43 Capsules Per 42 Days N/A
Anticoagulant BEVYXXA CAP 80MG 43 Capsules Per 42 Days N/A
Anticoagulant ELIQUIS TAB 2.5MG 60 Tablets Per 30 Days N/A
Anticoagulant ELIQUIS TAB 5MG 1 Pack Per 180 Days N/A
Anticoagulant ELIQUIS TAB 5MG 74 Tablets Per 30 Days N/A
Anticoagulant ELIQUIS STARTER PACK TAB 5MG 1 Pack Per 180 Days N/A
Anticoagulant ELIQUIS STARTER PACK TAB 5MG 74 Tablets Per 30 Days N/A
Anticoagulant PRADAXA CAP 110MG 71 Capsules Per 90 Days N/A
Anticoagulant PRADAXA CAP 150MG 60 Capsules Per 30 Days N/A
Anticoagulant PRADAXA CAP 75MG 60 Capsules Per 30 Days N/A
Anticoagulant SAVAYSA TAB 15MG 30 Tablets Per 30 Days N/A
Anticoagulant SAVAYSA TAB 30MG 30 Tablets Per 30 Days N/A
Anticoagulant SAVAYSA TAB 60MG 30 Tablets Per 30 Days N/A
Anticoagulant XARELTO TAB 10MG 30 Tablets Per 30 Days N/A
Anticoagulant XARELTO TAB 15MG 60 Tablets Per 30 Days N/A
Anticoagulant XARELTO TAB 2.5MG 60 Tablets Per 30 Days N/A
Anticoagulant XARELTO TAB 20MG 30 Tablets Per 30 Days N/A
Anticoagulant XARELTO STARTER PACK TAB 15MG 51 Tablets Per 30 Days N/A
Antidepressants APLENZIN TAB 174MG 30 Tablets Per 30 Days N/A
Antidepressants APLENZIN TAB 348MG 30 Tablets Per 30 Days N/A
Antidepressants APLENZIN TAB 522MG 30 Tablets Per 30 Days N/A
Antidepressants BUPROPION HYDROCHLORIDE ER (XL) TAB 450MG 30 Tablets Per 30 Days N/A
Antidepressants CELEXA TAB 10MG 30 Tablets Per 30 Days N/A
Antidepressants CELEXA TAB 20MG 30 Tablets Per 30 Days N/A
Antidepressants CELEXA TAB 40MG 30 Tablets Per 30 Days N/A
Antidepressants CYMBALTA CAP 20MG 60 Capsules Per 30 Days N/A
Antidepressants CYMBALTA CAP 30MG 60 Capsules Per 30 Days N/A
Antidepressants CYMBALTA CAP 60MG 60 Capsules Per 30 Days N/A
Antidepressants DESVENLAFAXINE ER TAB 100MG 30 Tablets Per 30 Days N/A
Antidepressants DESVENLAFAXINE ER TAB 50MG 30 Tablets Per 30 Days N/A
Antidepressants DRIZALMA SPRINKLE CAP 20MG 60 Capsules Per 30 Days N/A
Antidepressants DRIZALMA SPRINKLE CAP 30MG 60 Capsules Per 30 Days N/A
Antidepressants DRIZALMA SPRINKLE CAP 40MG 60 Capsules Per 30 Days N/A
Antidepressants DRIZALMA SPRINKLE CAP 60MG 60 Capsules Per 30 Days N/A
Antidepressants EFFEXOR XR CAP 150MG 30 Capsules Per 30 Days N/A
Antidepressants EFFEXOR XR CAP 37.MG 30 Capsules Per 30 Days N/A
Antidepressants EFFEXOR XR CAP 75MG 90 Capsules Per 30 Days N/A
Antidepressants FETZIMA CAP 120MG 30 Capsules Per 30 Days N/A
Antidepressants FETZIMA CAP 20MG 30 Capsules Per 30 Days N/A
Antidepressants FETZIMA CAP 40MG 30 Capsules Per 30 Days N/A
Antidepressants FETZIMA CAP 80MG 30 Capsules Per 30 Days N/A
Antidepressants FETZIMA TITRATION PACK CAP 40MG 28 Capsules Per 180 Days N/A
Antidepressants FLUOXETINE DR CAP 90MG 4 Capsules Per 28 Days N/A
Antidepressants FLUOXETINE HYDROCHLORIDE TAB 60MG 30 Tablets Per 30 Days N/A
Antidepressants FORFIVO XL TAB 450MG 30 Tablets Per 30 Days N/A
Antidepressants KHEDEZLA TAB 100MG 30 Tablets Per 30 Days N/A
Antidepressants KHEDEZLA TAB 50MG 30 Tablets Per 30 Days N/A
Antidepressants LEXAPRO TAB 10MG 30 Tablets Per 30 Days N/A
Antidepressants LEXAPRO TAB 20MG 30 Tablets Per 30 Days N/A
Antidepressants LEXAPRO TAB 5MG 30 Tablets Per 30 Days N/A
Antidepressants MAPROTILINE HCL TAB 25MG 90 Tablets Per 30 Days N/A
Antidepressants MAPROTILINE HCL TAB 50MG 90 Tablets Per 30 Days N/A
Antidepressants MAPROTILINE HCL TAB 75MG 90 Tablets Per 30 Days N/A
Antidepressants PAXIL SUSP 10MG/5ML 900 mLs Per 30 Days N/A
Antidepressants PAXIL TAB 10MG 30 Tablets Per 30 Days N/A
Antidepressants PAXIL TAB 20MG 30 Tablets Per 30 Days N/A
Antidepressants PAXIL TAB 30MG 60 Tablets Per 30 Days N/A
Antidepressants PAXIL TAB 40MG 30 Tablets Per 30 Days N/A
Antidepressants PAXIL CR TAB 12.MG 30 Tablets Per 30 Days N/A
Antidepressants PAXIL CR TAB 25MG 60 Tablets Per 30 Days N/A
Antidepressants PAXIL CR TAB 37.MG 60 Tablets Per 30 Days N/A
Antidepressants PEXEVA TAB 10MG 30 Tablets Per 30 Days N/A
Antidepressants PEXEVA TAB 20MG 30 Tablets Per 30 Days N/A
Antidepressants PEXEVA TAB 30MG 60 Tablets Per 30 Days N/A
Antidepressants PEXEVA TAB 40MG 30 Tablets Per 30 Days N/A
Antidepressants PRISTIQ TAB 100MG 30 Tablets Per 30 Days N/A
Antidepressants PRISTIQ TAB 25MG 30 Tablets Per 30 Days N/A
Antidepressants PRISTIQ TAB 50MG 30 Tablets Per 30 Days N/A
Antidepressants PROZAC CAP 10MG 30 Capsules Per 30 Days N/A
Antidepressants PROZAC CAP 20MG 120 Capsules Per 30 Days N/A
Antidepressants PROZAC CAP 40MG 60 Capsules Per 30 Days N/A
Antidepressants REMERON TAB 15MG 30 Tablets Per 30 Days N/A
Antidepressants REMERON TAB 30MG 30 Tablets Per 30 Days N/A
Antidepressants REMERON SOLTAB TAB 15MG 30 Tablets Per 30 Days N/A
Antidepressants REMERON SOLTAB TAB 30MG 30 Tablets Per 30 Days N/A
Antidepressants REMERON SOLTAB TAB 45MG 30 Tablets Per 30 Days N/A
Antidepressants TRINTELLIX TAB 10MG 30 Tablets Per 30 Days N/A
Antidepressants TRINTELLIX TAB 20MG 30 Tablets Per 30 Days N/A
Antidepressants TRINTELLIX TAB 5MG 30 Tablets Per 30 Days N/A
Antidepressants VIIBRYD TAB 10MG 30 Tablets Per 30 Days N/A
Antidepressants VIIBRYD TAB 20MG 30 Tablets Per 30 Days N/A
Antidepressants VIIBRYD TAB 40MG 30 Tablets Per 30 Days N/A
Antidepressants VIIBRYD STARTER PACK TAB (23)MG 1 Kit Per 180 Days N/A
Antidepressants WELLBUTRIN SR TAB 100MG 60 Tablets Per 30 Days N/A
Antidepressants WELLBUTRIN SR TAB 150MG 60 Tablets Per 30 Days N/A
Antidepressants WELLBUTRIN SR TAB 200MG 60 Tablets Per 30 Days N/A
Antidepressants WELLBUTRIN XL TAB 150MG 30 Tablets Per 30 Days N/A
Antidepressants WELLBUTRIN XL TAB 300MG 30 Tablets Per 30 Days N/A
Antidepressants ZOLOFT CONCENTRATE 20MG/ML 300 mLs Per 30 Days N/A
Antidepressants ZOLOFT TAB 100MG 60 Tablets Per 30 Days N/A
Antidepressants ZOLOFT TAB 25MG 30 Tablets Per 30 Days N/A
Antidepressants ZOLOFT TAB 50MG 30 Tablets Per 30 Days N/A
Antidepressants bupropion hcl tab 100mg 120 Tablets Per 30 Days N/A
Antidepressants bupropion hcl tab 75mg 60 Tablets Per 30 Days N/A
Antidepressants bupropion hydrochloride tab 100mg 120 Tablets Per 30 Days N/A
Antidepressants bupropion hydrochloride tab 75mg 60 Tablets Per 30 Days N/A
Antidepressants bupropion hydrochloride er (sr) tab 100mg 60 Tablets Per 30 Days N/A
Antidepressants bupropion hydrochloride er (sr) tab 150mg 60 Tablets Per 30 Days N/A
Antidepressants bupropion hydrochloride er (sr) tab 200mg 60 Tablets Per 30 Days N/A
Antidepressants bupropion hydrochloride er (xl) tab 150mg 30 Tablets Per 30 Days N/A
Antidepressants bupropion hydrochloride er (xl) tab 300mg 30 Tablets Per 30 Days N/A
Antidepressants citalopram tab 20mg 30 Tablets Per 30 Days N/A
Antidepressants citalopram tab 40mg 30 Tablets Per 30 Days N/A
Antidepressants citalopram hydrobromide soln 10mg 600 mLs Per 30 Days N/A
Antidepressants citalopram hydrobromide tab 10mg 30 Tablets Per 30 Days N/A
Antidepressants citalopram hydrobromide tab 20mg 30 Tablets Per 30 Days N/A
Antidepressants citalopram hydrobromide tab 40mg 30 Tablets Per 30 Days N/A
Antidepressants desvenlafaxine er tab 100mg 30 Tablets Per 30 Days N/A
Antidepressants desvenlafaxine er tab 25mg 30 Tablets Per 30 Days N/A
Antidepressants desvenlafaxine er tab 50mg 30 Tablets Per 30 Days N/A
Antidepressants duloxetine hcl cap 30mg 60 Capsules Per 30 Days N/A
Antidepressants duloxetine hcl cap 40mg 90 Capsules Per 30 Days N/A
Antidepressants duloxetine hydrochloride cap 20mg 60 Capsules Per 30 Days N/A
Antidepressants duloxetine hydrochloride cap 30mg 60 Capsules Per 30 Days N/A
Antidepressants duloxetine hydrochloride cap 40mg 90 Capsules Per 30 Days N/A
Antidepressants duloxetine hydrochloride cap 60mg 60 Capsules Per 30 Days N/A
Antidepressants escitalopram oxalate soln 5mg/5ml 600 mLs Per 30 Days N/A
Antidepressants escitalopram oxalate tab 10mg 30 Tablets Per 30 Days N/A
Antidepressants escitalopram oxalate tab 20mg 30 Tablets Per 30 Days N/A
Antidepressants escitalopram oxalate tab 5mg 30 Tablets Per 30 Days N/A
Antidepressants fluoxetine hcl cap 20mg 120 Capsules Per 30 Days N/A
Antidepressants fluoxetine hcl solution 20mg/5ml 600 mLs Per 30 Days N/A
Antidepressants fluoxetine hydrochloride cap 10mg 30 Capsules Per 30 Days N/A
Antidepressants fluoxetine hydrochloride cap 20mg 120 Capsules Per 30 Days N/A
Antidepressants fluoxetine hydrochloride cap 40mg 60 Capsules Per 30 Days N/A
Antidepressants fluoxetine hcl solution 20mg/5ml 600 mLs Per 30 Days N/A
Antidepressants fluoxetine hydrochloride tab 10mg 30 Tablets Per 30 Days N/A
Antidepressants fluoxetine hydrochloride tab 20mg 120 Tablets Per 30 Days N/A
Antidepressants fluoxetine hydrochloride tab 60mg 30 Tablets Per 30 Days N/A
Antidepressants fluvoxamine maleate tab 100mg 90 Tablets Per 30 Days N/A
Antidepressants fluvoxamine maleate tab 25mg 30 Tablets Per 30 Days N/A
Antidepressants fluvoxamine maleate tab 50mg 30 Tablets Per 30 Days N/A
Antidepressants fluvoxamine maleate er cap 100mg 60 Capsules Per 30 Days N/A
Antidepressants fluvoxamine maleate er cap 150mg 60 Capsules Per 30 Days N/A
Antidepressants mirtazapine tab 15mg 30 Tablets Per 30 Days N/A
Antidepressants mirtazapine tab 30mg 30 Tablets Per 30 Days N/A
Antidepressants mirtazapine tab 45mg 30 Tablets Per 30 Days N/A
Antidepressants mirtazapine tab 7.5mg 30 Tablets Per 30 Days N/A
Antidepressants mirtazapine odt tab 15mg 30 Tablets Per 30 Days N/A
Antidepressants mirtazapine odt tab 30mg 30 Tablets Per 30 Days N/A
Antidepressants mirtazapine odt tab 45mg 30 Tablets Per 30 Days N/A
Antidepressants paroxetine hcl tab 30mg 60 Tablets Per 30 Days N/A
Antidepressants paroxetine hcl tab 40mg 30 Tablets Per 30 Days N/A
Antidepressants paroxetine hcl er tab 12.mg 30 Tablets Per 30 Days N/A
Antidepressants paroxetine hcl er tab 25mg 60 Tablets Per 30 Days N/A
Antidepressants paroxetine hcl er tab 37.mg 60 Tablets Per 30 Days N/A
Antidepressants paroxetine hydrochloride tab 10mg 30 Tablets Per 30 Days N/A
Antidepressants paroxetine hydrochloride tab 20mg 30 Tablets Per 30 Days N/A
Antidepressants paroxetine hydrochloride er tab 12.mg 30 Tablets Per 30 Days N/A
Antidepressants paroxetine hydrochloride er tab 25mg 60 Tablets Per 30 Days N/A
Antidepressants paroxetine hydrochloride er tab 37.mg 60 Tablets Per 30 Days N/A
Antidepressants sertraline hcl concentrate 20mg/ml 300 mLs Per 30 Days N/A
Antidepressants sertraline hcl tab 25mg 30 Tablets Per 30 Days N/A
Antidepressants sertraline hcl tab 50mg 30 Tablets Per 30 Days N/A
Antidepressants sertraline hcl concentrate 20mg/ml 300 mLs Per 30 Days N/A
Antidepressants sertraline hydrochloride tab 100mg 60 Tablets Per 30 Days N/A
Antidepressants sertraline hydrochloride tab 25mg 30 Tablets Per 30 Days N/A
Antidepressants sertraline hydrochloride tab 50mg 30 Tablets Per 30 Days N/A
Antidepressants venlafaxine hcl tab 100mg 90 Tablets Per 30 Days N/A
Antidepressants venlafaxine hcl tab 25mg 90 Tablets Per 30 Days N/A
Antidepressants venlafaxine hcl tab 37.mg 90 Tablets Per 30 Days N/A
Antidepressants venlafaxine hcl tab 50mg 90 Tablets Per 30 Days N/A
Antidepressants venlafaxine hcl tab 75mg 90 Tablets Per 30 Days N/A
Antidepressants venlafaxine hcl er cap 150mg 30 Capsules Per 30 Days N/A
Antidepressants venlafaxine hcl er cap 37.mg 30 Capsules Per 30 Days N/A
Antidepressants venlafaxine hcl er tab 37.mg 30 Tablets Per 30 Days N/A
Antidepressants venlafaxine hydrochloride tab 75mg 90 Tablets Per 30 Days N/A
Antidepressants venlafaxine hydrochloride er cap 75mg 90 Capsules Per 30 Days N/A
Antidepressants venlafaxine hydrochloride er tab 150mg 30 Tablets Per 30 Days N/A
Antidepressants venlafaxine hydrochloride er tab 225mg 30 Tablets Per 30 Days N/A
Antidepressants venlafaxine hydrochloride er tab 37.mg 30 Tablets Per 30 Days N/A
Antidepressants venlafaxine hydrochloride er tab 75mg 90 Tablets Per 30 Days N/A
Antiemetic AKYNZEO CAP -0.5MG 2 Capsules Per 30 Days N/A
Antiemetic ANZEMET TAB 100MG 7 Tablets Per 30 Days N/A
Antiemetic ANZEMET TAB 50MG 7 Tablets Per 30 Days N/A
Antiemetic CESAMET CAP 1MG 42 Capsules Per 30 Days N/A
Antiemetic EMEND CAP 125MG 2 Capsules Per 30 Days N/A
Antiemetic EMEND CAP 80MG 4 Capsules Per 30 Days N/A
Antiemetic EMEND SUSP-MG 125MG/5ML 6 Packs Per 30 Days N/A
Antiemetic EMEND TRIPACK CAP 80 & 125MG 2 Packs Per 30 Days N/A
Antiemetic SANCUSO PATCH 3.1MG 2 Patches Per 30 Days N/A
Antiemetic VARUBI TAB 90MG 4 Tablets Per 30 Days N/A
Antiemetic ZOFRAN SOLN 4MG/5ML 2 Bottles Per 30 Days N/A
Antiemetic ZOFRAN TAB 4MG 21 Tablets Per 30 Days N/A
Antiemetic ZOFRAN TAB 8MG 21 Tablets Per 30 Days N/A
Antiemetic ZOFRAN ODT TAB 4MG 21 Tablets Per 30 Days N/A
Antiemetic ZOFRAN ODT TAB 8MG 21 Tablets Per 30 Days N/A
Antiemetic ZUPLENZ FILM 4MG 2 Boxes Per 30 Days N/A
Antiemetic ZUPLENZ FILM 8MG 2 Boxes Per 30 Days N/A
Antiemetic aprepitant cap 125MG 2 Capsules Per 30 Days N/A
Antiemetic aprepitant cap 80MG 4 Capsules Per 30 Days N/A
Antiemetic aprepitant cap 80 & 125mg 6 Capsules Per 30 Days N/A
Antiemetic granisetron hcl tab 1mg 14 Tablets Per 30 Days N/A
Antiemetic ondansetron hcl soln 4mg/5ml 2 Bottles Per 30 Days N/A
Antiemetic ondansetron hcl tab 24mg 1 Tablet Per 30 Days N/A
Antiemetic ondansetron hydrochloride tab 4 mg 21 Tablets Per 30 Days N/A
Antiemetic ondansetron hydrochloride tab 8 mg 21 Tablets Per 30 Days N/A
Antiemetic ondansetron odt tab 4mg 21 Tablets Per 30 Days N/A
Antiemetic ondansetron odt tab 8mg 21 Tablets Per 30 Days N/A
Antiemetic Agents ONDANSETRON HCL TAB 24MG 1 Tablet Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) JUBLIA SOLN 10% 4 mLs Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) KERYDIN SOLN 5% 4 mLs Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) LAMISIL TABL 250MG 30 Tablets Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) ONMEL TAB 200MG 30 Tablets Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) PENLAC NAIL LACQUER SOLN 8% 7 mLs Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) SPORANOXCAP 100MG 120 Capsules Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) SPORANOX SOLN 10MG/ML 1200 mLs Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) SPORANOX PULSEPAK CAP 100MG 120 Capsules Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) TOLSURA CAP 65MG 120 Capsules Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) ciclodan soln 8% 7 mLs Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) ciclopirox nail lacquer soln 8% 7 mLs Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) itraconazole cap 100mg 120 Capsules Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) itraconazole soln 10mg/ml 1200 mLs Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) terbinafine hcl tab 250mg 30 Tablets Per 30 Days N/A
Antifungal (Lamisil/Sporanox/Penlac) terbinafine hydrochloride tab 250mg 30 Tablets Per 30 Days N/A
Anti-Influenza TAMIFLU CAP 30MG 40 Capsules Per 120 Days N/A
Anti-Influenza TAMIFLU CAP 45MG 20 Capsules Per 120 Days N/A
Anti-Influenza TAMIFLU CAP 75MG 20 Capsules Per 120 Days N/A
Anti-Influenza TAMIFLU SUSP 6MG/ML 300 mLs Per 120 Days N/A
Anti-Influenza XOFLUZA TAB (2)MG 4 Tablets Per 120 Days N/A
Anti-Influenza XOFLUZA TAB (2)MG 4 Tablets Per 120 Days N/A
Anti-Influenza oseltamivir phosphate cap 30mg 40 Capsules Per 120 Days N/A
Anti-Influenza oseltamivir phosphate cap 45mg 20 Capsules Per 120 Days N/A
Anti-Influenza oseltamivir phosphate cap 75mg 20 Capsules Per 120 Days N/A
Anti-Influenza oseltamivir phosphate susp 6mg/ml 300 mLs Per 120 Days N/A
Antiretroviral APTIVUS CAP 250MG 120 Capsules Per 30 Days N/A
Antiretroviral APTIVUS SOLN 100MG/ML 380 mLs Per 30 Days N/A
Antiretroviral ATRIPLA TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral BIKTARVY TAB -25MG 30 Tablets Per 30 Days N/A
Antiretroviral CIMDUO TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral COMBIVIR TAB -300MG 60 Tablets Per 30 Days N/A
Antiretroviral COMPLERA TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral CRIXIVAN CAP 200MG 270 Capsules Per 30 Days N/A
Antiretroviral CRIXIVAN CAP 400MG 180 Capsules Per 30 Days N/A
Antiretroviral DELSTRIGO TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral DESCOVY TAB -25MG 30 Tablets Per 30 Days N/A
Antiretroviral DIDANOSINE CAP 200MG 30 Capsules Per 30 Days N/A
Antiretroviral DIDANOSINE CAP 400MG 30 Capsules Per 30 Days N/A
Antiretroviral DOVATO TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral EDURANT TAB 25MG 30 Tablets Per 30 Days N/A
Antiretroviral EMTRIVA CAP 200MG 30 Capsules Per 30 Days N/A
Antiretroviral EMTRIVA SOLN 10MG/ML 680 mLs Per 28 Days N/A
Antiretroviral EMTRIVA SOLN 10MG/ML 960 mLs Per 30 Days N/A
Antiretroviral EPIVIR TAB 150MG 60 Tablets Per 30 Days N/A
Antiretroviral EPIVIR TAB 300MG 30 Tablets Per 30 Days N/A
Antiretroviral EPZICOM TAB 300MG 30 Tablets Per 30 Days N/A
Antiretroviral EVOTAZ TAB 150MG 30 Tablets Per 30 Days N/A
Antiretroviral FUZEON INJ 90MG 60 Vials Per 30 Days N/A
Antiretroviral GENVOYA TAB -10MG 30 Tablets Per 30 Days N/A
Antiretroviral INTELENCE TAB 100MG 60 Tablets Per 30 Days N/A
Antiretroviral INTELENCE TAB 200MG 60 Tablets Per 30 Days N/A
Antiretroviral INTELENCE TAB 25MG 120 Tablets Per 30 Days N/A
Antiretroviral INVIRASE CAP 200MG 300 Capsules Per 30 Days N/A
Antiretroviral INVIRASE TAB 500MG 120 Tablets Per 30 Days N/A
Antiretroviral ISENTRESS TAB 100MG 180 Tablets Per 30 Days N/A
Antiretroviral ISENTRESS TAB 25MG 180 Tablets Per 30 Days N/A
Antiretroviral ISENTRESS SUSP 100MG 60 Packets Per 30 Days N/A
Antiretroviral ISENTRESS TAB 400MG 60 Tablets Per 30 Days N/A
Antiretroviral ISENTRESS HD TAB 600MG 60 Tablets Per 30 Days N/A
Antiretroviral JULUCA TAB -25MG 30 Tablets Per 30 Days N/A
Antiretroviral KALETRA SOLN 400-100 MG/5ML 480 mLs Per 30 Days N/A
Antiretroviral KALETRA TAB -25MG 180 Tablets Per 30 Days N/A
Antiretroviral KALETRA TAB -50MG 120 Tablets Per 30 Days N/A
Antiretroviral LEXIVA SUSP 50MG/ML 1800 mLs Per 30 Days N/A
Antiretroviral LEXIVA TAB 700MG 120 Tablets Per 30 Days N/A
Antiretroviral NEVIRAPINE ER TAB 100MG 90 Tablets Per 30 Days N/A
Antiretroviral NORVIR CAP 100MG 360 Capsules Per 30 Days N/A
Antiretroviral NORVIR SOLN 80MG/ML 480 mLs Per 30 Days N/A
Antiretroviral NORVIR POWDER 100MG 360 Packets Per 30 Days N/A
Antiretroviral NORVIR TAB 100MG 360 Tablets Per 30 Days N/A
Antiretroviral ODEFSEY TAB -25MG 30 Tablets Per 30 Days N/A
Antiretroviral PIFELTRO TAB 100MG 30 Tablets Per 30 Days N/A
Antiretroviral PREZCOBIX TAB -150MG 30 Tablets Per 30 Days N/A
Antiretroviral PREZISTA SUSP 100 MG/ML 400 mLs Per 30 Days N/A
Antiretroviral PREZISTA TAB 150MG 180 Tablets Per 30 Days N/A
Antiretroviral PREZISTA TAB 600MG 60 Tablets Per 30 Days N/A
Antiretroviral PREZISTA TAB 75MG 300 Tablets Per 30 Days N/A
Antiretroviral PREZISTA TAB 800MG 30 Tablets Per 30 Days N/A
Antiretroviral RELENZA DISKHALER POWDER 5MG 40 Blisters Per 120 Days N/A
Antiretroviral RESCRIPTOR TAB 100MG 360 Tablets Per 30 Days N/A
Antiretroviral RESCRIPTOR TAB 200MG 180 Tablets Per 30 Days N/A
Antiretroviral RETROVIR CAP 100MG 180 Capsules Per 30 Days N/A
Antiretroviral RETROVIR SYRUP 10MG/ML 1920 mLs Per 30 Days N/A
Antiretroviral REYATAZ CAP 150MG 30 Capsules Per 30 Days N/A
Antiretroviral REYATAZ CAP 200MG 60 Capsules Per 30 Days N/A
Antiretroviral REYATAZ CAP 300MG 30 Capsules Per 30 Days N/A
Antiretroviral REYATAZ POWDER 50MG 240 Packets Per 30 Days N/A
Antiretroviral SELZENTRY SOLN 20MG/ML 1840 mLs Per 30 Days N/A
Antiretroviral SELZENTRY TAB 150MG 60 Tablets Per 30 Days N/A
Antiretroviral SELZENTRY TAB 25MG 240 Tablets Per 30 Days N/A
Antiretroviral SELZENTRY TAB 300MG 120 Tablets Per 30 Days N/A
Antiretroviral SELZENTRY TAB 75MG 60 Tablets Per 30 Days N/A
Antiretroviral STRIBILD TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral SUSTIVA CAP 200MG 60 Capsules Per 30 Days N/A
Antiretroviral SUSTIVA CAP 50MG 90 Capsules Per 30 Days N/A
Antiretroviral SUSTIVA TAB 600MG 30 Tablets Per 30 Days N/A
Antiretroviral SYMFI TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral SYMFI LO TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral SYMTUZA TAB -10MG 30 Tablets Per 30 Days N/A
Antiretroviral TEMIXYS TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral TIVICAY TAB 10MG 60 Tablets Per 30 Days N/A
Antiretroviral TIVICAY TAB 25MG 60 Tablets Per 30 Days N/A
Antiretroviral TIVICAY TAB 50MG 60 Tablets Per 30 Days N/A
Antiretroviral TRIUMEQ TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral TRIZIVIR TAB -300MG 60 Tablets Per 30 Days N/A
Antiretroviral TRUVADA TAB -150MG 30 Tablets Per 30 Days N/A
Antiretroviral TRUVADA TAB -200MG 30 Tablets Per 30 Days N/A
Antiretroviral TRUVADA TAB -250MG 30 Tablets Per 30 Days N/A
Antiretroviral TRUVADA TAB -300MG 30 Tablets Per 30 Days N/A
Antiretroviral TYBOST TAB 150MG 30 Tablets Per 30 Days N/A
Antiretroviral VIDEX SOLN 2GM 1200 mLs Per 30 Days N/A
Antiretroviral VIDEX SOLN 4GM 1200 mLs Per 30 Days N/A
Antiretroviral VIDEX EC CAPSULE 125MG 30 Capsules Per 30 Days N/A
Antiretroviral VIDEX EC CAPSULE 200MG 30 Capsules Per 30 Days N/A
Antiretroviral VIDEX EC CAPSULE 250MG 30 Capsules Per 30 Days N/A
Antiretroviral VIDEX EC CAPSULE 400MG 30 Capsules Per 30 Days N/A
Antiretroviral VIRACEPT TAB 250MG 270 Tablets Per 30 Days N/A
Antiretroviral VIRACEPT TAB 625MG 120 Tablets Per 30 Days N/A
Antiretroviral VIRACEPT SUSP 50MG/5ML 1200 mLs Per 30 Days N/A
Antiretroviral VIRAMUNE TAB 200MG 60 Tablets Per 30 Days N/A
Antiretroviral VIRAMUNE XR TAB 100MG 90 Tablets Per 30 Days N/A
Antiretroviral VIRAMUNE XR TAB 400MG 30 Tablets Per 30 Days N/A
Antiretroviral VIREAD POWDER 40 MG/GM 4 Bottles Per 30 Days N/A
Antiretroviral VIREAD TAB 150MG 30 Tablets Per 30 Days N/A
Antiretroviral VIREAD TAB 200MG 30 Tablets Per 30 Days N/A
Antiretroviral VIREAD TAB 250MG 30 Tablets Per 30 Days N/A
Antiretroviral VIREAD TAB 300MG 30 Tablets Per 30 Days N/A
Antiretroviral ZERIT CAP 15MG 60 Capsules Per 30 Days N/A
Antiretroviral ZERIT CAP 20MG 60 Capsules Per 30 Days N/A
Antiretroviral ZERIT CAP 30MG 60 Capsules Per 30 Days N/A
Antiretroviral ZERIT CAP 40MG 60 Capsules Per 30 Days N/A
Antiretroviral ZERIT SOLN 1MG/ML 2400 mLs Per 30 Days N/A
Antiretroviral ZIAGEN SOLN 20 MG/ML 960 mLs Per 30 Days N/A
Antiretroviral ZIAGEN TAB 300MG 60 Tablets Per 30 Days N/A
Antiretroviral abacavir soln 20 mg/ml 960 mLs Per 30 Days N/A
Antiretroviral abacavir tab 300mg 60 Tablets Per 30 Days N/A
Antiretroviral abacavir sulfate tab 300mg 60 Tablets Per 30 Days N/A
Antiretroviral abacavir sulfate/lamivudine tab -300mg 30 Tablets Per 30 Days N/A
Antiretroviral abacavir sulfate/lamivudine/zidovudine tab -300mg 60 Tablets Per 30 Days N/A
Antiretroviral atazanavir cap 150mg 30 Capsules Per 30 Days N/A
Antiretroviral atazanavir cap 200mg 60 Capsules Per 30 Days N/A
Antiretroviral atazanavir sulfate cap 150mg 30 Capsules Per 30 Days N/A
Antiretroviral atazanavir sulfate cap 200mg 60 Capsules Per 30 Days N/A
Antiretroviral atazanavir sulfate cap 300mg 30 Capsules Per 30 Days N/A
Antiretroviral didanosine cap 200mg 30 Capsules Per 30 Days N/A
Antiretroviral didanosine cap 250mg 30 Capsules Per 30 Days N/A
Antiretroviral didanosine cap 400mg 30 Capsules Per 30 Days N/A
Antiretroviral efavirenz cap 200mg 60 Capsules Per 30 Days N/A
Antiretroviral efavirenz cap 50mg 90 Capsules Per 30 Days N/A
Antiretroviral efavirenz tab 600mg 30 Tablets Per 30 Days N/A
Antiretroviral fosamprenavir calcium tab 700mg 120 Tablets Per 30 Days N/A
Antiretroviral lamivudine soln 10mg/ml 960 mLs Per 30 Days N/A
Antiretroviral lamivudine tab 150mg 60 Tablets Per 30 Days N/A
Antiretroviral lamivudine tab 300mg 30 Tablets Per 30 Days N/A
Antiretroviral lamivudine/zidovudine tab -300mg 60 Tablets Per 30 Days N/A
Antiretroviral lopinavir/ritonavir soln 400-100 mg/5ml 480 mLs Per 30 Days N/A
Antiretroviral nevirapine susp 50mg/5mg 1200 mLs Per 30 Days N/A
Antiretroviral nevirapine tab 200mg 60 Tablets Per 30 Days N/A
Antiretroviral nevirapine er tab 100mg 90 Tablets Per 30 Days N/A
Antiretroviral nevirapine er tab 400mg 30 Tablets Per 30 Days N/A
Antiretroviral ritonavir tab 100mg 360 Tablets Per 30 Days N/A
Antiretroviral stavudine cap 15mg 60 Capsules Per 30 Days N/A
Antiretroviral stavudine cap 20mg 60 Capsules Per 30 Days N/A
Antiretroviral stavudine cap 30mg 60 Capsules Per 30 Days N/A
Antiretroviral stavudine cap 40mg 60 Capsules Per 30 Days N/A
Antiretroviral tenofovir disoproxil fumarate tab 300mg 30 Tablets Per 30 Days N/A
Antiretroviral zidovudine cap 100mg 180 Capsules Per 30 Days N/A
Antiretroviral zidovudine syrup 10mg 1920 mLs Per 30 Days N/A
Antiretroviral zidovudine tab 300mg 60 Tablets Per 30 Days N/A
Arikayce ARIKAYCE SUSP 590MG/8.4ML 28 Vials Per 28 Days N/A
ATTR Amlyoidosis TEGSEDI SYR 284MG/1.5ML 4 Syringes Per 28 Days N/A
ATTR Amlyoidosis VYNDAMAX CAP 61MG 30 Capsules Per 30 Days N/A
ATTR Amlyoidosis VYNDAQEL CAP 20MG 120 Capsules Per 30 Days N/A
Atypical Antipsychotics ABILIFY TAB 10MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY TAB 15MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY TAB 2MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY TAB 20MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY TAB 30MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY TAB 5MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY MAINTENA SUSP 300MG 1 Syringe Per 28 Days N/A
Atypical Antipsychotics ABILIFY MAINTENA SUSP 400MG 1 Syringe Per 28 Days N/A
Atypical Antipsychotics ABILIFY MAINTENA SUSP 300MG 1 Vial Per 28 Days N/A
Atypical Antipsychotics ABILIFY MAINTENA SUSP 400MG 1 Vial Per 28 Days N/A
Atypical Antipsychotics ABILIFY MYCITE TAB 10MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY MYCITE TAB 15MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY MYCITE TAB 2MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY MYCITE TAB 20MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY MYCITE TAB 30MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ABILIFY MYCITE TAB 5MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ARISTADA SYRP 1064MG/3.9ML 1 Syringe Per 56 Days N/A
Atypical Antipsychotics ARISTADA SYRP 441MG/1.6ML 1 Syringe Per 28 Days N/A
Atypical Antipsychotics ARISTADA SYRP 662MG/2.4ML 1 Syringe Per 28 Days N/A
Atypical Antipsychotics ARISTADA SYRP 882MG/3.2ML 1 Syringe Per 28 Days N/A
Atypical Antipsychotics ARISTADA SYRP 675MG/2.4ML 1 Kit Per 180 Days N/A
Atypical Antipsychotics CAPLYTA CAP 42MG 30 Capsules Per 30 Days N/A
Atypical Antipsychotics CLOZAPINE ODT TAB 12.MG 90 Tablets Per 30 Days N/A
Atypical Antipsychotics CLOZAPINE ODT TAB 150MG 180 Tablets Per 30 Days N/A
Atypical Antipsychotics CLOZAPINE ODT TAB 200MG 120 Tablets Per 30 Days N/A
Atypical Antipsychotics CLOZARIL TAB 100MG 270 Tablets Per 30 Days N/A
Atypical Antipsychotics CLOZARIL TAB 200MG 120 Tablets Per 30 Days N/A
Atypical Antipsychotics CLOZARIL TAB 25MG 90 Tablets Per 30 Days N/A
Atypical Antipsychotics CLOZARIL TAB 50MG 90 Tablets Per 30 Days N/A
Atypical Antipsychotics FANAPT TAB 1MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics FANAPT TAB 10MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics FANAPT TAB 12MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics FANAPT TAB 2MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics FANAPT TAB 4MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics FANAPT TAB 6MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics FANAPT TAB 8MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics FANAPT TITRATION PACK TAB 1MG & 2 MG & 4 MG & 6MG 1 Pack Per 180 Days N/A
Atypical Antipsychotics FAZACLO TAB 100MG 90 Tablets Per 30 Days N/A
Atypical Antipsychotics FAZACLO TAB 12.MG 90 Tablets Per 30 Days N/A
Atypical Antipsychotics FAZACLO TAB 150MG 180 Tablets Per 30 Days N/A
Atypical Antipsychotics FAZACLO TAB 200MG 120 Tablets Per 30 Days N/A
Atypical Antipsychotics FAZACLO TAB 25MG 270 Tablets Per 30 Days N/A
Atypical Antipsychotics GEODON CAP 20MG 60 Capsules Per 30 Days N/A
Atypical Antipsychotics GEODON CAP 40MG 60 Capsules Per 30 Days N/A
Atypical Antipsychotics GEODON CAP 60MG 60 Capsules Per 30 Days N/A
Atypical Antipsychotics GEODON CAP 80MG 60 Capsules Per 30 Days N/A
Atypical Antipsychotics GEODON INJ 20MG 2 Vials Per 30 Days N/A
Atypical Antipsychotics INVEGA TAB 1.5MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics INVEGA TAB 3MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics INVEGA TAB 6MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics INVEGA TAB 9MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics INVEGA SUSTENNA SYRP 117MG/0.75ML 1 Syringe Per 28 Days N/A
Atypical Antipsychotics INVEGA SUSTENNA SYRP 156MG/ML 1 Syringe Per 28 Days N/A
Atypical Antipsychotics INVEGA SUSTENNA SYRP 234MG/1.5ML 1 Syringe Per 28 Days N/A
Atypical Antipsychotics INVEGA SUSTENNA SYRP 39MG/0.25ML 1 Syringe Per 28 Days N/A
Atypical Antipsychotics INVEGA SUSTENNA SYRP 78MG/0.5ML 1 Syringe Per 28 Days N/A
Atypical Antipsychotics INVEGA TRINZA SYRP 273MG/0.875ML 1 Syringe Per 90 Days N/A
Atypical Antipsychotics INVEGA TRINZA SYRP 410MG/1.315ML 1 Syringe Per 90 Days N/A
Atypical Antipsychotics INVEGA TRINZA SYRP 410MG/1.315ML 1 Syringe Per 90 Days N/A
Atypical Antipsychotics INVEGA TRINZA SYRP 819MG/2.625ML 1 Syringe Per 90 Days N/A
Atypical Antipsychotics LATUDA TAB 120MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics LATUDA TAB 20MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics LATUDA TAB 40MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics LATUDA TAB 60MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics LATUDA TAB 80MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics PERSERIS SYR 120MG 1 Kit Per 30 Days N/A
Atypical Antipsychotics PERSERIS SYR 90MG 1 Kit Per 30 Days N/A
Atypical Antipsychotics REXULTI TAB 0.2MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics REXULTI TAB 0.5MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics REXULTI TAB 1MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics REXULTI TAB 2MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics REXULTI TAB 3MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics REXULTI TAB 4MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics REXULTI SOLN 1MG/ML 480 mLs Per 30 Days N/A
Atypical Antipsychotics RISPERDAL TAB 0.2MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERDAL TAB 0.5MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERDAL TAB 1MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERDAL TAB 2MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERDAL TAB 3MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERDAL TAB 4MG 120 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERDAL CONSTA SUSP 12.5 2 Vials Per 28 Days N/A
Atypical Antipsychotics RISPERDAL CONSTA SUSP 25MG 2 Vials Per 28 Days N/A
Atypical Antipsychotics RISPERDAL CONSTA SUSP 37.5MG 2 Vials Per 28 Days N/A
Atypical Antipsychotics RISPERDAL CONSTA SUSP 50MG 2 Vials Per 28 Days N/A
Atypical Antipsychotics RISPERDAL M-TAB TAB 0.5MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERDAL M-TAB TAB 1MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERDAL M-TAB TAB 3MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERDAL M-TAB TAB 4MG 120 Tablets Per 30 Days N/A
Atypical Antipsychotics RISPERIDONE ODT TAB 0.2MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics SAPHRIS TAB 10MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics SAPHRIS TAB 2.5MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics SAPHRIS TAB-MG TAB 5 MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics SECUADO PATCH 3.8MG 30 Patches Per 30 Days N/A
Atypical Antipsychotics SECUADO PATCH 5.7MG 30 Patches Per 30 Days N/A
Atypical Antipsychotics SECUADO PATCH 7.6MG 30 Patches Per 30 Days N/A
Atypical Antipsychotics SEROQUEL TAB 100MG 90 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL TAB 200MG 90 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL TAB 25MG 90 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL TAB 300MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL TAB 400MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL TAB 50MG 90 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL XR TAB 150MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL XR TAB 200MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL XR TAB 300MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL XR TAB 400MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics SEROQUEL XR TAB 50MG 60 Tablets Per 30 Days N/A
Atypical Antipsychotics VERSACLOZ SUSP 50 MG/ML 540 mLs Per 30 Days N/A
Atypical Antipsychotics VRAYLAR CAP 1.5MG 30 Capsules Per 30 Days N/A
Atypical Antipsychotics VRAYLAR CAP 3MG 30 Capsules Per 30 Days N/A
Atypical Antipsychotics VRAYLAR CAP 4.5MG 30 Capsules Per 30 Days N/A
Atypical Antipsychotics VRAYLAR CAP 6MG 30 Capsules Per 30 Days N/A
Atypical Antipsychotics VRAYLAR CAP 1.5MG & 3mg 7 Capsules Per 180 Days N/A
Atypical Antipsychotics ZYPREXA INJ 10MG 90 Vials Per 30 Days N/A
Atypical Antipsychotics ZYPREXA TAB 10MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ZYPREXA TAB 15MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ZYPREXA TAB 2.5MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ZYPREXA TAB 20MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ZYPREXA TAB 5MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ZYPREXA TAB 7.5MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ZYPREXA RELPREVV SUSP 210MG 2 Vials Per 28 Days N/A
Atypical Antipsychotics ZYPREXA RELPREVV SUSP 300MG 2 Vials Per 28 Days N/A
Atypical Antipsychotics ZYPREXA RELPREVV SUSP 405MG 1 Vial Per 28 Days N/A
Atypical Antipsychotics ZYPREXA ZYDIS TAB 10MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ZYPREXA ZYDIS TAB 15MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ZYPREXA ZYDIS TAB 20MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics ZYPREXA ZYDIS TAB 5MG 30 Tablets Per 30 Days N/A
Atypical Antipsychotics aripiprazole solution 1mg/ml 900 mLs Per 30 Days N/A
Atypical Antipsychotics aripiprazole tab 10mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics aripiprazole tab 15mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics aripiprazole tab 2mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics aripiprazole tab 20mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics aripiprazole tab 30mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics aripiprazole tab 5mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics aripiprazole odt tab 10mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics aripiprazole odt tab 15mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics clozapine tab 100mg 270 Tablets Per 30 Days N/A
Atypical Antipsychotics clozapine tab 200mg 120 Tablets Per 30 Days N/A
Atypical Antipsychotics clozapine tab 25mg 90 Tablets Per 30 Days N/A
Atypical Antipsychotics clozapine tab 50mg 90 Tablets Per 30 Days N/A
Atypical Antipsychotics clozapine odt tab 100mg 90 Tablets Per 30 Days N/A
Atypical Antipsychotics clozapine odt tab 25mg 270 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine inj 10mg 90 Vials Per 30 Days N/A
Atypical Antipsychotics olanzapine tab 10mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine tab 15mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine tab 2.5mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine tab 20mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine tab 5mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine tab 7.5mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine odt tab 10mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine odt tab 15mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine odt tab 20mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics olanzapine odt tab 5mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics paliperidone er tab 1.5mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics paliperidone er tab 3mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics paliperidone er tab 6mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics paliperidone er tab 9mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate tab 100mg 90 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate tab 200mg 90 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate tab 25mg 90 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate tab 300mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate tab 400mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate tab 50mg 90 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate er tab 150mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate er tab 200mg 30 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate er tab 300mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate er tab 400mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics quetiapine fumarate er tab 50mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone soln 1mg/ml 480 mLs Per 30 Days N/A
Atypical Antipsychotics risperidone tab 0.2mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone tab 0.5mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone tab 1mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone tab 2mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone tab 3mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone tab 4mg 120 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone m-tab tab 0.5mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone m-tab tab 1mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone m-tab tab 2mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone odt tab 0.5mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone odt tab 1mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone odt tab 2mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone odt tab 3mg 60 Tablets Per 30 Days N/A
Atypical Antipsychotics risperidone odt tab 4mg 120 Tablets Per 30 Days N/A
Atypical Antipsychotics ziprasidone hcl cap 20mg 60 Capsules Per 30 Days N/A
Atypical Antipsychotics ziprasidone hcl cap 40mg 60 Capsules Per 30 Days N/A
Atypical Antipsychotics ziprasidone hcl cap 60mg 60 Capsules Per 30 Days N/A
Atypical Antipsychotics ziprasidone hcl cap 80mg 60 Capsules Per 30 Days N/A
Atypical Antipsychotics ziprasidone hydrochloride cap 20mg 60 Capsules Per 30 Days N/A
Atypical Antipsychotics ziprasidone hydrochloride cap 40mg 60 Capsules Per 30 Days N/A
Atypical Antipsychotics ziprasidone hydrochloride cap 60mg 60 Capsules Per 30 Days N/A
Atypical Antipsychotics ziprasidone hydrochloride cap 80mg 60 Capsules Per 30 Days N/A
Benlysta BENLYSTA AUTO-INJECTOR 200 MG/ML 4 Syringes Per 28 Days N/A
Benlysta BENLYSTA SOLN 200MG/ML 4 Syringes Per 28 Days N/A
Biologic Immunomodulators ACTEMRA SOLN 162MG/0.9ML 4 Syringes Per 28 Days N/A
Biologic Immunomodulators ACTEMRA ACTPEN 162G/0.9ML 4 Injections Per 28 Days N/A
Biologic Immunomodulators CIMZIA INJ 200MG/ML 2 Kits Per 28 Days N/A
Biologic Immunomodulators CIMZIA STARTER KIT INJ 200MG/ML 3 Kits Per 180 Days N/A
Biologic Immunomodulators COSENTYX SYRP 150MG/ML 1 Pack Per 28 Days N/A
Biologic Immunomodulators COSENTYX SYRP 150MG/ML 1 Syringe Per 28 Days N/A
Biologic Immunomodulators COSENTYX SOLN 150MG/ML 1 Syringe Per 28 Days N/A
Biologic Immunomodulators COSENTYX SENSOREADY PEN AUTO-INJ 150MG/ML 1 Injection Device Per 28 Days N/A
Biologic Immunomodulators COSENTYX SENSOREADY PEN AUTO-INJ 150MG/ML 1 Pack Per 28 Days N/A
Biologic Immunomodulators COSENTYX SENSOREADY PEN SOLN 150MG/ML 1 Injection Device Per 28 Days N/A
Biologic Immunomodulators COSENTYX SENSOREADY PEN SOLN 150MG/ML 1 Pack Per 28 Days N/A
Biologic Immunomodulators ENBREL INJ 25MG 8 Vials Per 28 Days N/A
Biologic Immunomodulators ENBREL SOLN 25MG/0.5ML 4 Syringes Per 28 Days N/A
Biologic Immunomodulators ENBREL SOLN 50MG/ML 4 Syringes Per 28 Days N/A
Biologic Immunomodulators ENBREL MINI SOLN 50NG/ML 4 CARTS Per 28 Days N/A
Biologic Immunomodulators ENBREL SURECLICK SOLN 50MG/ML 4 Pens Per 28 Days N/A
Biologic Immunomodulators HUMIRA SYRINGE 10MG/0.1ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators HUMIRA SYRINGE 10MG/0.2ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators HUMIRA SYRINGE 20MG/0.2ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators HUMIRA SYRINGE 20MG/0.2ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators HUMIRA SYRINGE 40MG/0.4ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators HUMIRA SYRINGE 40MG/0.8ML 1 Kit Per 180 Days N/A
Biologic Immunomodulators HUMIRA SYRINGE 40MG/0.8ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators HUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK SYRINGE 40MG/0.8ML 1 Kit Per 180 Days N/A
Biologic Immunomodulators HUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK SYRINGE 40MG/0.8ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators HUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK SYRINGE 80MG/0.8ML 3 Kits Per 180 Days N/A
Biologic Immunomodulators HUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK SYRINGE 80MG/0.8ML & 40MG/0.4ML 1 Kit Per 180 Days N/A
Biologic Immunomodulators HUMIRA PEN INJ 40MG/0.4ML 2 Pens Per 28 Days N/A
Biologic Immunomodulators HUMIRA PEN INJ 40MG/0.8ML 1 Kit Per 180 Days N/A
Biologic Immunomodulators HUMIRA PEN INJ 40MG/0.8ML 2 Pens Per 28 Days N/A
Biologic Immunomodulators HUMIRA PEN-CD/UC/HS STARTER INJ 40MG/0.8ML 1 Kit Per 180 Days N/A
Biologic Immunomodulators HUMIRA PEN-CD/UC/HS STARTER INJ 40MG/0.8ML 2 Pens Per 28 Days N/A
Biologic Immunomodulators HUMIRA PEN-CD/UC/HS STARTER INJ 40MG/0.8ML 1 Kit Per 180 Days N/A
Biologic Immunomodulators HUMIRA PEN-PS/UV STARTER INJ 40MG/0.8ML 1 Kit Per 180 Days N/A
Biologic Immunomodulators HUMIRA PEN-PS/UV STARTER INJ 40MG/0.8ML 2 Pens Per 28 Days N/A
Biologic Immunomodulators HUMIRA PEN-PS/UV STARTER INJ 40MG/0.8ML & 40MG/0.4ML 1 Kit Per 180 Days N/A
Biologic Immunomodulators KEVZARA SOLN 150MG/1.14ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators KEVZARA SOLN 200MG/1.14ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators KEVZARA SOLN 150MG/1.14ML 2 Pens Per 28 Days N/A
Biologic Immunomodulators KEVZARA SOLN 200MG/1.14ML 2 Pens Per 28 Days N/A
Biologic Immunomodulators KINERET SOLN 100MG/0.67ML 28 Syringes Per 30 Days N/A
Biologic Immunomodulators OLUMIANT TAB 1MG 30 Tablets Per 30 Days N/A
Biologic Immunomodulators OLUMIANT TAB 2MG 30 Tablets Per 30 Days N/A
Biologic Immunomodulators ORENCIA SOLN 125MG/ML 4 Syringes Per 28 Days N/A
Biologic Immunomodulators ORENCIA SOLN 50MG/0.4ML 4 Syringes Per 28 Days N/A
Biologic Immunomodulators ORENCIA SOLN 87.5MG/0.7ML 4 Syringes Per 28 Days N/A
Biologic Immunomodulators ORENCIA CLICKJECT SOLN 125MG/ML 4 Syringes Per 28 Days N/A
Biologic Immunomodulators RINVOQ TAB 15MG 30 Tablets Per 30 Days N/A
Biologic Immunomodulators SILIQ SOLN 210MG/1.5ML 2 Syringes Per 28 Days N/A
Biologic Immunomodulators SIMPONI SOLN 100MG/ML 1 Syringe Per 28 Days N/A
Biologic Immunomodulators SIMPONI SOLN 50MG/0.5ML 1 Syringe Per 28 Days N/A
Biologic Immunomodulators SIMPONI SOLN 100MG/ML 1 Syringe Per 28 Days N/A
Biologic Immunomodulators SIMPONI SOLN 50MG/0.5ML 1 Syringe Per 28 Days N/A
Biologic Immunomodulators SKYRIZI SOLN 2x75MG/0.83ML 1 Box Per 84 Days N/A
Biologic Immunomodulators STELARA INJ 45MG/0.5ML 1 Vial Per 84 Days N/A
Biologic Immunomodulators STELARA SOLN 45MG/0.5ML 1 Syringe Per 84 Days N/A
Biologic Immunomodulators STELARA SOLN 90MG/ML 1 Syringe Per 56 Days N/A
Biologic Immunomodulators TALTZ SOLN 80MG/ML 1 Syringe Per 28 Days N/A
Biologic Immunomodulators TALTZ SOLN 80MG/ML 1 Syringe Per 28 Days N/A
Biologic Immunomodulators TREMFYA SOLN 100MG/ML 1 Pen Per 56 Days N/A
Biologic Immunomodulators TREMFYA SOLN 100MG/ML 1 Syringe Per 56 Days N/A
Biologic Immunomodulators XELJANZ TAB 10MG 224 Tablets Per 365 Days N/A
Biologic Immunomodulators XELJANZ TAB 10MG 60 Tablets Per 30 Days N/A
Biologic Immunomodulators XELJANZ XR TAB 11MG 30 Tablets Per 30 Days N/A
Biologic Immunomodulators XELJANZ XR TAB 22MG 112 Tablets Per 365 Days N/A
Bonjesta Diclegis BONJESTA TAB 20-20MG 60 Tablets Per 30 Days N/A
Bonjesta Diclegis DICLEGIS TAB 10-10MG 120 Tablets Per 30 Days N/A
Bonjesta Diclegis doxylamine succinate/pyridoxine hydrochloride tab 10-10mg 120 Tablets Per 30 Days N/A
Cablivi CABLIVI INJ 11MG 58 Vials Per 365 Days N/A
CFTR KALYDECO PACKET 25MG 60 Packets Per 30 Days N/A
CFTR KALYDECO PACKET 50MG 60 Packets Per 30 Days N/A
CFTR KALYDECO PACKET 75MG 60 Packets Per 30 Days N/A
CFTR KALYDECO TAB 150MG 60 Tablets Per 30 Days N/A
CFTR ORKAMBI GRANULES 100-125MG 60 Packets Per 30 Days N/A
CFTR ORKAMBI GRANULES 150-188MG 60 Packets Per 30 Days N/A
CFTR ORKAMBI TAB -125MG 120 Tablets Per 30 Days N/A
CFTR ORKAMBI TAB -125MG 120 Tablets Per 30 Days N/A
CFTR SYMDEKO TAB -150MG 60 Tablets Per 30 Days N/A
CFTR SYMDEKO TAB -75MG 60 Tablets Per 30 Days N/A
CFTR DEXCOM G4 PLATINUM PEDIATRIC RECEIVER KIT 90 Tablets Per 30 Days N/A
CGM DEXCOM G4 PLATINUM PEDIATRIC RECEIVER KIT 1 READER Per 365 Days N/A
CGM DEXCOM G4 PLATINUM PEDIATRIC RECEIVER KIT 1 RECEIV Per 365 Days N/A
CGM DEXCOM G4 PLATINUM PEDIATRIC RECEIVER KIT/SHARE 1 READER Per 365 Days N/A
CGM DEXCOM G4 PLATINUM PEDIATRIC RECEIVER KIT/SHARE 1 RECEIV Per 365 Days N/A
CGM DEXCOM G4 PLATINUM RECEIVER KIT 1 READER Per 365 Days N/A
CGM DEXCOM G4 PLATINUM RECEIVER KIT 1 RECEIV Per 365 Days N/A
CGM DEXCOM G4 PLATINUM RECEIVER KIT/SHARE 1 READER Per 365 Days N/A
CGM DEXCOM G4 PLATINUM RECEIVER KIT/SHARE 1 RECEIV Per 365 Days N/A
CGM DEXCOM G4 PLATINUM TRANSMITTER KIT 1 RECEIV Per 90 Days N/A
CGM DEXCOM G4 PLATINUM TRANSMITTER KIT 1 SENSOR Per 84 Days N/A
CGM DEXCOM G4 SENSOR KIT 1 READER Per 365 Days N/A
CGM DEXCOM G4 SENSOR KIT 1 RECEIV Per 365 Days N/A
CGM DEXCOM G4 SENSOR KIT 1 SENSOR Per 84 Days N/A
CGM DEXCOM G4 SENSOR KIT 2 SENSRS Per 28 Days N/A
CGM DEXCOM G4 SENSOR KIT 3 SENSRS Per 30 Days N/A
CGM DEXCOM G4 SENSOR KIT 4 SENSRS Per 28 Days N/A
CGM DEXCOM G5 MOBILE RECEIVERKIT 1 READER Per 365 Days N/A
CGM DEXCOM G5 MOBILE RECEIVERKIT 1 RECEIV Per 365 Days N/A
CGM DEXCOM G5 MOBILE TRANSMITTER KIT 1 RECEIV Per 90 Days N/A
CGM DEXCOM G5 MOBILE TRANSMITTER KIT 1 SENSOR Per 84 Days N/A
CGM DEXCOM G5 MOBILE/G4 PLATINUM SENSOR KIT 1 READER Per 365 Days N/A
CGM DEXCOM G5 MOBILE/G4 PLATINUM SENSOR KIT 1 RECEIV Per 365 Days N/A
CGM DEXCOM G5 MOBILE/G4 PLATINUM SENSOR KIT 1 SENSOR Per 84 Days N/A
CGM DEXCOM G5 MOBILE/G4 PLATINUM SENSOR KIT 2 SENSRS Per 28 Days N/A
CGM DEXCOM G5 MOBILE/G4 PLATINUM SENSOR KIT 3 SENSRS Per 30 Days N/A
CGM DEXCOM G5 MOBILE/G4 PLATINUM SENSOR KIT 4 SENSRS Per 28 Days N/A
CGM DEXCOM G5 RECEIVER KIT 1 READER Per 365 Days N/A
CGM DEXCOM G5 RECEIVER KIT 1 RECEIV Per 365 Days N/A
CGM DEXCOM G6 RECEIVER 1 READER Per 365 Days N/A
CGM DEXCOM G6 RECEIVER 1 RECEIV Per 365 Days N/A
CGM DEXCOM G6 SENSOR 1 READER Per 365 Days N/A
CGM DEXCOM G6 SENSOR 1 RECEIV Per 365 Days N/A
CGM DEXCOM G6 SENSOR 1 SENSOR Per 84 Days N/A
CGM DEXCOM G6 SENSOR 2 SENSRS Per 28 Days N/A
CGM DEXCOM G6 SENSOR 3 SENSRS Per 30 Days N/A
CGM DEXCOM G6 SENSOR 4 SENSRS Per 28 Days N/A
CGM DEXCOM G6 TRANSMITTER 1 RECEIV Per 90 Days N/A
CGM DEXCOM G6 TRANSMITTER 1 SENSOR Per 84 Days N/A
CGM ENLITE GLUCOSE SENSOR 1 READER Per 365 Days N/A
CGM ENLITE GLUCOSE SENSOR 1 RECEIV Per 365 Days N/A
CGM ENLITE GLUCOSE SENSOR 1 SENSOR Per 84 Days N/A
CGM ENLITE GLUCOSE SENSOR 2 SENSRS Per 28 Days N/A
CGM ENLITE GLUCOSE SENSOR 3 SENSRS Per 30 Days N/A
CGM ENLITE GLUCOSE SENSOR 4 SENSRS Per 28 Days N/A
CGM EVERSENSE SENSOR/HOLDER 1 READER Per 365 Days N/A
CGM EVERSENSE SENSOR/HOLDER 1 RECEIV Per 365 Days N/A
CGM EVERSENSE SENSOR/HOLDER 1 SENSOR Per 84 Days N/A
CGM EVERSENSE SENSOR/HOLDER 2 SENSRS Per 28 Days N/A
CGM EVERSENSE SENSOR/HOLDER 3 SENSRS Per 30 Days N/A
CGM EVERSENSE SENSOR/HOLDER 4 SENSRS Per 28 Days N/A
CGM EVERSENSE SENSOR/HOLDER KIT 1 READER Per 365 Days N/A
CGM EVERSENSE SENSOR/HOLDER KIT 1 RECEIV Per 365 Days N/A
CGM EVERSENSE SENSOR/HOLDER KIT 1 SENSOR Per 84 Days N/A
CGM EVERSENSE SENSOR/HOLDER KIT 2 SENSRS Per 28 Days N/A
CGM EVERSENSE SENSOR/HOLDER KIT 3 SENSRS Per 30 Days N/A
CGM EVERSENSE SENSOR/HOLDER KIT 4 SENSRS Per 28 Days N/A
CGM EVERSENSE SMART TRANSMITTER 1 RECEIV Per 90 Days N/A
CGM EVERSENSE SMART TRANSMITTER 1 SENSOR Per 84 Days N/A
CGM FREESTYLE LIBRE 14 DAY/READER/FLASH MONITORING SYSTEM 1 READER Per 365 Days N/A
CGM FREESTYLE LIBRE 14 DAY/READER/FLASH MONITORING SYSTEM 1 RECEIV Per 365 Days N/A
CGM FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM 1 READER Per 365 Days N/A
CGM FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM 1 RECEIV Per 365 Days N/A
CGM FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM 1 SENSOR Per 84 Days N/A
CGM FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM 2 SENSRS Per 28 Days N/A
CGM FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM 3 SENSRS Per 30 Days N/A
CGM FREESTYLE LIBRE 14 DAY/SENSOR/FLASH MONITORING SYSTEM 4 SENSRS Per 28 Days N/A
CGM FREESTYLE LIBRE/READER/FLASH MONITORING SYSTEM 1 READER Per 365 Days N/A
CGM FREESTYLE LIBRE/READER/FLASH MONITORING SYSTEM 1 RECEIV Per 365 Days N/A
CGM FREESTYLE LIBRE/SENSOR/FLASH MONITORING SYSTEM 1 READER Per 365 Days N/A
CGM FREESTYLE LIBRE/SENSOR/FLASH MONITORING SYSTEM 1 RECEIV Per 365 Days N/A
CGM FREESTYLE LIBRE/SENSOR/FLASH MONITORING SYSTEM 1 SENSOR Per 84 Days N/A
CGM FREESTYLE LIBRE/SENSOR/FLASH MONITORING SYSTEM 2 SENSRS Per 28 Days N/A
CGM FREESTYLE LIBRE/SENSOR/FLASH MONITORING SYSTEM 3 SENSRS Per 30 Days N/A
CGM FREESTYLE LIBRE/SENSOR/FLASH MONITORING SYSTEM 4 SENSRS Per 28 Days N/A
CGM GUARDIAN CONNECT TRANSMITTER 1 RECEIV Per 90 Days N/A
CGM GUARDIAN CONNECT TRANSMITTER 1 SENSOR Per 84 Days N/A
CGM GUARDIAN LINK 3 1 RECEIV Per 90 Days N/A
CGM GUARDIAN LINK 3 1 SENSOR Per 84 Days N/A
CGM GUARDIAN REAL-TIME REPLACEMENT MONITOR 1 READER Per 365 Days N/A
CGM GUARDIAN REAL-TIME REPLACEMENT MONITOR 1 RECEIV Per 365 Days N/A
CGM GUARDIAN REAL-TIME REPLACEMENT MONITOR PEDIATRIC 1 READER Per 365 Days N/A
CGM GUARDIAN REAL-TIME REPLACEMENT MONITOR PEDIATRIC 1 RECEIV Per 365 Days N/A
CGM GUARDIAN SENSOR (3) 1 READER Per 365 Days N/A
CGM GUARDIAN SENSOR (3) 1 RECEIV Per 365 Days N/A
CGM GUARDIAN SENSOR (3) 1 SENSOR Per 84 Days N/A
CGM GUARDIAN SENSOR (3) 2 SENSRS Per 28 Days N/A
CGM GUARDIAN SENSOR (3) 3 SENSRS Per 30 Days N/A
CGM GUARDIAN SENSOR (3) 4 SENSRS Per 28 Days N/A
CGM GUARDIAN TRANSMITTER 1 RECEIV Per 90 Days N/A
CGM GUARDIAN TRANSMITTER 1 SENSOR Per 84 Days N/A
CGM MINIMED GUARDIAN SENSOR 3 1 READER Per 365 Days N/A
CGM MINIMED GUARDIAN SENSOR 3 1 RECEIV Per 365 Days N/A
CGM MINIMED GUARDIAN SENSOR 3 1 SENSOR Per 84 Days N/A
CGM MINIMED GUARDIAN SENSOR 3 2 SENSRS Per 28 Days N/A
CGM MINIMED GUARDIAN SENSOR 3 3 SENSRS Per 30 Days N/A
CGM MINIMED GUARDIAN SENSOR 3 4 SENSRS Per 28 Days N/A
CGM SOF-SENSOR 1 READER Per 365 Days N/A
CGM SOF-SENSOR 1 RECEIV Per 365 Days N/A
CGM SOF-SENSOR 1 SENSOR Per 84 Days N/A
CGM SOF-SENSOR 2 SENSRS Per 28 Days N/A
CGM SOF-SENSOR 3 SENSRS Per 30 Days N/A
CGM SOF-SENSOR 4 SENSRS Per 28 Days N/A
CGRP AIMOVIG SOLN 140MG/ML 1 Injection Device Per 28 Days N/A
CGRP AIMOVIG SOLN 140MG/ML 1 Injection Per 30 Days N/A
CGRP AIMOVIG SOLN 70MG/ML 1 Injection Device Per 28 Days N/A
CGRP AIMOVIG SOLN 70MG/ML 1 Injection Device Per 30 Days N/A
CGRP AJOVY SOLN 225MG/1.5ML 3 Syringes Per 84 Days N/A
CGRP AJOVY SOLN 225MG/1.5ML 3 Syringes Per 90 Days N/A
CGRP EMGALITY SOLN 120MG/ML 1 Injection Device Per 28 Days N/A
CGRP EMGALITY SOLN 120MG/ML 1 Injection Per 30 Days N/A
CGRP EMGALITY SOLN 100MG/ML 9 Syringes Per 180 Days N/A
CGRP EMGALITY SOLN 120MG/ML 1 Injection Device Per 28 Days N/A
CGRP EMGALITY SOLN 120MG/ML 1 Syringe Per 30 Days N/A
CGRP UBRELVY TAB 100MG 16 Tablets Per 30 Days N/A
CGRP UBRELVY TAB 50MG 16 Tablets Per 30 Days N/A
Circadian Rhythm Disorder HETLIOZ CAP 20MG 30 Capsules Per 30 Days N/A
Combination NSAID ASPIRIN/OMEPRAZOLE TAB 325-40MG 30 Tablets Per 30 Days N/A
Combination NSAID ASPIRIN/OMEPRAZOLE 81-40MG 30 Tablets Per 30 Days N/A
Combination NSAID CONSENSI TAB 10-200MG 30 Tablets Per 30 Days N/A
Combination NSAID CONSENSI TAB 2.5-200MG 30 Tablets Per 30 Days N/A
Combination NSAID CONSENSI TAB 5-200MG 30 Tablets Per 30 Days N/A
Combination NSAID DUEXIS TAB 800-26.6MG 90 Tablets Per 30 Days N/A
Combination NSAID VIMOVO TAB 375-20MG 60 Tablets Per 30 Days N/A
Combination NSAID VIMOVO TAB 500-20MG 60 Tablets Per 30 Days N/A
Combination NSAID YOSPRALA TAB 325-40MG 30 Tablets Per 30 Days N/A
Combination NSAID YOSPRALA TAB 81-40MG 30 Tablets Per 30 Days N/A
Constipation Agents AMITIZA CAP 24MCG 60 Capsules Per 30 Days N/A
Constipation Agents AMITIZA CAP 8 MCG 120 Capsules Per 30 Days N/A
Constipation Agents LINZESS CAP 145MCG 30 Capsules Per 30 Days N/A
Constipation Agents LINZESS CAP 290MCG 30 Capsules Per 30 Days N/A
Constipation Agents LINZESS CAP 72MCG 30 Capsules Per 30 Days N/A
Constipation Agents MOTEGRITY TAB 1MG 30 Tablets Per 30 Days N/A
Constipation Agents MOTEGRITY TAB 2MG 30 Tablets Per 30 Days N/A
Constipation Agents MOVANTIK TAB 12.5MG 30 Tablets Per 30 Days N/A
Constipation Agents MOVANTIK TAB 25MG 30 Tablets Per 30 Days N/A
Constipation Agents RELISTOR INJ 12MG/0.6ML 30 Syringes Per 30 Days N/A
Constipation Agents RELISTOR INJ 12MG/0.6ML 60 Vials Per 30 Days N/A
Constipation Agents RELISTOR INJ 8MG/0.4ML 30 Syringes Per 30 Days N/A
Constipation Agents RELISTOR TAB 150MG 90 Tablets Per 30 Days N/A
Constipation Agents SYMPROIC TAB 0.2MG 30 Tablets Per 30 Days N/A
Constipation Agents TRULANCE TAB 3MG 30 Tablets Per 30 Days N/A
Constipation Agents ZELNORM TAB 3MG 60 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN TAB 12.MG 30 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN TAB 25MG 30 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN TAB 6.2MG 30 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN/METFORMIN HCL TAB -100MG 60 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN/METFORMIN HCL TAB -500MG 60 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN/PIOGLITAZONE TAB -15MG 30 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN/PIOGLITAZONE TAB -30MG 30 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN/PIOGLITAZONE TAB -45MG 30 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN/PIOGLITAZONE TAB -15MG 30 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN/PIOGLITAZONE TAB -30MG 30 Tablets Per 30 Days N/A
DPP-4 ALOGLIPTIN/PIOGLITAZONE TAB -45MG 30 Tablets Per 30 Days N/A
DPP-4 JANUMET TAB -100MG 60 Tablets Per 30 Days N/A
DPP-4 JANUMET TAB -500MG 60 Tablets Per 30 Days N/A
DPP-4 JANUMET XR TAB -100MG 30 Tablets Per 30 Days N/A
DPP-4 JANUMET XR TAB -100MG 60 Tablets Per 30 Days N/A
DPP-4 JANUMET XR TAB -500MG 30 Tablets Per 30 Days N/A
DPP-4 JANUVIA TAB 100MG 30 Tablets Per 30 Days N/A
DPP-4 JANUVIA TAB 25MG 30 Tablets Per 30 Days N/A
DPP-4 JANUVIA TAB 50MG 30 Tablets Per 30 Days N/A
DPP-4 JENTADUETO TAB -100MG 60 Tablets Per 30 Days N/A
DPP-4 JENTADUETO TAB -500MG 60 Tablets Per 30 Days N/A
DPP-4 JENTADUETO TAB -850MG 60 Tablets Per 30 Days N/A
DPP-4 JENTADUETO XR TAB -100MG 60 Tablets Per 30 Days N/A
DPP-4 JENTADUETO XR TAB -100MG 30 Tablets Per 30 Days N/A
DPP-4 KAZANO TAB -100MG 60 Tablets Per 30 Days N/A
DPP-4 KAZANO TAB -500MG 60 Tablets Per 30 Days N/A
DPP-4 KOMBIGLYZE XR TAB -100MG 60 Tablets Per 30 Days N/A
DPP-4 KOMBIGLYZE XR TAB -100MG 30 Tablets Per 30 Days N/A
DPP-4 KOMBIGLYZE XR TAB -500MG 30 Tablets Per 30 Days N/A
DPP-4 NESINA TAB 12.MG 30 Tablets Per 30 Days N/A
DPP-4 NESINA TAB 25MG 30 Tablets Per 30 Days N/A
DPP-4 NESINA TAB 6.2MG 30 Tablets Per 30 Days N/A
DPP-4 ONGLYZA TAB 2.5MG 30 Tablets Per 30 Days N/A
DPP-4 ONGLYZA TAB 5 MG 30 Tablets Per 30 Days N/A
DPP-4 OSENI TAB -15MG 30 Tablets Per 30 Days N/A
DPP-4 OSENI TAB -30MG 30 Tablets Per 30 Days N/A
DPP-4 OSENI TAB -45MG 30 Tablets Per 30 Days N/A
DPP-4 OSENI TAB -15MG 30 Tablets Per 30 Days N/A
DPP-4 OSENI TAB -30MG 30 Tablets Per 30 Days N/A
DPP-4 OSENI TAB -45MG 30 Tablets Per 30 Days N/A
DPP-4 QTERN TAB 10-MG 30 Tablets Per 30 Days N/A
DPP-4 QTERN TAB 5-5MG 30 Tablets Per 30 Days N/A
DPP-4 STEGLUJAN TAB -100MG 30 Tablets Per 30 Days N/A
DPP-4 STEGLUJAN TAB -100MG 30 Tablets Per 30 Days N/A
DPP-4 TRADJENTA TAB 5 MG 30 Tablets Per 30 Days N/A
Egrifta EGRIFTA INJ 1 MG 60 Vials Per 30 Days N/A
Egrifta EGRIFTA SV INJ 2MG 30 Vials Per 30 Days N/A
Emflaza EMFLAZA TAB 18MG 30 Tablets Per 30 Days N/A
Emflaza EMFLAZA TAB 6MG 60 Tablets Per 30 Days N/A
Fibromyalgia LYRICA CAP 100MG 90 Capsules Per 30 Days N/A
Fibromyalgia LYRICA CAP 150MG 90 Capsules Per 30 Days N/A
Fibromyalgia LYRICA CAP 200MG 90 Capsules Per 30 Days N/A
Fibromyalgia LYRICA CAP 225MG 60 Capsules Per 30 Days N/A
Fibromyalgia LYRICA CAP 25MG 90 Capsules Per 30 Days N/A
Fibromyalgia LYRICA CAP 300MG 60 Capsules Per 30 Days N/A
Fibromyalgia LYRICA CAP 50MG 90 Capsules Per 30 Days N/A
Fibromyalgia LYRICA CAP 75MG 90 Capsules Per 30 Days N/A
Fibromyalgia LYRICA SOLN 20MG 900 mLs Per 30 Days N/A
Fibromyalgia SAVELLA TAB 100MG 60 Tablets Per 30 Days N/A
Fibromyalgia SAVELLA TAB 12.MG 60 Tablets Per 30 Days N/A
Fibromyalgia SAVELLA TAB 25MG 60 Tablets Per 30 Days N/A
Fibromyalgia SAVELLA TAB 50MG 60 Tablets Per 30 Days N/A
Fibromyalgia SAVELLA TITRATION PACK TAB 12.MG 1 Pack Per 180 Days N/A
Fibromyalgia pregabalin cap 100mg 90 Capsules Per 30 Days N/A
Fibromyalgia pregabalin cap 150mg 90 Capsules Per 30 Days N/A
Fibromyalgia pregabalin cap 200mg 90 Capsules Per 30 Days N/A
Fibromyalgia pregabalin cap 225mg 60 Capsules Per 30 Days N/A
Fibromyalgia pregabalin cap 25mg 90 Capsules Per 30 Days N/A
Fibromyalgia pregabalin cap 300mg 60 Capsules Per 30 Days N/A
Fibromyalgia pregabalin cap 50mg 90 Capsules Per 30 Days N/A
Fibromyalgia pregabalin cap 75mg 90 Capsules Per 30 Days N/A
Fibromyalgia pregabalin soln 20mg 900 mLs Per 30 Days N/A
Firdapse FIRDAPSE TAB 10MG 240 Tablets Per 30 Days N/A
Firdapse RUZURGI TAB 10MG 300 Tablets Per 30 Days N/A
Gabapentin ER GRALISE TAB 300MG 30 Tablets Per 30 Days N/A
Gabapentin ER GRALISE TAB 600MG 90 Tablets Per 30 Days N/A
Gabapentin ER GRALISE STARTER TAB 300MG 1 Pack Per 180 Days N/A
Gabapentin ER HORIZANT TAB 300MG 60 Tablets Per 30 Days N/A
Gabapentin ER HORIZANT TAB 600MG 60 Tablets Per 30 Days N/A
Galafold GALAFOLD CAP 123MG 14 Capsules Per 28 Days N/A
GLP-1 ADLYXIN PEN INJ 20ML/0.2ML 2 Pens Per 28 Days N/A
GLP-1 ADLYXIN STARTER PACK 10MCG/0.2ML 2 Pens Per 180 Days N/A
GLP-1 BYDUREON SUSP 2MG 4 Vials Per 28 Days N/A
GLP-1 BYDUREON BCISE AUTO-INJ 2MG/0.85ML 4 Pens Per 28 Days N/A
GLP-1 BYDUREON PEN USUSP 2MG 4 Pens Per 28 Days N/A
GLP-1 BYETTA SOLN 10MCG/0.04ML 1 Pen Per 30 Days N/A
GLP-1 BYETTA SOLN 5MCG/0.04ML 1 Pen Per 30 Days N/A
GLP-1 OZEMPIC SOLN 0.25 OR 0.5 MG 1 Pen Per 28 Days N/A
GLP-1 OZEMPIC SOLN 1MG 2 Pens Per 28 Days N/A
GLP-1 RYBELSUS TAB 14MG 30 Tablets Per 30 Days N/A
GLP-1 RYBELSUS TAB 3 MG 30 Tablets Per 180 Days N/A
GLP-1 RYBELSUS TAB 3 MG 30 Tablets Per 30 Days N/A
GLP-1 RYBELSUS TAB 7 MG 30 Tablets Per 30 Days N/A
GLP-1 TANZEUM SOLN 30MG 4 Pens Per 28 Days N/A
GLP-1 TANZEUM SOLN 50MG 4 Pens Per 28 Days N/A
GLP-1 TRULICITY SOLN 1.5MG/0,5ML 4 Pens Per 28 Days N/A
GLP-1 TRULICITY SOLN 18MG/3ML 4 Pens Per 28 Days N/A
GLP-1 VICTOZA SOLN 18MG/3ML 3 Pens Per 30 Days N/A
Glucose Test Strips Glucose Test Strips and Disks 4 Systems Per 30 Days N/A
Glucose Test Strips Glucose Test Strips and Disks 204 Strips Per 30 Days N/A
Gonadotropin Hormones BRAVELLE INJ 75 UNIT 60 Vials Per 30 Days N/A
Gonadotropin Hormones CETROTIDE INJ 0.25MG 5 Kits Per 30 Days N/A
Gonadotropin Hormones CHORIONIC GONADOTROPIN INJ 0.025 MG 2 Vials Per 30 Days N/A
Gonadotropin Hormones FOLLISTIM AQ INJ 300 UNIT/0.36ML 15 CARTS Per 30 Days N/A
Gonadotropin Hormones FOLLISTIM AQ INJ 600 UNIT/0.72ML 8 CARTS Per 30 Days N/A
Gonadotropin Hormones FOLLISTIM AQ INJ 900 UNIT/1.08ML 5 CARTS Per 30 Days N/A
Gonadotropin Hormones GANIRELIX ACETATE SOLN 250MCG/0.5ML 5 Syringes Per 30 Days N/A
Gonadotropin Hormones GONAL-F INJ 1050 UNIT 4 Syringes Per 30 Days N/A
Gonadotropin Hormones GONAL-F INJ 450 UNIT 10 Syringes Per 30 Days N/A
Gonadotropin Hormones GONAL F INJ 75 UNIT 20 Syringes Per 30 Days N/A
Gonadotropin Hormones GONAL-F RFF REDIJECT 300 UNIT/0.5ML 15 Pens Per 30 Days N/A
Gonadotropin Hormones GONAL-F RFF REDIJECT 450 UNIT/0.75ML 10 Pens Per 30 Days N/A
Gonadotropin Hormones GONAL-F RFF REDIJECT 900 UNIT/1.5ML 5 Pens Per 30 Days N/A
Gonadotropin Hormones MENOPUR INJ 75UNIT 60 Vials Per 30 Days N/A
Gonadotropin Hormones NOVAREL INJ 10000 UNIT 2 Vials Per 30 Days N/A
Gonadotropin Hormones NOVAREL INJ 5000 UNIT 4 Vials Per 30 Days N/A
Gonadotropin Hormones OVIDREL INJ 250MCG/0.5ML 2 Syringes Per 30 Days N/A
Gonadotropin Hormones PREGNYL W/DILUENT BENZYL ALCOHOL/NACL INJ 10000 UNIT 2 Vials Per 30 Days N/A
Gonadotropin Hormones ganirelix acetate soln 250mcg/0.5ml 5 Syringes Per 30 Days N/A
HAE BERINERT INJ 500 UNIT 10 Vials Per 30 Days N/A
HAE CINRYZE INJ 500 UNIT 20 Vials Per 30 Days N/A
HAE FIRAZYR INJ 30MG/3ML 6 Syringes Per 30 Days N/A
HAE HAEGARDA INJ 2000UNIT 24 Vials Per 30 Days N/A
HAE HAEGARDA INJ 3000UNIT 16 Vials Per 30 Days N/A
HAE KALBITOR INJ 10MG/ML 4 Kits Per 30 Days N/A
HAE RUCONEST INJ 2100 UNIT 8 Vials Per 30 Days N/A
HAE TAKHZYRO INJ 300 MG/2ML 2 Vials Per 28 Days N/A
HAE icatibant acetate inj 300 mg/2ml 6 Syringes Per 30 Days N/A
hATTR Amlyoidosis TEGSEDI SYR 284MG/1.5ML 4 Syringes Per 28 Days N/A
HCN Channel Blocker CORLANOR SOLN 5 MG/5ML 600 mLs Per 30 Days N/A
HCN Channel Blocker CORLANOR TAB 5MG 60 Tablets Per 30 Days N/A
HCN Channel Blocker CORLANOR TAB 7.5MG 60 Tablets Per 30 Days N/A
Hemlibra HEMLIBRA SOLN 105MG/0.7ML 4 Vials Per 28 Days N/A
Hemlibra HEMLIBRA SOLN 150MG/ML 4 Vials Per 28 Days N/A
Hemlibra HEMLIBRA SOLN 30MG/ML 4 Vials Per 28 Days N/A
Hemlibra HEMLIBRA SOLN 60MG/0.4ML 4 Vials Per 28 Days N/A
Hepatitis B Hepatitis C DAKLINZA TAB 30MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C DAKLINZA TAB 60MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C DAKLINZA TAB 90MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C EPCLUSA TAB -100MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C HARVONI TAB -200MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C HARVONI TAB -400MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C LEDIPASVIR/SOFOSBUVIR TAB -400MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C MAVYRET TAB -40MG 90 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C OLYSIO CAP 150MG 30 Capsules Per 30 Days N/A
Hepatitis B Hepatitis C SOFOSBUVIR/VELPATASVIR TAB -100MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C SOVALDI TAB 200MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C SOVALDI TAB 400MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C TECHNIVIE TAB -50MG 60 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C VIEKIRA PAK TAB 250MG 1 Pack Per 28 Days N/A
Hepatitis B Hepatitis C VIEKIRA XR TAB 33.3MG 90 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C VOSEVI TAB -100MG 30 Tablets Per 30 Days N/A
Hepatitis B Hepatitis C ZEPATIER TAB -100MG 30 Tablets Per 30 Days N/A
HoFH Agents JUXTAPID CAP 10MG 30 Capsules Per 30 Days N/A
HoFH Agents JUXTAPID CAP 20MG 30 Capsules Per 30 Days N/A
HoFH Agents JUXTAPID CAP 30MG 30 Capsules Per 30 Days N/A
HoFH Agents JUXTAPID CAP 40MG 30 Capsules Per 30 Days N/A
HoFH Agents JUXTAPID CAP 5MG 30 Capsules Per 30 Days N/A
HoFH Agents JUXTAPID CAP 60MG 30 Capsules Per 30 Days N/A
HoFH Agents KYNAMRO SOLN 200MG/ML 4 Injections Per 28 Days N/A
HSDD VYLEESI INJ 1.75MG/0.3ML 6 Pens Per 30 Days N/A
Hypoactive Sexual Desire Disorder ADDYI TAB 100MG 30 Tablets Per 30 Days N/A
Idiopathic Pulmonary Fibrosis ESBRIET CAP 267MG 180 Capsules Per 30 Days N/A
Idiopathic Pulmonary Fibrosis ESBRIET TAB 267MG 180 Tablets Per 30 Days N/A
Idiopathic Pulmonary Fibrosis ESBRIET TAB 801MG 90 Tablets Per 30 Days N/A
Idiopathic Pulmonary Fibrosis OFEV CAP 100MG 60 Capsules Per 30 Days N/A
Idiopathic Pulmonary Fibrosis OFEV CAP 150MG 60 Capsules Per 30 Days N/A
Insomnia AMBIEN TAB 10MG 30 Tablets Per 30 Days N/A
Insomnia AMBIEN TAB 5MG 30 Tablets Per 30 Days N/A
Insomnia AMBIEN CR TAB 12.MG 30 Tablets Per 30 Days N/A
Insomnia AMBIEN CR TAB 6.2MG 30 Tablets Per 30 Days N/A
Insomnia BELSOMRA TAB 10MG 30 Tablets Per 30 Days N/A
Insomnia BELSOMRA TAB 15MG 30 Tablets Per 30 Days N/A
Insomnia BELSOMRA TAB 20MG 30 Tablets Per 30 Days N/A
Insomnia BELSOMRA TAB 5MG 30 Tablets Per 30 Days N/A
Insomnia EDLUAR TAB 10MG 30 Tablets Per 30 Days N/A
Insomnia EDLUAR TAB 5MG 30 Tablets Per 30 Days N/A
Insomnia INTERMEZZO TAB 1.7MG 30 Tablets Per 30 Days N/A
Insomnia INTERMEZZO TAB 3.5MG 30 Tablets Per 30 Days N/A
Insomnia INTERMEZZO TAB 1MG 30 Tablets Per 30 Days N/A
Insomnia INTERMEZZO TAB 2MG 30 Tablets Per 30 Days N/A
Insomnia INTERMEZZO TAB 3MG 30 Tablets Per 30 Days N/A
Insomnia ROZEREM TAB 8MG 30 Tablets Per 30 Days N/A
Insomnia SILENOR TAB 3MG 30 Tablets Per 30 Days N/A
Insomnia SILENOR TAB 6MG 30 Tablets Per 30 Days N/A
Insomnia SONATA CAP 10MG 30 Capsules Per 30 Days N/A
Insomnia SONATA CAP 5MG 30 Capsules Per 30 Days N/A
Insomnia ZOLPIMIST SPRAY 5MG/ACT 1 Inhaler Per 30 Days N/A
Insomnia doxepin hydrochloride tab 3mg 30 Tablets Per 30 Days N/A
Insomnia doxepin hydrochloride tab 6mg 30 Tablets Per 30 Days N/A
Insomnia eszopiclone tab 1mg 30 Tablets Per 30 Days N/A
Insomnia eszopiclone tab 2mg 30 Tablets Per 30 Days N/A
Insomnia eszopiclone tab 3mg 30 Tablets Per 30 Days N/A
Insomnia ramelteon tab 8mg 30 Tablets Per 30 Days N/A
Insomnia zaleplon cap 10mg 30 Capsules Per 30 Days N/A
Insomnia zaleplon cap 5mg 30 Capsules Per 30 Days N/A
Insomnia zolpidem tartrate tab 1.7mg 30 Tablets Per 30 Days N/A
Insomnia zolpidem tartrate tab 3.5mg 30 Tablets Per 30 Days N/A
Insomnia zolpidem tartrate tab 10mg 30 Tablets Per 30 Days N/A
Insomnia zolpidem tartrate tab 5mg 30 Tablets Per 30 Days N/A
Insomnia zolpidem tartrate er tab 12.mg 30 Tablets Per 30 Days N/A
Insomnia zolpidem tartrate er tab 6.2mg 30 Tablets Per 30 Days N/A
Insulin ADMELOG INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin ADMELOG SOLOSTAR SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin AFREZZA POWD 4 & 8 & 12 UNIT 1260 CARTS Per 30 Days N/A
Insulin AFREZZA POWD 8(60) & 12(30) 1080 CARTS Per 30 Days N/A
Insulin AFREZZA POWD 8(90) & 12(90) 1260 CARTS Per 30 Days N/A
Insulin AFREZZA POWD 4(30) & 8(60) 1530 CARTS Per 30 Days N/A
Insulin AFREZZA POWD 4(60) & 8(30) 1890 CARTS Per 30 Days N/A
Insulin AFREZZA POWD 4(90) & 8(90) 1800 CARTS Per 30 Days N/A
Insulin AFREZZA POWD 12 UNIT 900 CARTS Per 30 Days N/A
Insulin AFREZZA POWD 4 UNIT 2520 CARTS Per 30 Days N/A
Insulin AFREZZA POWD 8 UNIT 1260 CARTS Per 30 Days N/A
Insulin APIDRA INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin APIDRA SOLOSTAR SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin BASAGLAR KWIKPEN SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin FIASP INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin FIASP FLEXTOUCH SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin FIASP PENFILL SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMALOG INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMALOG SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMALOG JUNIOR KWIKPEN INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMALOG KWIKPEN INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMALOG KWIKPEN INJ 200 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMALOG MIX 50/50 INJ 100 UNIT UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMALOG MIX 50/50 KWIKPEN INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMALOG MIX 75/25 INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMALOG MIX 75/25 KWIKPEN INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMULIN R U-500 (CONCENTRATED) INJ 500 UNIT/ML 100 mLs Per 30 Days N/A
Insulin HUMULIN R U-500 KWIKPEN SOLN 500 UNIT/ML 100 mLs Per 30 Days N/A
Insulin INSULIN ASPART INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin INSULIN ASPART FLEXPEN SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin INSULIN ASPART PENFILL SLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin INSULIN ASPART PROTAMINE/INSULIN ASPART INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin INSULIN ASPART PROTAMINE/INSULIN ASPART FLEXPEN INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin INSULIN LISPRO INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin INSULIN LISPRO KWIKPEN SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin LANTUS INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin LANTUS SOLOSTAR SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin LEVEMIR INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin LEVEMIR FLEXTOUCH SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin NOVOLOG INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin NOVOLOG FLEXPEN INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin NOVOLOG MIX 70/30 INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin NOVOLOG MIX 70/30 PREFILLED FLEXPEN INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin NOVOLOG PENFILL SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin TOUJEO MAX SOLOSTAR SOLN 300 UNIT/ML 100 mLs Per 30 Days N/A
Insulin TOUJEO SOLOSTAR SOLN 300 UNIT/ML 100 mLs Per 30 Days N/A
Insulin TRESIBA INJ 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin TRESIBA FLEXTOUCH SOLN 100 UNIT/ML 100 mLs Per 30 Days N/A
Insulin TRESIBA FLEXTOUCH SOLN 200 UNIT/ML 100 mLs Per 30 Days N/A
Insulin Combination SOLIQUA 100/33 SOLN 100-33 UNIT-MCG/ML 5 Pens Per 30 Days N/A
Insulin Combination XULTOPHY 100/3.6 UNIT-MG/ML 5 Pens Per 30 Days N/A
Interleukin (IL)-1 Inhibitor ARCALYST INJ 220 MG 4 Vials Per 28 Days N/A
Interleukin (IL)-1 Inhibitor ILARIS INJ 150 MG/ML 2 Vials Per 28 Days N/A
Interleukin (IL)-4 Inhibitor DUPIXENT SOLN 300 MG/2ML 4 mLs Per 28 Days N/A
Interleukin (IL)-4 Inhibitors DUPIXENT SOLN 200 MG/1.14ML 2 mLs Per 28 Days N/A
Interleukin-5 (IL-5) Inhibitors FASENRA PEN SOLN 30 MG/ML 1 Pen Per 56 Days N/A
Interleukin-5 (IL-5) Inhibitors NUCALA 100 MG/ML 3 Syringes Per 28 Days N/A
Interleukin-5 (IL-5) Inhibitors NUCALA 100 MG/ML 3 Syringes Per 28 Days N/A
Jynarque JYNARQUE TAB 15MG 60 Tablets Per 30 Days N/A
Jynarque JYNARQUE TAB 30MG 30 Tablets Per 30 Days N/A
Jynarque JYNARQUE TAB 15MG 56 Tablets Per 28 Days N/A
Jynarque JYNARQUE TAB 30MG 56 Tablets Per 28 Days N/A
Jynarque JYNARQUE TAB 30MG 56 Tablets Per 28 Days N/A
Jynarque SAMSCA TAB 15MG 60 Tablets Per 30 Days N/A
Jynarque SAMSCA TAB 30MG 30 Tablets Per 30 Days N/A
Ketorolac SPRIX SPRAY 15.75 MG 5 Bottles Per 5 Days N/A
Ketorolac ketorolac tromethamine tab 10mg 20 Tablets Per 5 Days N/A
Keveyis KEVEYIS TAB 50MG 120 Tablets Per 30 Days N/A
Korlym KORLYM TAB 300MG 120 Tablets Per 30 Days N/A
Leukotriene Modifiers ACCOLATE TAB 10MG 60 Tablets Per 30 Days N/A
Leukotriene Modifiers ACCOLATE TAB 20MG 60 Tablets Per 30 Days N/A
Leukotriene Modifiers SINGULAIR TAB 4 MG 30 Tablets Per 30 Days N/A
Leukotriene Modifiers SINGULAIR TAB 5 MG 30 Tablets Per 30 Days N/A
Leukotriene Modifiers SINGULAIR GRANULES 4 MG 30 Packets Per 30 Days N/A
Leukotriene Modifiers SINGULAIR TAB 10MG 30 Tablets Per 30 Days N/A
Leukotriene Modifiers ZYFLO TAB 600MG 120 Tablets Per 30 Days N/A
Leukotriene Modifiers ZYFLO CR TAB 600MG 120 Tablets Per 30 Days N/A
Leukotriene Modifiers montelukast sodium tab 4 mg 30 Tablets Per 30 Days N/A
Leukotriene Modifiers montelukast sodium tab 5 mg 30 Tablets Per 30 Days N/A
Leukotriene Modifiers montelukast sodium granules 4 mg 30 Packets Per 30 Days N/A
Leukotriene Modifiers montelukast sodium tab 10mg 30 Tablets Per 30 Days N/A
Leukotriene Modifiers zafirlukast tab 10mg 60 Tablets Per 30 Days N/A
Leukotriene Modifiers zafirlukast tab 20mg 60 Tablets Per 30 Days N/A
Leukotriene Modifiers zileuton er tab 600mg 120 Tablets Per 30 Days N/A
LMWH Arixtra ARIXTRA INJ 10MG/0.8ML 30 Syringes Per 90 Days N/A
LMWH Arixtra ARIXTRA INJ 2.5MG/0.5ML 30 Syringes Per 90 Days N/A
LMWH Arixtra ARIXTRA INJ 5MG/0.4ML 30 Syringes Per 90 Days N/A
LMWH Arixtra ARIXTRA INJ 7.5MG/0.6ML 30 Syringes Per 90 Days N/A
LMWH Arixtra FRAGMIN INJ 10000 UNIT/ML 30 Syringes Per 90 Days N/A
LMWH Arixtra FRAGMIN INJ 12500 UNIT/0.5ML 30 Syringes Per 90 Days N/A
LMWH Arixtra FRAGMIN INJ 15000 UNIT/0.6ML 30 Syringes Per 90 Days N/A
LMWH Arixtra FRAGMIN INJ 18000 UNIT/0,72ML 30 Syringes Per 90 Days N/A
LMWH Arixtra FRAGMIN INJ 2500 UNIT/0.2ML 30 Syringes Per 90 Days N/A
LMWH Arixtra FRAGMIN INJ 5000 UNIT/0.2ML 30 Syringes Per 90 Days N/A
LMWH Arixtra FRAGMIN INJ 7500 UNIT/0.3ML 30 Syringes Per 90 Days N/A
LMWH Arixtra FRAGMIN INJ 95000 UNIT/3.8ML 10 Vials Per 90 Days N/A
LMWH Arixtra LOVENOX INJ 100MG/ML 30 Syringes Per 90 Days N/A
LMWH Arixtra LOVENOX INJ 120MG/0.8ML 30 Syringes Per 90 Days N/A
LMWH Arixtra LOVENOX INJ 150MG/ML 30 Syringes Per 90 Days N/A
LMWH Arixtra LOVENOX INJ 30MG/0.3ML 30 Syringes Per 90 Days N/A
LMWH Arixtra LOVENOX INJ 300MG/3ML 10 Vials Per 90 Days N/A
LMWH Arixtra LOVENOX INJ 40MG/0.4ML 30 Syringes Per 90 Days N/A
LMWH Arixtra LOVENOX INJ 60MG/0,6ML 30 Syringes Per 90 Days N/A
LMWH Arixtra LOVENOX INJ 80MG/0.8ML 30 Syringes Per 90 Days N/A
LMWH Arixtra enoxaparin sodium inj 100/0.8ml 30 Syringes Per 90 Days N/A
LMWH Arixtra enoxaparin sodium inj 120mg/0.8ml 30 Syringes Per 90 Days N/A
LMWH Arixtra enoxaparin sodium inj 150/ml 30 Syringes Per 90 Days N/A
LMWH Arixtra enoxaparin sodium inj 30mg/0.3ml 30 Syringes Per 90 Days N/A
LMWH Arixtra enoxaparin sodium inj 300/3ml 10 Vials Per 90 Days N/A
LMWH Arixtra enoxaparin sodium inj 40mg/0.4ml 30 Syringes Per 90 Days N/A
LMWH Arixtra enoxaparin sodium inj 60mg/0.6ml 30 Syringes Per 90 Days N/A
LMWH Arixtra enoxaparin sodium inj 80mg/0.8ml 30 Syringes Per 90 Days N/A
LMWH Arixtra fondaparinux sodium inj 10 mg/0/0.8ml 30 Syringes Per 90 Days N/A
LMWH Arixtra fondaparinux sodium inj 2.5 mg/0.5ml 30 Syringes Per 90 Days N/A
LMWH Arixtra fondaparinux sodium inj 5 mg/0/0.4ml 30 Syringes Per 90 Days N/A
LMWH Arixtra fondaparinux sodium inj 7.5 mg/0.6ml 30 Syringes Per 90 Days N/A
Lucemyra LUCEMYRA TAB 0.1MG 228 Tablets Per 180 Days N/A
Metformin ER FORTAMET TAB 100MG 60 Tablets Per 30 Days N/A
Metformin ER FORTAMET TAB 500MG 150 Tablets Per 30 Days N/A
Metformin ER FORTAMET TAB 500MG 90 Tablets Per 30 Days N/A
Metformin ER GLUCOPHAGE XR TAB 500MG 120 Tablets Per 30 Days N/A
Metformin ER GLUCOPHAGE XR TAB 750MG 60 Tablets Per 30 Days N/A
Metformin ER GLUMETZA TAB 100MG 60 Tablets Per 30 Days N/A
Metformin ER GLUMETZA TAB 500MG 120 Tablets Per 30 Days N/A
Metformin ER GLUMETZA TAB 500MG 90 Tablets Per 30 Days N/A
Metformin ER RIOMET ER SUSP 500 MG/5ML 960 mLs Per 30 Days N/A
Metformin ER metformin hydrochloride er tab 500mg 120 Tablets Per 30 Days N/A
Metformin ER metformin hydrochloride er tab 750mg 60 Tablets Per 30 Days N/A
Metformin ER metformin hydrochloride er tab 100mg 60 Tablets Per 30 Days N/A
Metformin ER metformin hydrochloride er tab 500mg 120 Tablets Per 30 Days N/A
Metformin ER metformin hydrochloride er tab 500mg 90 Tablets Per 30 Days N/A
Metformin ER metformin hydrochloride er tab 100mg 60 Tablets Per 30 Days N/A
Metformin ER metformin hydrochloride er tab 500mg 150 Tablets Per 30 Days N/A
Metformin ER metformin hydrochloride er tab 500mg 90 Tablets Per 30 Days N/A
Multiple Sclerosis AUBAGIO TAB 14MG 30 Tablets Per 30 Days N/A
Multiple Sclerosis AUBAGIO TAB 7MG 30 Tablets Per 30 Days N/A
Multiple Sclerosis AUBAGIO IN 30MCG 1 Pack Per 28 Days N/A
Multiple Sclerosis AVONEX SYRINGE 30MCG/0.5ML 1 Pack Per 28 Days N/A
Multiple Sclerosis AVONEX PEN INJ 30MCG/0.5ML 1 Pack Per 28 Days N/A
Multiple Sclerosis BETASERON SYRINGE 30 MCG/0.5ML 1 Box Per 28 Days N/A
Multiple Sclerosis BETASERON SYRINGE 30 MCG/0.5ML 15 Vials Per 30 Days N/A
Multiple Sclerosis BETASERON INJ 0.3MG 30 Syringes Per 30 Days N/A
Multiple Sclerosis COPAXONE SOLN 40 MG/ML 12 Syringes Per 28 Days N/A
Multiple Sclerosis EXTAVIA INJ 0.3MG 1 Box Per 28 Days N/A
Multiple Sclerosis EXTAVIA INJ 0.3MG 15 Vials Per 30 Days N/A
Multiple Sclerosis GILENYA CAP 0.2MG 30 Tablets Per 30 Days N/A
Multiple Sclerosis GILENYA CAP 0.5MG 30 Tablets Per 30 Days N/A
Multiple Sclerosis MAVENCLAD TAB 10MG 20 Tablets Per 301 Days N/A
Multiple Sclerosis MAVENCLAD TAB 10MG 8 Tablets Per 301 Days N/A
Multiple Sclerosis MAVENCLAD TAB 10MG 10 Tablets Per 301 Days N/A
Multiple Sclerosis MAVENCLAD TAB 10MG 12 Tablets Per 301 Days N/A
Multiple Sclerosis MAVENCLAD TAB 10MG 14 Tablets Per 301 Days N/A
Multiple Sclerosis MAVENCLAD TAB 10MG 8 Tablets Per 301 Days N/A
Multiple Sclerosis MAVENCLAD TAB 10MG 9 Tablets Per 301 Days N/A
Multiple Sclerosis MAYZENT TAB 0.2MG 120 Tablets Per 30 Days N/A
Multiple Sclerosis MAYZENT TAB 2MG 30 Tablets Per 30 Days N/A
Multiple Sclerosis MAYZENT STARTER PACK TAB 0.2MG 1 Pack Per 180 Days N/A
Multiple Sclerosis PLEGRIDY SOLN 125MCG/0.5ML 2 Pens Per 28 Days N/A
Multiple Sclerosis PLEGRIDY SOLN 125MCG/0.5ML 2 Syringes Per 28 Days N/A
Multiple Sclerosis PLEGRIDY STARTER PACK SOLN 63 & 94 MCG/0.5ML 1 Kit Per 180 Days N/A
Multiple Sclerosis PLEGRIDY STARTER PACK SOLN 63 & 94 MCG/0.5ML 1 Kit Per 180 Days N/A
Multiple Sclerosis REBIF SOLN 22MCG/0.5ML 1 Carton Per 28 Days N/A
Multiple Sclerosis REBIF SOLN 4MCG/0.5ML 1 Carton Per 28 Days N/A
Multiple Sclerosis REBIF REBIDOSE SOLN 22MCG/0.5ML 1 Carton Per 28 Days N/A
Multiple Sclerosis REBIF REBIDOSE SOLN 4MCG/0.5ML 1 Carton Per 28 Days N/A
Multiple Sclerosis REBIF REBIDOSE TITRATION PACK SOLN 22 MCG/0.5ML 1 Kit Per 180 Days N/A
Multiple Sclerosis REBIF TITRATION PACK 6x8.8 MCG 1 Kit Per 180 Days N/A
Multiple Sclerosis TECFIDERA CAP 120MG 56 Capsules Per 180 Days N/A
Multiple Sclerosis TECFIDERA CAP 240MG 60 Capsules Per 30 Days N/A
Multiple Sclerosis TECFIDERA STARTER PACK CAP 120MG & 240MG 60 Capsules Per 180 Days N/A
Multiple Sclerosis VUMERITY CAP 231MG 120 Capsules Per 30 Days N/A
Multiple Sclerosis VUMERITY CAP 231MG 106 Capsules Per 180 Days N/A
Multiple Sclerosis glatiramer acetate soln 20MG/ML 30 Syringes Per 30 Days N/A
Multiple Sclerosis glatiramer acetate soln 40MG/ML 12 Syringes Per 28 Days N/A
Multiple Sclerosis glatopa soln 20MG/ML 30 Syringes Per 30 Days N/A
Multiple Sclerosis glatopa soln 40MG/ML 12 Syringes Per 28 Days N/A
Nasal Antiepileptics NAYZILAM SOLN 5MG/0.1ML 10 SPRAYS Per 30 Days N/A
Nasal Antiepileptics VALTOCO SPRAY 10MG/0.1ML 5 Boxes Per 30 Days N/A
Nasal Antiepileptics VALTOCO SPRAY 5MG/0.1ML 5 Boxes Per 30 Days N/A
Nasal Antiepileptics VALTOCO SPRAY 20MG 5 Boxes Per 30 Days N/A
Nasal Antiepileptics VALTOCO SPRAY 15MG 5 Boxes Per 30 Days N/A
Nasal Inhalers ASTEPRO SPRAY 205.5MCG 2 Bottles Per 30 Days N/A
Nasal Inhalers BECONASE AQ 205.5MCG 2 Bottles Per 30 Days N/A
Nasal Inhalers DYMISTA SPRAY 137-50MCG 1 Bottle Per 30 Days N/A
Nasal Inhalers FLUNISOLIDE SOLN 25MCG 3 Bottles Per 30 Days N/A
Nasal Inhalers NASONEX SUSP 50MCG 2 Bottles Per 30 Days N/A
Nasal Inhalers OMNARIS SUSP 50MCG 1 Bottle Per 30 Days N/A
Nasal Inhalers PATANASE SOLN 0.6% 1 Bottle Per 30 Days N/A
Nasal Inhalers QNASL AEROSOL 80MCG 1 Inhaler Per 30 Days N/A
Nasal Inhalers QNASL CHILDRENS AEROSOL 40MCG 1 Inhaler Per 30 Days N/A
Nasal Inhalers XHANCE SUSP 93MCG 2 Bottles Per 30 Days N/A
Nasal Inhalers ZETONNA SOL 37MCG 1 Inhaler Per 30 Days N/A
Nasal Inhalers azelastine hcl soln 205.5mcg 2 Bottles Per 30 Days N/A
Nasal Inhalers azelastine hydrochloride spray 137mcg 2 Bottles Per 30 Days N/A
Nasal Inhalers azelastine hydrochloride spray 205.5mcg 2 Bottles Per 30 Days N/A
Nasal Inhalers fluticasone propionate susp 50mcg 1 Bottle Per 30 Days N/A
Nasal Inhalers ipratropium bromide soln 21mcg 2 Bottles Per 30 Days N/A
Nasal Inhalers ipratropium bromide soln 42mcg 3 Bottles Per 30 Days N/A
Nasal Inhalers mometasone furoate susp 50mcg 2 Bottles Per 30 Days N/A
Nasal Inhalers olopatadine hcl soln 0.6% 1 Bottle Per 30 Days N/A
Nasal Inhalers triamcinolone acetonide susp 55mcg 1 Bottle Per 30 Days N/A
Natpara NATPARA INJ CARTRIDGE 100MCG 1 Kit Per 28 Days N/A
Natpara NATPARA INJ CARTRIDGE 25MCG 1 Kit Per 28 Days N/A
Natpara NATPARA INJ CARTRIDGE 50MCG 1 Kit Per 28 Days N/A
Natpara NATPARA INJ CARTRIDGE 75MCG 1 Kit Per 28 Days N/A
Neurotrophic Keratitis OXERVATE SOLN 20MCG 56 Vials Per 56 Days N/A
Nocturia NOCDURNA TAB 27.7MCG 30 Tablets Per 30 Days N/A
Nocturia NOCDURNA TAB 55.3MCG 30 Tablets Per 30 Days N/A
Nocturia NOCTIVA SPRAY 0.83MCG/1.0ML 1 Bottle Per 30 Days N/A
Nocturia NOCTIVA SPRAY 1.66MCG/1.0ML 1 Bottle Per 30 Days N/A
Northera NORTHERA CAP 100MG 450 Capsules Per 30 Days N/A
Northera NORTHERA CAP 200MG 180 Capsules Per 30 Days N/A
Northera NORTHERA CAP 300MG 180 Capsules Per 30 Days N/A
Nuvigil/Provigil NUVIGIL TAB 150MG 30 Tablets Per 30 Days N/A
Nuvigil/Provigil NUVIGIL TAB 200MG 30 Tablets Per 30 Days N/A
Nuvigil/Provigil NUVIGIL TAB 250MG 30 Tablets Per 30 Days N/A
Nuvigil/Provigil NUVIGIL TAB 50MG 30 Tablets Per 30 Days N/A
Nuvigil/Provigil PROVIGIL TAB 100MG 30 Tablets Per 30 Days N/A
Nuvigil/Provigil PROVIGIL TAB 200MG 30 Tablets Per 30 Days N/A
Nuvigil/Provigil armodafinil tab 150mg 30 Tablets Per 30 Days N/A
Nuvigil/Provigil armodafinil tab 200mg 30 Tablets Per 30 Days N/A
Nuvigil/Provigil armodafinil tab 250mg 30 Tablets Per 30 Days N/A
Nuvigil/Provigil armodafinil tab 50mg 30 Tablets Per 30 Days N/A
Nuvigil/Provigil modafinil tab 100mg 30 Tablets Per 30 Days N/A
Nuvigil/Provigil modafinil tab 200mg 30 Tablets Per 30 Days N/A
Ocaliva OCALIVA TAB 10MG 30 Tablets Per 30 Days N/A
Ocaliva LATANOPROST SOLN 0.005% 30 Tablets Per 30 Days N/A
Ophthalmic Immunomodulators CEQUA SOLN 0.09% 60 Vials Per 30 Days N/A
Ophthalmic Immunomodulators RESTASIS EMULSION 0.05% 1 Bottle Per 30 Days N/A
Ophthalmic Immunomodulators RESTASIS EMULSION 0.05% 60 Containers Per 30 Days N/A
Ophthalmic Immunomodulators RESTASIS MULTIDOSE EMULSION 0.05% 1 Bottle Per 30 Days N/A
Ophthalmic Immunomodulators RESTASIS MULTIDOSE EMULSION 0.05% 60 Containers Per 30 Days N/A
Ophthalmic Immunomodulators XIIDRA SOLN 5% 60 Vials Per 30 Days N/A
Ophthalmic Prostaglandins LUMIGAN SOLN 0.01% 3 mLs Per 30 Days N/A
Ophthalmic Prostaglandins RESCULA SOLN 0.15% 3 mLs Per 30 Days N/A
Ophthalmic Prostaglandins TRAVATAN Z SOLN 1.5% 1 Bottle Per 30 Days N/A
Ophthalmic Prostaglandins VYZULTA SOLN 0.004% 3 mLs Per 30 Days N/A
Ophthalmic Prostaglandins VYZULTA SOLN 0.024% 3 mLs Per 30 Days N/A
Ophthalmic Prostaglandins VYZULTA SOLN 0.024% 5 mLs Per 30 Days N/A
Ophthalmic Prostaglandins XELPROS SOLN 0.024% 3 mLs Per 30 Days N/A
Ophthalmic Prostaglandins ZIOPTAN SOLN 0.005% 3 mLs Per 30 Days N/A
Ophthalmic Prostaglandins bimatoprost soln 0.0015% 30 Containers Per 30 Days N/A
Ophthalmic Prostaglandins latanoprost soln 0.03% 3 mLs Per 30 Days N/A
Ophthalmic Prostaglandins travoprost soln0.005% 3 mLs Per 30 Days N/A
Ophthalmic Prostaglandins travoprost soln 0.004% 3 mLs Per 30 Days N/A
Opioids ER ARYMO ER TAB 15MG 60 Tablets Per 30 Days N/A
Opioids ER ARYMO ER TAB 30MG 30 Tablets Per 30 Days N/A
Opioids ER ARYMO ER TAB 60MG 0 Tablets Per 30 Days N/A
Opioids ER BELBUCA FILM 150MCG 60 Films Per 30 Days N/A
Opioids ER BELBUCA FILM 300MCG 60 Films Per 30 Days N/A
Opioids ER BELBUCA FILM 450MCG 60 Films Per 30 Days N/A
Opioids ER BELBUCA FILM 600MCG 60 Films Per 30 Days N/A
Opioids ER BELBUCA FILM 750MCG 60 Films Per 30 Days N/A
Opioids ER BELBUCA FILM 75MCG 60 Films Per 30 Days N/A
Opioids ER BELBUCA FILM 900MCG 30 Films Per 30 Days N/A
Opioids ER BUPRENORPHINE PATCH 10MCG 4 Systems Per 28 Days N/A
Opioids ER BUPRENORPHINE PATCH 15MCG 4 Systems Per 28 Days N/A
Opioids ER BUPRENORPHINE PATCH 20MCG 4 Systems Per 28 Days N/A
Opioids ER BUPRENORPHINE PATCH 5MCG 4 Systems Per 28 Days N/A
Opioids ER BUPRENORPHINE PATCH 7.5MCG 4 Systems Per 28 Days N/A
Opioids ER BUTRANS PATCH 10MCG 4 Systems Per 28 Days N/A
Opioids ER BUTRANS PATCH 15MCG 4 Systems Per 28 Days N/A
Opioids ER BUTRANS PATCH 20MCG 4 Systems Per 28 Days N/A
Opioids ER BUTRANS PATCH 5MCG 4 Systems Per 28 Days N/A
Opioids ER BUTRANS PATCH 7.5MCG 4 Systems Per 28 Days N/A
Opioids ER CONZIP CAP 100MG 30 Capsules Per 30 Days N/A
Opioids ER CONZIP CAP 200MG 30 Capsules Per 30 Days N/A
Opioids ER CONZIP CAP 300MG 30 Capsules Per 30 Days N/A
Opioids ER DURAGESIC PATCH 100MCG 0 Patches Per 30 Days N/A
Opioids ER DURAGESIC PATCH 12MCG 10 Patches Per 30 Days N/A
Opioids ER DURAGESIC PATCH 25MCG 0 Patches Per 30 Days N/A
Opioids ER DURAGESIC PATCH 50MCG 0 Patches Per 30 Days N/A
Opioids ER DURAGESIC PATCH 75MCG 0 Patches Per 30 Days N/A
Opioids ER EMBEDA CAP 100 mg/4 mg 0 Capsules Per 30 Days N/A
Opioids ER EMBEDA CAP 20 mg/0.8 mg 30 Capsules Per 30 Days N/A
Opioids ER EMBEDA CAP 30 mg/1.2 mg 30 Capsules Per 30 Days N/A
Opioids ER EMBEDA CAP 50 mg/2 mg 30 Capsules Per 30 Days N/A
Opioids ER EMBEDA CAP 60 mg/2.4 mg 0 Capsules Per 30 Days N/A
Opioids ER EMBEDA CAP 80 mg/3.2 mg 0 Capsules Per 30 Days N/A
Opioids ER EXALGO TAB 12MG 30 Tablets Per 30 Days N/A
Opioids ER EXALGO TAB 16MG 0 Tablets Per 30 Days N/A
Opioids ER EXALGO TAB 32MG 0 Tablets Per 30 Days N/A
Opioids ER EXALGO TAB 8MG 30 Tablets Per 30 Days N/A
Opioids ER HYSINGLA ER TAB 100MG 0 Tablets Per 30 Days N/A
Opioids ER HYSINGLA ER TAB 120MG 0 Tablets Per 30 Days N/A
Opioids ER HYSINGLA ER TAB 20MG 30 Tablets Per 30 Days N/A
Opioids ER HYSINGLA ER TAB 30MG 30 Tablets Per 30 Days N/A
Opioids ER HYSINGLA ER TAB 40MG 30 Tablets Per 30 Days N/A
Opioids ER HYSINGLA ER TAB 60MG 0 Tablets Per 30 Days N/A
Opioids ER HYSINGLA ER TAB 80MG 0 Tablets Per 30 Days N/A
Opioids ER KADIAN CAP 10MG 30 Capsules Per 30 Days N/A
Opioids ER KADIAN CAP 100MG 0 Capsules Per 30 Days N/A
Opioids ER KADIAN CAP 20MG 30 Capsules Per 30 Days N/A
Opioids ER KADIAN CAP 200MG 0 Capsules Per 30 Days N/A
Opioids ER KADIAN CAP 30MG 30 Capsules Per 30 Days N/A
Opioids ER KADIAN CAP 40MG 30 Capsules Per 30 Days N/A
Opioids ER KADIAN CAP 50MG 30 Capsules Per 30 Days N/A
Opioids ER KADIAN CAP 60MG 0 Capsules Per 30 Days N/A
Opioids ER KADIAN CAP 80MG 0 Capsules Per 30 Days N/A
Opioids ER MORPHABOND ER TAB 100MG 0 Tablets Per 30 Days N/A
Opioids ER MORPHABOND ER TAB 15MG 60 Tablets Per 30 Days N/A
Opioids ER MORPHABOND ER TAB 30MG 30 Tablets Per 30 Days N/A
Opioids ER MORPHABOND ER TAB 60MG 0 Tablets Per 30 Days N/A
Opioids ER MORPHINE SULFATE ER CAP 120MG 0 Capsules Per 30 Days N/A
Opioids ER MORPHINE SULFATE ER CAP 30MG 30 Capsules Per 30 Days N/A
Opioids ER MORPHINE SULFATE ER CAP 45MG 30 Capsules Per 30 Days N/A
Opioids ER MORPHINE SULFATE ER CAP 60MG 0 Capsules Per 30 Days N/A
Opioids ER MORPHINE SULFATE ER CAP 75MG 0 Capsules Per 30 Days N/A
Opioids ER MORPHINE SULFATE ER CAP 90MG 0 Capsules Per 30 Days N/A
Opioids ER MS CONTIN TAB 100MG 0 Tablets Per 30 Days N/A
Opioids ER MS CONTIN TAB 15MG 60 Tablets Per 30 Days N/A
Opioids ER MS CONTIN TAB 200MG 0 Tablets Per 30 Days N/A
Opioids ER MS CONTIN TAB 30MG 30 Tablets Per 30 Days N/A
Opioids ER MS CONTIN TAB 60MG 0 Tablets Per 30 Days N/A
Opioids ER NUCYNTA ER TAB 100MG 30 Tablets Per 30 Days N/A
Opioids ER NUCYNTA ER TAB 150MG 30 Tablets Per 30 Days N/A
Opioids ER NUCYNTA ER TAB 200MG 30 Tablets Per 30 Days N/A
Opioids ER NUCYNTA ER TAB 250MG 0 Tablets Per 30 Days N/A
Opioids ER NUCYNTA ER TAB 50MG 60 Tablets Per 30 Days N/A
Opioids ER OPANA ER (CRUSH RESISTANT) TAB 10MG 30 Tablets Per 30 Days N/A
Opioids ER OPANA ER (CRUSH RESISTANT) TAB 15MG 30 Tablets Per 30 Days N/A
Opioids ER OPANA ER (CRUSH RESISTANT) TAB 20MG 0 Tablets Per 30 Days N/A
Opioids ER OPANA ER (CRUSH RESISTANT) TAB 30MG 0 Tablets Per 30 Days N/A
Opioids ER OPANA ER (CRUSH RESISTANT) TAB 40MG 0 Tablets Per 30 Days N/A
Opioids ER OPANA ER (CRUSH RESISTANT) TAB 5MG 60 Tablets Per 30 Days N/A
Opioids ER OPANA ER (CRUSH RESISTANT) TAB 7.5MG 60 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HCL ER TAB 10MG 60 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HCL ER TAB 15MG 60 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HCL ER TAB 20MG 30 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HCL ER TAB 30MG 30 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HCL ER TAB 40MG 0 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HCL ER TAB 60MG 0 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HCL ER TAB 80MG 0 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HYDROCHLORIDE ER TAB 10MG 60 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HYDROCHLORIDE ER TAB 20MG 60 Tablets Per 30 Days N/A
Opioids ER OXYCODONE HYDROCHLORIDE ER TAB 40MG 0 Tablets Per 30 Days N/A
Opioids ER OXYCONTIN TAB 10MG 60 Tablets Per 30 Days N/A
Opioids ER OXYCONTIN TAB 15MG 60 Tablets Per 30 Days N/A
Opioids ER OXYCONTIN TAB 20MG 30 Tablets Per 30 Days N/A
Opioids ER OXYCONTIN TAB 30MG 30 Tablets Per 30 Days N/A
Opioids ER OXYCONTIN TAB 40MG 0 Tablets Per 30 Days N/A
Opioids ER OXYCONTIN TAB 60MG 0 Tablets Per 30 Days N/A
Opioids ER OXYCONTIN TAB 80MG 0 Tablets Per 30 Days N/A
Opioids ER OXYMORPHONE HYDROCHLORIDE ER TAB 10MG 30 Tablets Per 30 Days N/A
Opioids ER OXYMORPHONE HYDROCHLORIDE ER TAB 15MG 30 Tablets Per 30 Days N/A
Opioids ER OXYMORPHONE HYDROCHLORIDE ER TAB 20MG 0 Tablets Per 30 Days N/A
Opioids ER OXYMORPHONE HYDROCHLORIDE ER TAB 30MG 0 Tablets Per 30 Days N/A
Opioids ER OXYMORPHONE HYDROCHLORIDE ER TAB 40MG 0 Tablets Per 30 Days N/A
Opioids ER OXYMORPHONE HYDROCHLORIDE ER TAB 5MG 60 Tablets Per 30 Days N/A
Opioids ER OXYMORPHONE HYDROCHLORIDE ER TAB 7.5MG 60 Tablets Per 30 Days N/A
Opioids ER OXYMORPHONE HYDROCHLORIDE ER TAB 40MG 0 Tablets Per 30 Days N/A
Opioids ER TRAMADOL HCL ER CAP 100MG 30 Capsules Per 30 Days N/A
Opioids ER TRAMADOL HCL ER CAP 150MG 30 Capsules Per 30 Days N/A
Opioids ER TRAMADOL HCL ER CAP 200MG 30 Capsules Per 30 Days N/A
Opioids ER TRAMADOL HCL ER CAP 300MG 30 Capsules Per 30 Days N/A
Opioids ER XTAMPZA ER CAP 13.5MG 60 Capsules Per 30 Days N/A
Opioids ER XTAMPZA ER CAP 18MG 30 Capsules Per 30 Days N/A
Opioids ER XTAMPZA ER CAP 27MG 30 Capsules Per 30 Days N/A
Opioids ER XTAMPZA ER CAP 36MG 0 Capsules Per 30 Days N/A
Opioids ER XTAMPZA ER CAP 9 MG 60 Capsules Per 30 Days N/A
Opioids ER ZOHYDRO ER CAP 10MG 60 Capsules Per 30 Days N/A
Opioids ER ZOHYDRO ER CAP 15MG 60 Capsules Per 30 Days N/A
Opioids ER ZOHYDRO ER CAP 20MG 60 Capsules Per 30 Days N/A
Opioids ER ZOHYDRO ER CAP 30MG 30 Capsules Per 30 Days N/A
Opioids ER ZOHYDRO ER CAP 40MG 30 Capsules Per 30 Days N/A
Opioids ER ZOHYDRO ER CAP 50MG 30 Capsules Per 30 Days N/A
Opioids ER buprenorphine patch 10mcg 4 Systems Per 28 Days N/A
Opioids ER buprenorphine patch 15mcg 4 Systems Per 28 Days N/A
Opioids ER buprenorphine patch 20mcg 4 Systems Per 28 Days N/A
Opioids ER buprenorphine patch 5mcg 4 Systems Per 28 Days N/A
Opioids ER fentanyl patch 100mcg 0 Patches Per 30 Days N/A
Opioids ER fentanyl patch 12mcg 10 Patches Per 30 Days N/A
Opioids ER fentanyl patch 25mcg 0 Patches Per 30 Days N/A
Opioids ER fentanyl patch 37.5mcg 0 Patches Per 30 Days N/A
Opioids ER fentanyl patch 50mcg 0 Patches Per 30 Days N/A
Opioids ER fentanyl patch 62.5mcg 0 Patches Per 30 Days N/A
Opioids ER fentanyl patch 75mcg 0 Patches Per 30 Days N/A
Opioids ER fentanyl patch 87.5mcg 0 Patches Per 30 Days N/A
Opioids ER hydrocodone bitartrate er cap 10mg 60 Capsules Per 30 Days N/A
Opioids ER hydrocodone bitartrate er cap 15mg 60 Capsules Per 30 Days N/A
Opioids ER hydrocodone bitartrate er cap 20mg 30 Capsules Per 30 Days N/A
Opioids ER hydrocodone bitartrate er cap 30mg 30 Capsules Per 30 Days N/A
Opioids ER hydrocodone bitartrate er cap 40mg 30 Capsules Per 30 Days N/A
Opioids ER hydrocodone bitartrate er cap 50mg 0 Capsules Per 30 Days N/A
Opioids ER hydromorphone hcl er tab 12mg 30 Tablets Per 30 Days N/A
Opioids ER hydromorphone hcl er tab 16mg 0 Tablets Per 30 Days N/A
Opioids ER hydromorphone hcl er tab 32mg 0 Tablets Per 30 Days N/A
Opioids ER hydromorphone hcl er tab 8mg 30 Tablets Per 30 Days N/A
Opioids ER hydromorphone hydrochloride tab 32mg 0 Tablets Per 30 Days N/A
Opioids ER hydromorphone hydrochloride er tab 32mg 0 Tablets Per 30 Days N/A
Opioids ER morphine sulfate er cap 10mg 30 Capsules Per 30 Days N/A
Opioids ER morphine sulfate er cap 100mg 0 Capsules Per 30 Days N/A
Opioids ER morphine sulfate er cap 20mg 30 Capsules Per 30 Days N/A
Opioids ER morphine sulfate er cap 30mg 30 Capsules Per 30 Days N/A
Opioids ER morphine sulfate er cap 40mg 30 Capsules Per 30 Days N/A
Opioids ER morphine sulfate er cap 50mg 30 Capsules Per 30 Days N/A
Opioids ER morphine sulfate er cap 60mg 0 Capsules Per 30 Days N/A
Opioids ER morphine sulfate er cap 80mg 0 Capsules Per 30 Days N/A
Opioids ER morphine sulfate er tab 100mg 0 Tablets Per 30 Days N/A
Opioids ER morphine sulfate er tab 15mg 60 Tablets Per 30 Days N/A
Opioids ER morphine sulfate er tab 200mg 0 Tablets Per 30 Days N/A
Opioids ER morphine sulfate er tab 30mg 30 Tablets Per 30 Days N/A
Opioids ER morphine sulfate er tab 60mg 0 Tablets Per 30 Days N/A
Opioids ER tramadol hcl er tab 100mg 30 Tablets Per 30 Days N/A
Opioids ER tramadol hcl er tab 200mg 30 Tablets Per 30 Days N/A
Opioids ER tramadol hcl er tab 300mg 30 Tablets Per 30 Days N/A
Opioids ER tramadol hcl er tab 100mg 30 Tablets Per 30 Days N/A
Opioids ER tramadol hcl er tab 200mg 30 Tablets Per 30 Days N/A
Opioids ER tramadol hcl er tab 300mg 30 Tablets Per 30 Days N/A
Opioids IR ACETAMINOPHEN/CAFFEINE/DIHYDROCODEINE CAP 320.5 mg/30 mg/16 mg 50 Capsules Per 30 Days N/A
Opioids IR ACETAMINOPHEN/CAFFEINE/DIHYDROCODEINE BITARTRATE TAB 325 mg/30 mg/16 mg 50 Tablets Per 30 Days N/A
Opioids IR APADAZ TAB 4.08/325MG 50 Tablets Per 30 Days N/A
Opioids IR APADAZ TAB 6.12/325MG 40 Tablets Per 30 Days N/A
Opioids IR APADAZ TAB 8.16/325MG 30 Tablets Per 30 Days N/A
Opioids IR CODEINE SULFATE TAB 15MG 30 Tablets Per 30 Days N/A
Opioids IR CODEINE SULFATE TAB 30MG 30 Tablets Per 30 Days N/A
Opioids IR CODEINE SULFATE TAB 60MG 25 Tablets Per 30 Days N/A
Opioids IR DILAUDID LIQD 1MG/ML 60 mLs Per 30 Days N/A
Opioids IR DILAUDID TAB 2MG 30 Tablets Per 30 Days N/A
Opioids IR DILAUDID TAB 4MG 15 Tablets Per 30 Days N/A
Opioids IR DILAUDID TAB 8MG 5 Tablets Per 30 Days N/A
Opioids IR DOLOPHINE TAB 10MG 30 Tablets Per 30 Days N/A
Opioids IR DOLOPHINE TAB 5MG 60 Tablets Per 30 Days N/A
Opioids IR HYDROCODONE BITARTRATE/ACETAMINOPHEN SLN 10-325MG/15ML 225 mLs Per 30 Days N/A
Opioids IR IBUDONE TAB 5MG/200MG 25 Tablets Per 30 Days N/A
Opioids IR LEVORPHANOL TARTRATE TAB 3MG 10 Tablets Per 30 Days N/A
Opioids IR LORTAB SOL 10MG/300MG/15ML 203 mLs Per 30 Days N/A
Opioids IR MEPERIDINE HCL SOLN 50MG/5ML 150 mLs Per 30 Days N/A
Opioids IR MEPERIDINE HCL TAB 100MG 15 Tablets Per 30 Days N/A
Opioids IR MEPERIDINE HCL TAB 50MG 30 Tablets Per 30 Days N/A
Opioids IR METHADONE HCL SOLN 10MG/5ML 150 mLs Per 30 Days N/A
Opioids IR METHADONE HCL SOLN 5MG/5ML 300 mLs Per 30 Days N/A
Opioids IR MORPHINE SULFATE TAB 15MG 60 Tablets Per 30 Days N/A
Opioids IR MORPHINE SULFATE TAB 30MG 30 Tablets Per 30 Days N/A
Opioids IR NORCO TAB 7.5 mg/325 mg 30 Tablets Per 30 Days N/A
Opioids IR NORCO TAB 5 mg/325 mg 40 Tablets Per 30 Days N/A
Opioids IR NORCO TAB 10 mg/325 mg 25 Tablets Per 30 Days N/A
Opioids IR NORCO TAB 2.5 mg/325 mg 60 Tablets Per 30 Days N/A
Opioids IR NUCYNTA TAB 100MG 5 Tablets Per 30 Days N/A
Opioids IR NUCYNTA TAB 50MG 10 Tablets Per 30 Days N/A
Opioids IR NUCYNTA TAB 75MG 5 Tablets Per 30 Days N/A
Opioids IR OPANA TAB 10MG 5 Tablets Per 30 Days N/A
Opioids IR OPANA TAB 5MG 15 Tablets Per 30 Days N/A
Opioids IR OXAYDO TAB 5MG 30 Tablets Per 30 Days N/A
Opioids IR OXAYDO TAB 7.5MG 20 Tablets Per 30 Days N/A
Opioids IR OXYCODONE/ACETAMINOPHEN SOLN 5-325MG/5ML 100 mLs Per 30 Days N/A
Opioids IR OXYCODONE/ASPIRIN TAB 4.8355 mg/325 mg 30 Tablets Per 30 Days N/A
Opioids IR OXYCODONE/IBUPROFEN TAB 5 mg/400 mg 20 Tablets Per 30 Days N/A
Opioids IR PERCOCET TAB 2.5 mg/325 mg 60 Tablets Per 30 Days N/A
Opioids IR PERCOCET TAB 5 mg/325 mg 30 Tablets Per 30 Days N/A
Opioids IR PERCOCET TAB 7.5 mg/325 mg 20 Tablets Per 30 Days N/A
Opioids IR PERCOCET TAB 10 mg/325 mg 15 Tablets Per 30 Days N/A
Opioids IR PRIMLEV TAB 5 mg/300 mg 30 Tablets Per 30 Days N/A
Opioids IR PRIMLEV TAB 7.5 mg/300 mg 20 Tablets Per 30 Days N/A
Opioids IR PRIMLEV TAB 10 mg/300 mg 15 Tablets Per 30 Days N/A
Opioids IR ROXICODONE TAB 15MG 10 Tablets Per 30 Days N/A
Opioids IR ROXICODONE TAB 30MG 5 Tablets Per 30 Days N/A
Opioids IR ROXICODONE TAB 5MG 30 Tablets Per 30 Days N/A
Opioids IR TRAMADOL HYDROCHLORIDE TAB 100MG 0 Tablets Per 30 Days N/A
Opioids IR TREZIX CAP 320.5 mg/30 mg/16 mg 50 Capsules Per 30 Days N/A
Opioids IR TYLENOL/CODEINE #2 TAB 300-15MG 30 Tablets Per 30 Days N/A
Opioids IR TYLENOL/CODEINE #3 TAB 300-30MG 30 Tablets Per 30 Days N/A
Opioids IR TYLENOL/CODEINE #4 TAB 300-60MG 30 Tablets Per 30 Days N/A
Opioids IR ULTRACET TAB 37.5mg/325MG 40 Tablets Per 30 Days N/A
Opioids IR ULTRAM TAB 50MG 50 Tablets Per 30 Days N/A
Opioids IR acetaminophen/caffeine/dihydrocodeine tab 325 mg/30 mg/16 mg 50 Tablets Per 30 Days N/A
Opioids IR acetaminophen w/ codeine soln 120-12 mg/5ml 450 mLs Per 30 Days N/A
Opioids IR acetaminophen/codeine tab 300 mg/15 mg 30 Tablets Per 30 Days N/A
Opioids IR acetaminophen/codeine tab 300 mg/30 mg 30 Tablets Per 30 Days N/A
Opioids IR acetaminophen/codeine tab 300 mg/60 mg 25 Tablets Per 30 Days N/A
Opioids IR acetaminophen/codeine phosphate tab 300 mg/15 mg 30 Tablets Per 30 Days N/A
Opioids IR acetaminophen/codeine phosphate tab 300 mg/30 mg 30 Tablets Per 30 Days N/A
Opioids IR acetaminophen/codeine phosphate tab 300 mg/60 mg 25 Tablets Per 30 Days N/A
Opioids IR butorphanol tartrate nasal soln 10 mg/ml 2.5 mLs Per 30 Days N/A
Opioids IR codeine sulfate tab 30mg 30 Tablets Per 30 Days N/A
Opioids IR codeine sulfate tab 60mg 25 Tablets Per 30 Days N/A
Opioids IR endocet tab 2.5 mg/325 mg 60 Tablets Per 30 Days N/A
Opioids IR endocet tab 5 mg/325 mg 30 Tablets Per 30 Days N/A
Opioids IR endocet tab 7.5 mg/325 mg 20 Tablets Per 30 Days N/A
Opioids IR endocet tab 10 mg/325 mg 15 Tablets Per 30 Days N/A
Opioids IR hydrocodone bitartrate/acetaminophen soln 7.5-325mg/15ml 450 mLs Per 30 Days N/A
Opioids IR hydrocodone bitartrate/acetaminophen tab 5mg/300mg 40 Tablets Per 30 Days N/A
Opioids IR hydrocodone bitartrate/acetaminophen tab 7.5-325mg 30 Tablets Per 30 Days N/A
Opioids IR hydrocodone bitartrate/acetaminophen tab 10-325mg 25 Tablets Per 30 Days N/A
Opioids IR hydrocodone bitartrate/acetaminophen tab 7.5-300mg 30 Tablets Per 30 Days N/A
Opioids IR hydrocodone bitartrate/acetaminophen tab 5-325mg 40 Tablets Per 30 Days N/A
Opioids IR hydrocodone bitartrate/acetaminophen tab 7.5-325mg 30 Tablets Per 30 Days N/A
Opioids IR hydrocodone bitartrate/acetaminophen tab 10-300mg 25 Tablets Per 30 Days N/A
Opioids IR hydrocodone bitartrate/acetaminophen tab 2.5-325mg 60 Tablets Per 30 Days N/A
Opioids IR hydrocodone/ibuprofen tab 2.5mg/200mg 25 Tablets Per 30 Days N/A
Opioids IR hydrocodone/ibuprofen tab 5mg/200mg 25 Tablets Per 30 Days N/A
Opioids IR hydrocodone/ibuprofen tab 10mg/200mg 25 Tablets Per 30 Days N/A
Opioids IR hydromorphone hcl liqd 1/ml 60 mLs Per 30 Days N/A
Opioids IR hydromorphone hcl tab 2mg 30 Tablets Per 30 Days N/A
Opioids IR hydromorphone hcl tab 4mg 15 Tablets Per 30 Days N/A
Opioids IR hydromorphone hcl tab 8mg 5 Tablets Per 30 Days N/A
Opioids IR ibudone tab 10mg/200mg 25 Tablets Per 30 Days N/A
Opioids IR levorphanol tartrate tab 2mg 10 Tablets Per 30 Days N/A
Opioids IR lorcet tab 5 mg/325 mg 40 Tablets Per 30 Days N/A
Opioids IR lorcet tab 7.5 mg/325 mg 30 Tablets Per 30 Days N/A
Opioids IR lorcet hd tab -325mg 180 Tablets Per 30 Days N/A
Opioids IR lorcet plus tab -325mg 180 Tablets Per 30 Days N/A
Opioids IR meperidine hcl tab 100mg 15 Tablets Per 30 Days N/A
Opioids IR meperidine hcl tab 50mg 30 Tablets Per 30 Days N/A
Opioids IR methadone hcl conc 10/ml 90 mLs Per 30 Days N/A
Opioids IR methadone hcl soln 10/5ml 150 mLs Per 30 Days N/A
Opioids IR methadone hcl soln 5/5ml 300 mLs Per 30 Days N/A
Opioids IR methadone hcl tab 10mg 30 Tablets Per 30 Days N/A
Opioids IR methadone hcl tab 5mg 60 Tablets Per 30 Days N/A
Opioids IR methadone hcl tab 40mg 0 Tablets Per 30 Days N/A
Opioids IR methadone hcl intensol conc 10mg/ml 90 mLs Per 30 Days N/A
Opioids IR methadone hydrochloride tab 10mg 30 Tablets Per 30 Days N/A
Opioids IR methadone hydrochloride tab 5mg 60 Tablets Per 30 Days N/A
Opioids IR methadose tab 40mg 0 Tablets Per 30 Days N/A
Opioids IR morphine sulfate soln 10mg/5ml 125 mLs Per 30 Days N/A
Opioids IR morphine sulfate soln 20mg/5ml 60 mLs Per 30 Days N/A
Opioids IR nalocet tab 2.5 mg/300 mg 60 Tablets Per 30 Days N/A
Opioids IR oxycodone hcl cap 5mg 30 Capsules Per 30 Days N/A
Opioids IR oxycodone hydrochloride cap 5mg 30 Capsules Per 30 Days N/A
Opioids IR oxycodone hydrochloride soln 5mg/5ml 165 mLs Per 30 Days N/A
Opioids IR oxycodone hydrochloride tab 10mg 15 Tablets Per 30 Days N/A
Opioids IR oxycodone hydrochloride tab 15mg 10 Tablets Per 30 Days N/A
Opioids IR oxycodone hydrochloride tab 20mg 5 Tablets Per 30 Days N/A
Opioids IR oxycodone hydrochloride tab 30mg 5 Tablets Per 30 Days N/A
Opioids IR oxycodone hydrochloride tab 5mg 15 Tablets Per 30 Days N/A
Opioids IR oxycodone/acetaminophen tab 2.5-325mg 60 Tablets Per 30 Days N/A
Opioids IR oxycodone/acetaminophen tab 2.5-300mg 60 Tablets Per 30 Days N/A
Opioids IR oxycodone/acetaminophen tab 5-325mg 30 Tablets Per 30 Days N/A
Opioids IR oxycodone/acetaminophen tab 7.5-325mg 20 Tablets Per 30 Days N/A
Opioids IR oxycodone/acetaminophen tab 10-325mg 15 Tablets Per 30 Days N/A
Opioids IR oxycodone/aspirin tab 4.8355 mg/325 mg 30 Tablets Per 30 Days N/A
Opioids IR oxymorphone hydrochloride tab 10mg 5 Tablets Per 30 Days N/A
Opioids IR oxymorphone hydrochloride tab 5mg 15 Tablets Per 30 Days N/A
Opioids IR panlor tab 320.5 mg/30 mg/16 mg 50 Tablets Per 30 Days N/A
Opioids IR pentazocine/naloxone hcl tab 50 mg/0.5 mg 10 Tablets Per 30 Days N/A
Opioids IR tramadol hcl tab 50mg 50 Tablets Per 30 Days N/A
Opioids IR tramadol hydrochloride/acetaminophen tab 37.5-325mg 40 Tablets Per 30 Days N/A
Opioids IR Duration Limit morphine sulfate tab 15mg 15 Tablets Per 30 Days N/A
Opioids IR Duration Limit morphine sulfate tab 30mg 5 Tablets Per 30 Days N/A
Oral Immunotherapy GRASTEK TAB 2800 BAU 30 Tablets Per 30 Days N/A
Oral Immunotherapy ODACTRA TAB 12SQ-HDM 30 Tablets Per 30 Days N/A
Oral Immunotherapy ORALAIR TAB 300 IR 30 Tablets Per 30 Days N/A
Oral Immunotherapy ORALAIR ADULT SAMPLE KIT TAB 300 IR 30 Tablets Per 30 Days N/A
Oral Immunotherapy ORALAIR ADULT STARTER PACK TAB 300 IR 30 Tablets Per 30 Days N/A
Oral Immunotherapy ORALAIR CHILDREN/ADOLESCENTS STARTER PACK TAB 300 IR 1 Pack Per 180 Days N/A
Oral Immunotherapy RAGWITEK TAB 12AMB A 1-U 30 Tablets Per 30 Days N/A
Oral Inhalers ADVAIR DISKUS POWDER BA 100-50MCG 60 Blisters Per 30 Days N/A
Oral Inhalers ADVAIR DISKUS POWDER BA 250-50MCG 60 Blisters Per 30 Days N/A
Oral Inhalers ADVAIR DISKUS POWDER BA 500-50MCG 60 Blisters Per 30 Days N/A
Oral Inhalers ADVAIR HFA AEROSOL 115-21MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ADVAIR HFA AEROSOL 230-21MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ADVAIR HFA AEROSOL 45-21MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers AIRDUO RESPICLICK 113/14 POWDER 113-14MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers AIRDUO RESPICLICK 232/14 POWDER 1232-14MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers AIRDUO RESPICLICK 55/14 POWDER 55-14MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ALBUTEROL SULFATE HFA AERO 108MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers ALVESCO AERO 160MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers ALVESCO AERO 80 MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ANORO ELLIPTA POWDER BA 113MCG 60 Blisters Per 30 Days N/A
Oral Inhalers ARCAPTA NEOHALER CAP 75MCG 30 Capsules Per 30 Days N/A
Oral Inhalers ARMONAIR RESPICLICK 113 POWDER 113MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ARMONAIR RESPICLICK 232 POWDER 232MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ARMONAIR RESPICLICK 55 POWDER 55MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ARNUITY ELLIPTA POWDER 100MCG 30 Blisters Per 30 Days N/A
Oral Inhalers ARNUITY ELLIPTA POWDER 200MCG 30 Blisters Per 30 Days N/A
Oral Inhalers ARNUITY ELLIPTA POWDER 50MCG 30 Blisters Per 30 Days N/A
Oral Inhalers ASMANEX HFA AERO 100MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ASMANEX HFA AERO 200MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ASMANEX HFA AERO 50MCG 1 Canister Per 30 Days N/A
Oral Inhalers ASMANEX TWISTHALER 120 METERED DOSES POWDER 220MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ASMANEX TWISTHALER 14 METERED DOSES POWDER 220MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ASMANEX TWISTHALER 30 METERED DOSES POWDER 110MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ASMANEX TWISTHALER 30 METERED DOSES POWDER 220MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ASMANEX TWISTHALER 60 METERED DOSES POWDER 110MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ASMANEX TWISTHALER 7 METERED DOSES POWDER 110MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers ATROVENT HFA AERO 17MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers BEVESPI AEROSPHERE AERO 9-4.8MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers BREO ELLIPTA AERO 100-25MCG 60 Blisters Per 30 Days N/A
Oral Inhalers BREO ELLIPTA AERO 200-25MCG 60 Blisters Per 30 Days N/A
Oral Inhalers BUDESONIDE/FORMOTEROL FUMARATE DIHYDRATE AERO 160-4.5MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers BUDESONIDE/FORMOTEROL FUMARATE DIHYDRATE AERO 80-4.5MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers COMBIVENT RESPIMAT SOLN 20-100MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers DUAKLIR PRESSAIR AERO 400-12MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers DULERA AERO 100-5MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers DULERA AERO 200-5MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers DULERA AERO 50-5MCG 1 Canister Per 30 Days N/A
Oral Inhalers FLOVENT DISKUS AERO 100MCG 60 Blisters Per 30 Days N/A
Oral Inhalers FLOVENT DISKUS AERO 250MCG 240 Blisters Per 30 Days N/A
Oral Inhalers FLOVENT DISKUS AERO 50MCG 60 Blisters Per 30 Days N/A
Oral Inhalers FLOVENT HFA AERO 110MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers FLOVENT HFA AERO 220MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers FLOVENT HFA AERO 44MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers FLUTICASONE PROPIONATE/SALMETEROL AERO 113-14MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers FLUTICASONE PROPIONATE/SALMETEROL AERO 232-14MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers FLUTICASONE PROPIONATE/SALMETEROL AERO 55-14MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers INCRUSE ELLIPTA AERO 62.5MCG 30 Blisters Per 30 Days N/A
Oral Inhalers LEVALBUTEROL TARTRATE HFA AERO 45MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers PROAIR DIGIHALER AERO 108MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers PROAIR HFA AERO 108MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers PROAIR RESPICLICK AERO 108MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers PROVENTIL HFA AERO 108MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers PULMICORT FLEXHALER AERO 180MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers PULMICORT FLEXHALER AERO 90MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers QVAR SOLN 40MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers QVAR SOLN 80MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers QVAR REDIHALER AERO 40MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers QVAR REDIHALER AERO 80MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers SEEBRI NEOHALER CAP 15.6MCG 60 Capsules Per 30 Days N/A
Oral Inhalers SEREVENT DISKUS AERO 50 MCG 60 Blisters Per 30 Days N/A
Oral Inhalers SPIRIVA HANDIHALER CAP 18MCG 30 Capsules Per 30 Days N/A
Oral Inhalers SPIRIVA RESPIMAT AEROSOL 1.25MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers SPIRIVA RESPIMAT AEROSOL 2.5MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers STIOLTO RESPIMAT SOLN 2.5-2.5MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers STRIVERDI RESPIMAT SOLN 2.5MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers SYMBICORT AERO 160-4.5MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers SYMBICORT AERO 8-4.5MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers TRELEGY ELLIPTA AEPB 100-62 5-25MCG 60 Blisters Per 30 Days N/A
Oral Inhalers TUDORZA PRESSAIR AERO 400MCG 1 Inhaler Per 30 Days N/A
Oral Inhalers UTIBRON NEOHALER CAP 27.5-15.6MCG 60 Capsules Per 30 Days N/A
Oral Inhalers VENTOLIN HFA ASERO 108MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers XOPENEX HFA AERO 45MCG 2 Inhalers Per 30 Days N/A
Oral Inhalers fluticasone propionate/salmeterol diskus aero 100-50mcg 60 Blisters Per 30 Days N/A
Oral Inhalers fluticasone propionate/salmeterol diskus aero 250-50mcg 60 Blisters Per 30 Days N/A
Oral Inhalers fluticasone propionate/salmeterol diskus aero 500-50mcg 60 Blisters Per 30 Days N/A
Oral Inhalers wixela inhub aero 100-50mcg 60 Blisters Per 30 Days N/A
Oral Inhalers wixela inhub aero 250-50mcg 60 Blisters Per 30 Days N/A
Oral Inhalers wixela inhub aero 500-50mcg 60 Blisters Per 30 Days N/A
Oral PAH ADCIRCA TAB 20MG 60 Tablets Per 30 Days N/A
Oral PAH ADEMPAS TAB 0.5MG 90 Tablets Per 30 Days N/A
Oral PAH ADEMPAS TAB 1MG 90 Tablets Per 30 Days N/A
Oral PAH ADEMPAS TAB 1.5MG 90 Tablets Per 30 Days N/A
Oral PAH ADEMPAS TAB 1.5MG 90 Tablets Per 30 Days N/A
Oral PAH ADEMPAS TAB 2.5MG 90 Tablets Per 30 Days N/A
Oral PAH LETAIRIS TAB 10MG 30 Tablets Per 30 Days N/A
Oral PAH LETAIRIS TAB 5MG 30 Tablets Per 30 Days N/A
Oral PAH OPSUMIT TAB 10MG 30 Tablets Per 30 Days N/A
Oral PAH REVATIO SUSP 10MG 2 Bottles Per 30 Days N/A
Oral PAH REVATIO TAB 20MG 90 Tablets Per 30 Days N/A
Oral PAH TRACLEER TAB 125MG 60 Tablets Per 30 Days N/A
Oral PAH TRACLEER TAB 62.MG 60 Tablets Per 30 Days N/A
Oral PAH TRACLEER TAB 32MG 120 Tablets Per 30 Days N/A
Oral PAH TYVASO SOLN 0.6MG/ML 1 Kit Per 180 Days N/A
Oral PAH TYVASO SOLN 0.6MG/ML 1 Kit Per 28 Days N/A
Oral PAH TYVASO SOLN 0.6MG/ML 7 Packages Per 28 Days N/A
Oral PAH TYVASO REFILL SOLN 0.6MG/ML 1 Kit Per 180 Days N/A
Oral PAH TYVASO REFILL SOLN 0.6MG/ML 1 Kit Per 28 Days N/A
Oral PAH TYVASO REFILL SOLN 0.6MG/ML 7 Packages Per 28 Days N/A
Oral PAH TYVASO STARTER SOLN 0.6MG/ML 1 Kit Per 180 Days N/A
Oral PAH TYVASO STARTER SOLN 0.6MG/ML 1 Kit Per 28 Days N/A
Oral PAH TYVASO STARTER SOLN 0.6MG/ML 7 Packages Per 28 Days N/A
Oral PAH UPTRAVI TAB 1000MCG 60 Tablets Per 30 Days N/A
Oral PAH UPTRAVI TAB 1200MCG 60 Tablets Per 30 Days N/A
Oral PAH UPTRAVI TAB 1400MCG 60 Tablets Per 30 Days N/A
Oral PAH UPTRAVI TAB 1600MCG 60 Tablets Per 30 Days N/A
Oral PAH UPTRAVI TAB 200MCG 140 Tablets Per 180 Days N/A
Oral PAH UPTRAVI TAB 200MCG 60 Tablets Per 30 Days N/A
Oral PAH UPTRAVI TAB 400MCG 60 Tablets Per 30 Days N/A
Oral PAH UPTRAVI TAB 600MCG 60 Tablets Per 30 Days N/A
Oral PAH UPTRAVI TAB 800MCG 60 Tablets Per 30 Days N/A
Oral PAH UPTRAVI TAB 200MCG 1 Package Per 180 Days N/A
Oral PAH VENTAVIS SOLN 10MCG/ML 270 Ampules Per 30 Days N/A
Oral PAH VENTAVIS SOLN 20MCG/ML 270 Ampules Per 30 Days N/A
Oral PAH alyq tab 20mg 60 Tablets Per 30 Days N/A
Oral PAH ambrisentan tab 10mg 30 Tablets Per 30 Days N/A
Oral PAH ambrisentan tab 5mg 30 Tablets Per 30 Days N/A
Oral PAH bosentan tab 125mg 60 Tablets Per 30 Days N/A
Oral PAH bosentan tab 62.mg 60 Tablets Per 30 Days N/A
Oral PAH sildenafil citrate susp 10mg/ml 2 Bottles Per 30 Days N/A
Oral PAH sildenafil citrate tab 20mg 90 Tablets Per 30 Days N/A
Oral PAH tadalafil tab 20mg 60 Tablets Per 30 Days N/A
Orilissa ORILISSA TAB 150MG 30 Tablets Per 30 Days N/A
Orilissa ORILISSA TAB 200MG 60 Tablets Per 30 Days N/A
Otezla OTEZLA TAB 30MG 60 Tablets Per 30 Days N/A
Otezla OTEZLA TAB 10MG 1 Kit Per 180 Days N/A
Pain Meds vanatol lq soln 50-325-40mg/15ml 2700 mLs Per 30 Days N/A
Pain Meds vanatol s soln 50-325-40mg/15ml 2700 mLs Per 30 Days N/A
Pain Meds vtol lq soln 50-325-40mg/15ml 2700 mLs Per 30 Days N/A
Parathyroid Hormone Analog Osteoporosis FORTEO INJ 600MCG/2.4ML 1 Pen Per 28 Days N/A
Parathyroid Hormone Analog Osteoporosis TYMLOS 3120MCG.1.56ML 1 Pen Per 30 Days N/A
PCSK-9 REPATHA SON 140MG/ML 2 Syringes Per 28 Days N/A
PCSK-9 REPATHA PUSHTRONEX SYSTEM SOLN 420MG/3.5ML 1 CART Per 30 Days N/A
PCSK-9 REPATHA SURECLICK SOLN 140MG/ML 2 Pens Per 28 Days N/A
PCSK-9 Inhibitors PRALUENT SOLN 150MG/ML 2 Syringes Per 28 Days N/A
PCSK-9 Inhibitors PRALUENT SOLN 75MG/ML 2 Syringes Per 28 Days N/A
PDE5 Inhibitors CIALIS TAB 10MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors CIALIS TAB 2.5MG 30 Tablets Per 30 Days N/A
PDE5 Inhibitors CIALIS TAB 20MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors CIALIS TAB 5MG 30 Tablets Per 30 Days N/A
PDE5 Inhibitors LEVITRA TAB 10MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors LEVITRA TAB 2.5MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors LEVITRA TAB 20MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors LEVITRA TAB 5MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors STAXYN TAB 10MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors STENDRA TAB 100MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors STENDRA TAB 200MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors STENDRA TAB 50MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors VIAGRA TAB 100MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors VIAGRA TAB 25MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors VIAGRA TAB 50MG 6 Tablets Per 30 Days N/A
PDE5 Inhibitors sildenafil tab 100mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors sildenafil tab 25mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors sildenafil citrate tab 100mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors sildenafil citrate tab 25mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors sildenafil citrate tab 50mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors tadalafil tab 10mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors tadalafil tab 2.5mg 30 Tablets Per 30 Days N/A
PDE5 Inhibitors tadalafil tab 20mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors tadalafil tab 5mg 30 Tablets Per 30 Days N/A
PDE5 Inhibitors vardenafil hydrochloride tab 10mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors vardenafil hydrochloride tab 2.5mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors vardenafil hydrochloride tab 20mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors vardenafil hydrochloride odt tab 5mg 6 Tablets Per 30 Days N/A
PDE5 Inhibitors vardenafil hydrochloride odt tab 10mg 6 Tablets Per 30 Days N/A
PPI ACIPHEX TAB 20MG 30 Tablets Per 30 Days N/A
PPI ACIPHEX SPRINKLE CAP 10MG 30 Capsules Per 30 Days N/A
PPI ACIPHEX SPRINKLE CAP 5MG 30 Capsules Per 30 Days N/A
PPI DEXILANT CAP 30MG 30 Capsules Per 30 Days N/A
PPI DEXILANT CAP 60MG 30 Capsules Per 30 Days N/A
PPI ESOMEPRAZOLE STRONTIUM CAP 49.MG 30 Capsules Per 30 Days N/A
PPI NEXIUM CAP 20MG 30 Capsules Per 30 Days N/A
PPI NEXIUM CAP 40MG 30 Capsules Per 30 Days N/A
PPI NEXIUM SUSP 2.5MG 30 Packets Per 30 Days N/A
PPI NEXIUM SUSP 210MG 30 Packets Per 30 Days N/A
PPI NEXIUM SUSP 20MG 30 Packets Per 30 Days N/A
PPI NEXIUM SUSP 40MG 30 Packets Per 30 Days N/A
PPI NEXIUM SUSP 5MG 30 Packets Per 30 Days N/A
PPI PREVACID CAP 15MG 30 Capsules Per 30 Days N/A
PPI PREVACID CAP 30MG 30 Capsules Per 30 Days N/A
PPI PREVACID SOLUTAB TAB 15MG 30 Tablets Per 30 Days N/A
PPI PREVACID SOLUTAB TAB 30MG 30 Tablets Per 30 Days N/A
PPI PRILOSEC SUSP 10MG 30 Packets Per 30 Days N/A
PPI PRILOSEC SUSP 2.5MG 60 Packets Per 30 Days N/A
PPI PROTONIX TAB 20MG 30 Tablets Per 30 Days N/A
PPI PROTONIX TAB 40MG 30 Tablets Per 30 Days N/A
PPI PROTONIX SUSP 40MG 30 Packets Per 30 Days N/A
PPI RABEPRAZOLE SODIUM DR SPRINKLE CAP 10MG 30 Capsules Per 30 Days N/A
PPI ZEGERID CAP -110MG 30 Capsules Per 30 Days N/A
PPI ZEGERID CAP -110MG 30 Capsules Per 30 Days N/A
PPI ZEGERID SUSP 20MG 30 Packets Per 30 Days N/A
PPI ZEGERID SUSP 40MG 30 Packets Per 30 Days N/A
PPI esomeprazole magnesium cap 20mg 30 Capsules Per 30 Days N/A
PPI esomeprazole magnesium cap 40mg 30 Capsules Per 30 Days N/A
PPI lansoprazole cap 15mg 30 Capsules Per 30 Days N/A
PPI lansoprazole cap 30mg 30 Capsules Per 30 Days N/A
PPI lansoprazole tab 15mg 30 Tablets Per 30 Days N/A
PPI lansoprazole tab 30mg 30 Tablets Per 30 Days N/A
PPI lansoprazole odt tab 15mg 30 Tablets Per 30 Days N/A
PPI lansoprazole odt tab 30mg 30 Tablets Per 30 Days N/A
PPI omeppi cap -110mg 30 Capsules Per 30 Days N/A
PPI omeppi cap -110mg 30 Capsules Per 30 Days N/A
PPI omeprazole cap 10mg 30 Capsules Per 30 Days N/A
PPI omeprazole cap 20mg 30 Capsules Per 30 Days N/A
PPI omeprazole cap 40mg 30 Capsules Per 30 Days N/A
PPI omeprazole dr cap 10mg 30 Capsules Per 30 Days N/A
PPI omeprazole dr cap 40mg 30 Capsules Per 30 Days N/A
PPI omeprazole/sodium bicarbonate cap -110mg 30 Capsules Per 30 Days N/A
PPI omeprazole/sodium bicarbonate cap -110mg 30 Capsules Per 30 Days N/A
PPI omeprazole/sodium bicarbonate susp 20-1680mg 30 Packets Per 30 Days N/A
PPI omeprazole/sodium bicarbonate susp 40-1680mg 30 Packets Per 30 Days N/A
PPI pantoprazole sodium tab 20mg 30 Tablets Per 30 Days N/A
PPI pantoprazole sodium tab 40mg 30 Tablets Per 30 Days N/A
PPI pantoprazole sodium dr tab 20mg 30 Tablets Per 30 Days N/A
PPI pantoprazole sodium dr tab 40mg 30 Tablets Per 30 Days N/A
PPI rabeprazole sodium tab 20mg 30 Tablets Per 30 Days N/A
Prevymis PREVYMIS TAB 240MG 100 Tablets Per 365 Days N/A
Prevymis PREVYMIS TAB 480MG 100 Tablets Per 365 Days N/A
Progesterones CRINONE GEL 4% 6 Applicators Per 30 Days N/A
Progesterones CRINONE GEL 8% 60 Applicators Per 30 Days N/A
Progesterones ENDOMETRIN INSERT 100MG 84 Suppositories Per 28 Days N/A
Pseudobulbar Affect NUEDEXTA CAP 20-10MG 60 Capsules Per 30 Days N/A
SA Oncology AFINITOR TAB 10MG 30 Tablets Per 30 Days N/A
SA Oncology AFINITOR TAB 2.5MG 30 Tablets Per 30 Days N/A
SA Oncology AFINITOR TAB 5MG 30 Tablets Per 30 Days N/A
SA Oncology AFINITOR TAB 7.5MG 30 Tablets Per 30 Days N/A
SA Oncology AFINITOR DISPERZ SUSP 2MG 60 Tablets Per 30 Days N/A
SA Oncology AFINITOR DISPERZ SUSP 3MG 90 Tablets Per 30 Days N/A
SA Oncology AFINITOR DISPERZ SUSP 5MG 60 Tablets Per 30 Days N/A
SA Oncology ALECENSA CAP 150MG 240 Capsules Per 30 Days N/A
SA Oncology ALUNBRIG TAB 180MG 30 Tablets Per 30 Days N/A
SA Oncology ALUNBRIG TAB 30MG 180 Tablets Per 30 Days N/A
SA Oncology ALUNBRIG TAB 90MG 30 Tablets Per 30 Days N/A
SA Oncology ALUNBRIG TAB 90MG 30 Tablets Per 180 Days N/A
SA Oncology AYVAKIT TAB 100MG 30 Tablets Per 30 Days N/A
SA Oncology AYVAKIT TAB 200MG 30 Tablets Per 30 Days N/A
SA Oncology AYVAKIT TAB 300MG 30 Tablets Per 30 Days N/A
SA Oncology BALVERSA TAB 3MG 90 Tablets Per 28 Days N/A
SA Oncology BALVERSA TAB 4MG 60 Tablets Per 28 Days N/A
SA Oncology BALVERSA TAB 5MG 30 Tablets Per 30 Days N/A
SA Oncology BOSULIF TAB 100MG 120 Tablets Per 30 Days N/A
SA Oncology BOSULIF TAB 400MG 30 Tablets Per 30 Days N/A
SA Oncology BOSULIF TAB 500MG 30 Tablets Per 30 Days N/A
SA Oncology BRAFTOVI CAP 50MG 180 Capsules Per 30 Days N/A
SA Oncology BRAFTOVI CAP 75MG 180 Capsules Per 30 Days N/A
SA Oncology BRUKINSA CAP 80MG 120 Capsules Per 30 Days N/A
SA Oncology CABOMETYX TAB 20MG 30 Tablets Per 30 Days N/A
SA Oncology CABOMETYX TAB 40MG 30 Tablets Per 30 Days N/A
SA Oncology CABOMETYX TAB 60MG 30 Tablets Per 30 Days N/A
SA Oncology CALQUENCE CAP 100MG 60 Capsules Per 30 Days N/A
SA Oncology CAPRELSA TAB 100MG 60 Tablets Per 30 Days N/A
SA Oncology CAPRELSA TAB 300MG 30 Tablets Per 30 Days N/A
SA Oncology COMETRIQ CAP 80MG 1 Carton Per 28 Days N/A
SA Oncology COMETRIQ CAP 80MG 1 Carton Per 28 Days N/A
SA Oncology COMETRIQ CAP 20MG 1 Carton Per 28 Days N/A
SA Oncology COPIKTRA CAP 15MG 56 Capsules Per 28 Days N/A
SA Oncology COPIKTRA CAP 25MG 56 Capsules Per 28 Days N/A
SA Oncology COTELLIC TAB 20MG 63 Tablets Per 28 Days N/A
SA Oncology DAURISMO TAB 100MG 30 Tablets Per 30 Days N/A
SA Oncology DAURISMO TAB 25MG 60 Tablets Per 30 Days N/A
SA Oncology ERIVEDGE CAP 150MG 30 Capsules Per 30 Days N/A
SA Oncology ERLEADA TAB 60MG 120 Tablets Per 30 Days N/A
SA Oncology FARYDAK CAP 10MG 6 Capsules Per 21 Days N/A
SA Oncology FARYDAK CAP 15MG 6 Capsules Per 21 Days N/A
SA Oncology FARYDAK CAP 20MG 6 Capsules Per 21 Days N/A
SA Oncology GILOTRIF TAB 20MG 30 Tablets Per 30 Days N/A
SA Oncology GILOTRIF TAB 30MG 30 Tablets Per 30 Days N/A
SA Oncology GILOTRIF TAB 40MG 30 Tablets Per 30 Days N/A
SA Oncology GLEEVEC TAB 100MG 90 Tablets Per 30 Days N/A
SA Oncology GLEEVEC TAB 400MG 60 Tablets Per 30 Days N/A
SA Oncology IBRANCE CAP 100MG 21 Capsules Per 28 Days N/A
SA Oncology IBRANCE CAP 125MG 21 Capsules Per 28 Days N/A
SA Oncology IBRANCE CAP 75MG 21 Capsules Per 28 Days N/A
SA Oncology ICLUSIG TAB 15MG 60 Tablets Per 30 Days N/A
SA Oncology ICLUSIG TAB 45MG 30 Tablets Per 30 Days N/A
SA Oncology IDHIFA TAB 100MG 30 Tablets Per 30 Days N/A
SA Oncology IDHIFA TAB 50MG 30 Tablets Per 30 Days N/A
SA Oncology IMBRUVICA CAP 140MG 120 Capsules Per 30 Days N/A
SA Oncology IMBRUVICA CAP 70MG 30 Capsules Per 30 Days N/A
SA Oncology IMBRUVICA TAB 140MG 30 Tablets Per 30 Days N/A
SA Oncology IMBRUVICA TAB 280MG 30 Tablets Per 30 Days N/A
SA Oncology IMBRUVICA TAB 420MG 30 Tablets Per 30 Days N/A
SA Oncology IMBRUVICA TAB 560MG 30 Tablets Per 30 Days N/A
SA Oncology INLYTA TAB 1MG 180 Tablets Per 30 Days N/A
SA Oncology INLYTA TAB 5MG 120 Tablets Per 30 Days N/A
SA Oncology INREBIC CAP 100MG 120 Capsules Per 30 Days N/A
SA Oncology IRESSA TAB 250MG 30 Tablets Per 30 Days N/A
SA Oncology JAKAFI TAB 10MG 60 Tablets Per 30 Days N/A
SA Oncology JAKAFI TAB 15MG 60 Tablets Per 30 Days N/A
SA Oncology JAKAFI TAB 20MG 60 Tablets Per 30 Days N/A
SA Oncology JAKAFI TAB 25MG 60 Tablets Per 30 Days N/A
SA Oncology JAKAFI TAB 5MG 60 Tablets Per 30 Days N/A
SA Oncology KISQALI TAB 200MG 21 Tablets Per 28 Days N/A
SA Oncology KISQALI TAB 400MG 42 Tablets Per 28 Days N/A
SA Oncology KISQALI TAB 600MG 63 Tablets Per 28 Days N/A
SA Oncology KISQALI FEMARA 200 DOSE TAB 200 MG & LETROZOLE 2.5 MG TBK 49 Tablets Per 28 Days N/A
SA Oncology KISQALI FEMARA 400 DOSE TAB 200 MG & LETROZOLE 2.5 MG TBK 70 Tablets Per 28 Days N/A
SA Oncology KISQALI FEMARA 600 DOSE TAB 200 MG & LETROZOLE 2.5 MG TBK 91 Tablets Per 28 Days N/A
SA Oncology LENVIMA CAP (2)MG 90 Capsules Per 30 Days N/A
SA Oncology LENVIMA CAP 14MG 60 Capsules Per 30 Days N/A
SA Oncology LENVIMA CAP 24MG 90 Capsules Per 30 Days N/A
SA Oncology LENVIMA CAP (2)MG 60 Capsules Per 30 Days N/A
SA Oncology LENVIMA CAP 10MG 30 Capsules Per 30 Days N/A
SA Oncology LENVIMA CAP 8MG 60 Capsules Per 30 Days N/A
SA Oncology LENVIMA CAP 12MG 90 Capsules Per 30 Days N/A
SA Oncology LENVIMA CAP 4MG 30 Capsules Per 30 Days N/A
SA Oncology LONSURF TAB -6.1MG 100 Tablets Per 28 Days N/A
SA Oncology LONSURF TAB -8.1MG 80 Tablets Per 28 Days N/A
SA Oncology LORBRENA TAB 100MG 30 Tablets Per 30 Days N/A
SA Oncology LORBRENA TAB 25MG 90 Tablets Per 30 Days N/A
SA Oncology LYNPARZA CAP 50MG 480 Capsules Per 30 Days N/A
SA Oncology LYNPARZA TAB 100MG 120 Tablets Per 30 Days N/A
SA Oncology LYNPARZA TAB 150MG 120 Tablets Per 30 Days N/A
SA Oncology MEKINIST TAB 0.5MG 30 Tablets Per 30 Days N/A
SA Oncology MEKINIST TAB 02MG 30 Tablets Per 30 Days N/A
SA Oncology MEKTOVI TAB 15MG 180 Tablets Per 30 Days N/A
SA Oncology NERLYNX TAB 40MG 180 Tablets Per 30 Days N/A
SA Oncology NEXAVAR TAB 200MG 120 Tablets Per 30 Days N/A
SA Oncology NINLARO CAP 2.3MG 3 Capsules Per 28 Days N/A
SA Oncology NINLARO CAP 3MG 3 Capsules Per 28 Days N/A
SA Oncology NINLARO CAP 4MG 3 Capsules Per 28 Days N/A
SA Oncology NUBEQA TAB 300MG 120 Tablets Per 30 Days N/A
SA Oncology ODOMZO CAP 200MG 30 Capsules Per 30 Days N/A
SA Oncology PIQRAY 200MG DAILY DOSE TAB 200MG 28 Tablets Per 28 Days N/A
SA Oncology PIQRAY 250MG DAILY DOSE TAB 250MG 56 Tablets Per 28 Days N/A
SA Oncology PIQRAY 300MG DAILY DOSE TAB 300MG 56 Tablets Per 28 Days N/A
SA Oncology POMALYST CAP 1MG 21 Capsules Per 28 Days N/A
SA Oncology POMALYST CAP 2MG 21 Capsules Per 28 Days N/A
SA Oncology POMALYST CAP 3MG 21 Capsules Per 28 Days N/A
SA Oncology POMALYST CAP 4MG 21 Capsules Per 28 Days N/A
SA Oncology REVLIMID CAP 10MG 30 Capsules Per 30 Days N/A
SA Oncology REVLIMID CAP 15MG 21 Capsules Per 28 Days N/A
SA Oncology REVLIMID CAP 20MG 21 Capsules Per 28 Days N/A
SA Oncology REVLIMID CAP 25MG 21 Capsules Per 28 Days N/A
SA Oncology REVLIMID CAP 5MG 30 Capsules Per 30 Days N/A
SA Oncology REVLIMID CAP 2.5MG 30 Capsules Per 30 Days N/A
SA Oncology ROZLYTREK CAP 100MG 30 Capsules Per 30 Days N/A
SA Oncology ROZLYTREK CAP 200MG 90 Capsules Per 30 Days N/A
SA Oncology RUBRACA TAB 200MG 120 Tablets Per 30 Days N/A
SA Oncology RUBRACA TAB 250MG 120 Tablets Per 30 Days N/A
SA Oncology RUBRACA TAB 300MG 120 Tablets Per 30 Days N/A
SA Oncology RYDAPT CAP 25MG 240 Capsules Per 30 Days N/A
SA Oncology SPRYCEL TAB 100MG 30 Tablets Per 30 Days N/A
SA Oncology SPRYCEL TAB 140MG 30 Tablets Per 30 Days N/A
SA Oncology SPRYCEL TAB 20MG 90 Tablets Per 30 Days N/A
SA Oncology SPRYCEL TAB 50MG 30 Tablets Per 30 Days N/A
SA Oncology SPRYCEL TAB 70MG 30 Tablets Per 30 Days N/A
SA Oncology SPRYCEL TAB 80MG 30 Tablets Per 30 Days N/A
SA Oncology STIVARGA TAB 40MG 84 Tablets Per 28 Days N/A
SA Oncology SUTENT CAP 12.MG 90 Capsules Per 30 Days N/A
SA Oncology SUTENT CAP 25MG 30 Capsules Per 30 Days N/A
SA Oncology SUTENT CAP 37.MG 30 Capsules Per 30 Days N/A
SA Oncology SUTENT CAP 50MG 30 Capsules Per 30 Days N/A
SA Oncology TAFINLAR CAP 50MG 120 Capsules Per 30 Days N/A
SA Oncology TAFINLAR CAP 75MG 120 Capsules Per 30 Days N/A
SA Oncology TAGRISSO TAB 40MG 30 Tablets Per 30 Days N/A
SA Oncology TAGRISSO TAB 80MG 30 Tablets Per 30 Days N/A
SA Oncology TALZENNA CAP 0.2MG 90 Capsules Per 30 Days N/A
SA Oncology TALZENNA CAP 1MG 30 Capsules Per 30 Days N/A
SA Oncology TARCEVA TAB 100MG 30 Tablets Per 30 Days N/A
SA Oncology TARCEVA TAB 150MG 30 Tablets Per 30 Days N/A
SA Oncology TARCEVA TAB 25MG 60 Tablets Per 30 Days N/A
SA Oncology TASIGNA CAP 150MG 120 Capsules Per 30 Days N/A
SA Oncology TASIGNA CAP 200MG 120 Capsules Per 30 Days N/A
SA Oncology TASIGNA CAP 50MG 120 Capsules Per 30 Days N/A
SA Oncology TAZVERIK TAB 200MG 240 Tablets Per 30 Days N/A
SA Oncology THALOMID CAP 100MG 30 Capsules Per 30 Days N/A
SA Oncology THALOMID CAP 150MG 60 Capsules Per 30 Days N/A
SA Oncology THALOMID CAP 200MG 60 Capsules Per 30 Days N/A
SA Oncology THALOMID CAP 50MG 30 Capsules Per 30 Days N/A
SA Oncology TIBSOVO TAB 250MG 60 Tablets Per 30 Days N/A
SA Oncology TURALIO CAP 200MG 120 Tablets Per 30 Days N/A
SA Oncology TYKERB TAB 250MG 180 Tablets Per 30 Days N/A
SA Oncology VENCLEXTA TAB 10MG 60 Tablets Per 30 Days N/A
SA Oncology VENCLEXTA TAB 100MG 180 Tablets Per 30 Days N/A
SA Oncology VENCLEXTA TAB 50MG 30 Tablets Per 30 Days N/A
SA Oncology VENCLEXTA STARTING PACK TAB 100MG 1 Pack Per 180 Days N/A
SA Oncology VERZENIO TAB 100MG 60 Tablets Per 30 Days N/A
SA Oncology VERZENIO TAB 150MG 60 Tablets Per 30 Days N/A
SA Oncology VERZENIO TAB 200MG 60 Tablets Per 30 Days N/A
SA Oncology VERZENIO TAB 50MG 60 Tablets Per 30 Days N/A
SA Oncology VITRAKVI CAP 100MG 60 Capsules Per 30 Days N/A
SA Oncology VITRAKVI CAP 25MG 180 Capsules Per 30 Days N/A
SA Oncology VITRAKVI SOLN 20MG/ML 300 mLs Per 30 Days N/A
SA Oncology VIZIMPRO TAB 15MG 30 Tablets Per 30 Days N/A
SA Oncology VIZIMPRO TAB 30MG 30 Tablets Per 30 Days N/A
SA Oncology VIZIMPRO TAB 45MG 30 Tablets Per 30 Days N/A
SA Oncology VOTRIENT TAB 200MG 120 Tablets Per 30 Days N/A
SA Oncology XALKORI CAP 200MG 60 Capsules Per 30 Days N/A
SA Oncology XALKORI CAP 250MG 60 Capsules Per 30 Days N/A
SA Oncology XOSPATA TAB 40MG 90 Tablets Per 30 Days N/A
SA Oncology XPOVIO 100 MG ONCE WEEKLY TAB 20MG 20 Tablets Per 28 Days N/A
SA Oncology XPOVIO 60 MG ONCE WEEKLY TAB 20MG 12 Tablets Per 28 Days N/A
SA Oncology XPOVIO 80 MG ONCE WEEKLY TAB 20MG 16 Tablets Per 28 Days N/A
SA Oncology XPOVIO 80 MG TWICE WEEKLY TAB 20MG 32 Tablets Per 28 Days N/A
SA Oncology XTANDI CAP 40MG 120 Capsules Per 30 Days N/A
SA Oncology YONSA TAB 125MG 120 Tablets Per 30 Days N/A
SA Oncology ZEJULA CAP 100MG 90 Capsules Per 30 Days N/A
SA Oncology ZELBORAF TAB 240MG 240 Tablets Per 30 Days N/A
SA Oncology ZOLINZA CAP 100MG 120 Capsules Per 30 Days N/A
SA Oncology ZYDELIG TAB 100MG 60 Tablets Per 30 Days N/A
SA Oncology ZYDELIG TAB 150MG 60 Tablets Per 30 Days N/A
SA Oncology ZYKADIA CAP 150MG 90 Capsules Per 30 Days N/A
SA Oncology ZYKADIA TAB 150MG 90 Tablets Per 30 Days N/A
SA Oncology ZYTIGA TAB 250MG 120 Tablets Per 30 Days N/A
SA Oncology ZYTIGA TAB 500MG 60 Tablets Per 30 Days N/A
SA Oncology abiraterone acetate tab 250mg 120 Tablets Per 30 Days N/A
SA Oncology erlotinib hydrochloride tab 100mg 30 Tablets Per 30 Days N/A
SA Oncology erlotinib hydrochloride tab 150mg 30 Tablets Per 30 Days N/A
SA Oncology erlotinib hydrochloride tab 25mg 60 Tablets Per 30 Days N/A
SA Oncology everolimus tab 2.5mg 30 Tablets Per 30 Days N/A
SA Oncology everolimus tab 5mg 30 Tablets Per 30 Days N/A
SA Oncology everolimus tab 7.5mg 30 Tablets Per 30 Days N/A
SA Oncology imatinib mesylate tab 100mg 90 Tablets Per 30 Days N/A
SA Oncology imatinib mesylate tab 400mg 60 Tablets Per 30 Days N/A
Samsca JYNARQUE TAB 15MG 30 Tablets Per 365 Days N/A
Samsca JYNARQUE TAB 30MG 60 Tablets Per 365 Days N/A
Samsca SAMSCA TAB 15MG 30 Tablets Per 365 Days N/A
Samsca SAMSCA TAB 30MG 60 Tablets Per 365 Days N/A
SGLT-2 Inhibitors FARXIGA TAB 10MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors FARXIGA TAB 5MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors GLYXAMBI TAB 10-MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors GLYXAMBI TAB 25-MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKAMET TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKAMET TAB -500MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKAMET TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKAMET TAB -500MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKAMET XR TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKAMET XR TAB -500MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKAMET XR TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKAMET XR TAB -500MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKANA TAB 100MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors INVOKANA TAB 300MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors JARDIANCE TAB 10MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors JARDIANCE TAB 25MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SEGLUROMET TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SEGLUROMET TAB -500MG 120 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SEGLUROMET TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SEGLUROMET TAB -500MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors STEGLATRO TAB 15MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors STEGLATRO TAB 5MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SYNJARDY TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SYNJARDY TAB -500MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SYNJARDY TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SYNJARDY TAB -500MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SYNJARDY XR TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SYNJARDY XR TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SYNJARDY XR TAB -100MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors SYNJARDY XR TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors XIGDUO XR TAB -100MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors XIGDUO XR TAB -500MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors XIGDUO XR TAB -100MG 30 Tablets Per 30 Days N/A
SGLT-2 Inhibitors XIGDUO XR TAB -100MG 60 Tablets Per 30 Days N/A
SGLT-2 Inhibitors XIGDUO XR TAB -500MG 30 Tablets Per 30 Days N/A
Sodium Oxybate XYREM SOLN 500MCG/ML 3 Bottles Per 30 Days N/A
SSIA NUPLAZID CAP 34MG 30 Capsules Per 30 Days N/A
SSIA NUPLAZID TAB 10MG 30 Tablets Per 30 Days N/A
SSIA NUPLAZID TAB 17MG 60 Tablets Per 30 Days N/A
Substrate Reduction Therapy CERDELGA CAP 84MG 60 Capsules Per 30 Days N/A
Substrate Reduction Therapy ZAVESCA CAP 100MG 90 Capsules Per 30 Days N/A
Substrate Reduction Therapy miglustat cap 100mg 90 Capsules Per 30 Days N/A
Sunosi SUNOSI TAB 150MG 30 Tablets Per 30 Days N/A
Sunosi SUNOSI TAB 75MG 30 Tablets Per 30 Days N/A
Tafamidis VYNDAMAX CAP 61MG 30 Capsules Per 30 Days N/A
Tafamidis VYNDAQEL CAP 20MG 120 Capsules Per 30 Days N/A
Thrombopoietin Receptor Agonists DOPTELET TAB 20MG 60 Tablets Per 30 Days N/A
Thrombopoietin Receptor Agonists MULPLETA TAB 3MG 7 Tablets Per 7 Days N/A
Thrombopoietin Receptor Agonists PROMACTA POWDER 12.5MG 30 Packets Per 30 Days N/A
Thrombopoietin Receptor Agonists PROMACTA TAB 12.MG 30 Tablets Per 30 Days N/A
Thrombopoietin Receptor Agonists PROMACTA TAB 25MG 30 Tablets Per 30 Days N/A
Thrombopoietin Receptor Agonists PROMACTA TAB 50MG 60 Tablets Per 30 Days N/A
Thrombopoietin Receptor Agonists PROMACTA TAB 75MG 60 Tablets Per 30 Days N/A
Thrombopoietin Receptor Agonists TAVALISSE TAB 100MG 60 Tablets Per 30 Days N/A
Thrombopoietin Receptor Agonists TAVALISSE TAB 150MG 60 Tablets Per 30 Days N/A
Topical Corticosteroids ALA SCALP LOTION 2% 118 mLs Per 30 Days N/A
Topical Corticosteroids AMCINONIDE CREAM 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids AMCINONIDE LOTION 0.1% 120 mLs Per 30 Days N/A
Topical Corticosteroids AMCINONIDE OINT 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids APEXICON E OINT 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids AUGMENTED BETAMETHASONE DIPROPIONATE GEL 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids BRYHALI LOTION 0.01% 200 Grams Per 28 Days N/A
Topical Corticosteroids CAPEX SHAMPOO 0.01% 840 mLs Per 28 Days N/A
Topical Corticosteroids CLOBEX LOTION 0.01% 177 mLs Per 28 Days N/A
Topical Corticosteroids CLOBEX LOTION 0.05% 236 mLs Per 30 Days N/A
Topical Corticosteroids CLOBEX SPRAY 0.05% 236 mLs Per 28 Days N/A
Topical Corticosteroids CLOCORTOLONE PIVALATE CREAM 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids CLOCORTOLONE PIVALATE PUMP CREAM 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids CLODERM CREAM 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids CLODERM PUMP CREAM 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids CORDRAN CREAM 0.025% 120 Grams Per 30 Days N/A
Topical Corticosteroids CORDRAN CREAM 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids CORDRAN LOTION 0.05% 120 mLs Per 30 Days N/A
Topical Corticosteroids CORDRAN OINT 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids CORDRAN TAPE 4MCG/SQCM 1 Box Per 30 Days N/A
Topical Corticosteroids CUTIVATE LOTION 0.05% 120 mLs Per 30 Days N/A
Topical Corticosteroids DERMA-SMOOTHE/FS BODY OIL 0.01% 118 mLs Per 30 Days N/A
Topical Corticosteroids DERMA-SMOOTHE/FS SCALP OIL 0.01% 118 mLs Per 30 Days N/A
Topical Corticosteroids DESONATE GEL 0,05% 120 Grams Per 30 Days N/A
Topical Corticosteroids DESOWEN CREAM 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids DESOWEN LOTION 0.05% 118 mLs Per 30 Days N/A
Topical Corticosteroids DIFLORASONE DIACETATE CREAM 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids DIPROLENE OINT 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids DIPROLENE AF CREAM 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids ELOCON CREAM 0.01% 135 Grams Per 30 Days N/A
Topical Corticosteroids ELOCON OINT 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids HALOBETASOL PROPIONATE FOAM 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids HALOG CREAM 0.1% 240 Grams Per 30 Days N/A
Topical Corticosteroids HALOG OINT 0.1% 240 Grams Per 30 Days N/A
Topical Corticosteroids IMPOYZ CREAM 0.025% 200 Grams Per 28 Days N/A
Topical Corticosteroids KENALOG SOLN 0.147MG/GM 126 Grams Per 30 Days N/A
Topical Corticosteroids LEXETTE FOAM 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids LOCOID CREAM 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids LOCOID LOTION 0.1% 118 mLs Per 30 Days N/A
Topical Corticosteroids LOCOID OINT 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids LOCOID SOLN 0.1% 120 mLs Per 30 Days N/A
Topical Corticosteroids LOCOID LIPOCREAM CREAM 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids LUXIQ FOAM 0.12% 150 Grams Per 30 Days N/A
Topical Corticosteroids MICORT-HC CREAM 0.12% 120 Grams Per 30 Days N/A
Topical Corticosteroids OLUX FOAM 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids OLUX-E FOAM 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids PANDEL CREAM 0.1% 160 Grams Per 30 Days N/A
Topical Corticosteroids PREDNICARBATE CREAM 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids PREDNICARBATE OINT 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids PSORCON CREAM 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids SERNIVO SPRAY 0.05% 120 mLs Per 30 Days N/A
Topical Corticosteroids SYNALAR CREAM 0.025% 120 Grams Per 30 Days N/A
Topical Corticosteroids SYNALAR OINT 0.025% 120 Grams Per 30 Days N/A
Topical Corticosteroids SYNALAR SOLN 0.025% 120 mLs Per 30 Days N/A
Topical Corticosteroids TEMOVATE CREAM 0.05% 210 Grams Per 28 Days N/A
Topical Corticosteroids TEMOVATE OINT 0.05% 210 Grams Per 28 Days N/A
Topical Corticosteroids TEXACORT SOLN 2.5% 120 mLs Per 30 Days N/A
Topical Corticosteroids TOPICORT CREAM 0.25% 120 Grams Per 30 Days N/A
Topical Corticosteroids TOPICORT CREAM 0.25% 120 Grams Per 30 Days N/A
Topical Corticosteroids TOPICORT GEL 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids TOPICORT OINT 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids TOPICORT OINT 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids TOPICORT SPRAY 0.25% 100 mLs Per 30 Days N/A
Topical Corticosteroids TRIANEX OINT 0.05% 430 Grams Per 30 Days N/A
Topical Corticosteroids TRIDESILON CREAM 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids ULTRAVATE CREAM 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids ULTRAVATE LOTION 0.05% 240 mLs Per 30 Days N/A
Topical Corticosteroids ULTRAVATE OINT 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids VANOS CREAM 0.1% 240 Grams Per 28 Days N/A
Topical Corticosteroids VERDESO FOAM 0.05% 100 Grams Per 30 Days N/A
Topical Corticosteroids WESTCORT OINT 0.2% 120 Grams Per 30 Days N/A
Topical Corticosteroids ala-cort oint 0.2% 454 Grams Per 30 Days N/A
Topical Corticosteroids ala-cort cream 2.5% 454 Grams Per 30 Days N/A
Topical Corticosteroids alclometasone dipropionate cream 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids alclometasone dipropionate oint 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids augmented betamethasone dipropionate cream 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids augmented betamethasone dipropionate lotion 0.05% 210 mLs Per 30 Days N/A
Topical Corticosteroids augmented betamethasone dipropionate oint 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids beser lotion 0.05% 120 mLs Per 30 Days N/A
Topical Corticosteroids betamethasone dipropionate cream 0.05% 135 Grams Per 30 Days N/A
Topical Corticosteroids betamethasone dipropionate lotion 0.05% 120 mLs Per 30 Days N/A
Topical Corticosteroids betamethasone dipropionate oint 0.05% 135 Grams Per 30 Days N/A
Topical Corticosteroids betamethasone valerate foam 0.12% 150 Grams Per 30 Days N/A
Topical Corticosteroids betamethasone valerate cream 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids betamethasone valerate lotion 0.1% 120 mLs Per 30 Days N/A
Topical Corticosteroids betamethasone valerate oint 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids clobetasol propionate cream 0.05% 210 Grams Per 28 Days N/A
Topical Corticosteroids clobetasol propionate foam 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids clobetasol propionate foam 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids clobetasol propionate gel 0.05% 210 Grams Per 28 Days N/A
Topical Corticosteroids clobetasol propionate lotion 0.05% 177 mLs Per 28 Days N/A
Topical Corticosteroids clobetasol propionate oint 0.05% 210 Grams Per 28 Days N/A
Topical Corticosteroids clobetasol propionate shampoo 0.05% 236 mLs Per 30 Days N/A
Topical Corticosteroids clobetasol propionate soln 0.05% 200 mLs Per 28 Days N/A
Topical Corticosteroids clobetasol propionate spray 0.05% 236 mLs Per 28 Days N/A
Topical Corticosteroids clobetasol propionate e cream 0.05% 210 Grams Per 28 Days N/A
Topical Corticosteroids clobetasol propionate emollient cream 0.05% 210 Grams Per 28 Days N/A
Topical Corticosteroids clobetasol propionate emollient foam 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids clodan shampoo 0.05% 236 mLs Per 30 Days N/A
Topical Corticosteroids desonide cream 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids desonide lotion 0.05% 118 mLs Per 30 Days N/A
Topical Corticosteroids desonide oint 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids desoximetasone cream 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids desoximetasone cream 0.25% 120 Grams Per 30 Days N/A
Topical Corticosteroids desoximetasone gel 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids desoximetasone oint 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids desoximetasone oint 0.25% 120 Grams Per 30 Days N/A
Topical Corticosteroids desoximetasone spray 0.25% 100 mLs Per 30 Days N/A
Topical Corticosteroids diflorasone diacetate oint 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluocinolone acetonide cream 0.01% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluocinolone acetonide cream 0.025% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluocinolone acetonide oint 0.025% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluocinolone acetonide soln 0.01% 120 mLs Per 30 Days N/A
Topical Corticosteroids fluocinolone acetonide body oil 0.01% 118 mLs Per 30 Days N/A
Topical Corticosteroids fluocinolone acetonide scalp oil 0.01% 118 mLs Per 30 Days N/A
Topical Corticosteroids fluocinonide cream 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluocinonide cream 0.01% 240 Grams Per 28 Days N/A
Topical Corticosteroids fluocinonide gel 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluocinonide oint 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluocinonides soln 0.05% 120 mLs Per 30 Days N/A
Topical Corticosteroids fluocinonide emulsified base cream 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluocinonide emulsified base cream 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids flurandrenolide cream 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids flurandrenolide lotion 0.05% 120 mLs Per 30 Days N/A
Topical Corticosteroids flurandrenolide oint 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluticasone propionate cream 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids fluticasone propionate lotion 0.05% 120 mLs Per 30 Days N/A
Topical Corticosteroids fluticasone propionate oint 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids halcinonide cream 0.1% 240 Grams Per 30 Days N/A
Topical Corticosteroids halobetasol propionate cream 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids halobetasol propionate oint 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids hydrocortisone cream 1% 454 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone cream 2.5% 454 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone lotion 2.5% 118 mLs Per 30 Days N/A
Topical Corticosteroids hydrocortisone oint 0.1% 454 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone oint 2.5% 454 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone 1% in absorbase oint 1% 454 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone butyrate cream 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone butyrate cream 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone butyrate lotion 0.1% 118 mLs Per 30 Days N/A
Topical Corticosteroids hydrocortisone butyrate oint 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone butyrate soln 0.1% 120 mLs Per 30 Days N/A
Topical Corticosteroids hydrocortisone butyrate (lipid) cream 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone butyrate (lipophilic) cream 0.1% 120 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone in absorbase oint 1% 454 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone valerate cream 0.2% 120 Grams Per 30 Days N/A
Topical Corticosteroids hydrocortisone valerate oint 0.2% 120 Grams Per 30 Days N/A
Topical Corticosteroids mometasone furoate cream 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids mometasone furoate oint 0.1% 135 Grams Per 30 Days N/A
Topical Corticosteroids mometasone furoate soln 0.1% 120 mLs Per 30 Days N/A
Topical Corticosteroids nolix cream 0.05% 120 Grams Per 30 Days N/A
Topical Corticosteroids nolix lotion 0.05% 120 mLs Per 30 Days N/A
Topical Corticosteroids tovet foam 0.05% 200 Grams Per 28 Days N/A
Topical Corticosteroids triamcinolone acetonide cream soln 0.147mg/gm 126 Grams Per 30 Days N/A
Topical Corticosteroids triamcinolone acetonide cream 0.025% 454 Grams Per 30 Days N/A
Topical Corticosteroids triamcinolone acetonide cream 0.1% 454 Grams Per 30 Days N/A
Topical Corticosteroids triamcinolone acetonide cream 0.5% 454 Grams Per 30 Days N/A
Topical Corticosteroids triamcinolone acetonide lotion 0.025% 120 mLs Per 30 Days N/A
Topical Corticosteroids triamcinolone acetonide lotion 0.1% 120 mLs Per 30 Days N/A
Topical Corticosteroids triamcinolone acetonide oint 0.025% 454 Grams Per 30 Days N/A
Topical Corticosteroids triamcinolone acetonide oint 0.05% 430 Grams Per 30 Days N/A
Topical Corticosteroids triamcinolone acetonide oint 0.01% 454 Grams Per 30 Days N/A
Topical Corticosteroids triamcinolone acetonide oint 0.5% 120 Grams Per 30 Days N/A
Topical Corticosteroids trianext oint 0.05% 430 Grams Per 30 Days N/A
Topical Corticosteroids triderm cream 0.1% 454 Grams Per 30 Days N/A
Topical Corticosteroids triderm cream 0.5% 454 Grams Per 30 Days N/A
Topical Doxepin DOXEPIN HYDROCHLORIDE CREAM 5% 45 Grams Per 30 Days N/A
Topical Doxepin PRUDOXIN CREAM 5% 45 Grams Per 30 Days N/A
Topical Doxepin ZONALON CREAM 5% 45 Grams Per 30 Days N/A
Topical Estrogen COMBIPATCH PATCH 0.05-014 MG/DAY 8 Patches Per 28 Days N/A
Topical Estrogen COMBIPATCH PATCH 0.05-025 MG/DAY 8 Patches Per 28 Days N/A
Topical Estrogen DIVIGEL GEL 0.75MG/0.75GM 30 Packets Per 30 Days N/A
Topical Estrogen DIVIGEL GEL 1.25MG/1.25GM 38 Grams Per 30 Days N/A
Topical Estrogen IMVEXXY MAINTENANCE PACK INSERT 10MCG 18 Suppositories Per 28 Days N/A
Topical Estrogen IMVEXXY MAINTENANCE PACK INSERT 10MCG 8 Suppositories Per 28 Days N/A
Topical Estrogen IMVEXXY MAINTENANCE PACK INSERT 4MCG 18 Suppositories Per 28 Days N/A
Topical Estrogen IMVEXXY MAINTENANCE PACK INSERT 4MCG 8 Suppositories Per 28 Days N/A
Topical Estrogens ALORA PATCH 0.02MG 8 Patches Per 28 Days N/A
Topical Estrogens ALORA PATCH 0.0MG 8 Patches Per 28 Days N/A
Topical Estrogens ALORA PATCH 0.07MG 8 Patches Per 28 Days N/A
Topical Estrogens ALORA PATCH 0.1MG 8 Patches Per 28 Days N/A
Topical Estrogens CLIMARA PATCH 0.02MG 4 Patches Per 28 Days N/A
Topical Estrogens CLIMARA PATCH .037MG 4 Patches Per 28 Days N/A
Topical Estrogens CLIMARA PATCH 0.0MG 4 Patches Per 28 Days N/A
Topical Estrogens CLIMARA PATCH 0.0MG 4 Patches Per 28 Days N/A
Topical Estrogens CLIMARA PATCH 0.07MG 4 Patches Per 28 Days 30 Capsules Per 30 Days
Topical Estrogens CLIMARA PATCH 0.1MG 4 Patches Per 28 Days 30 Tablets Per 30 Days
Topical Estrogens CLIMARA PRO PATCH 0.01MG 4 Patches Per 28 Days 30 Tablets Per 30 Days
Topical Estrogens DIVIGEL GEL 0.25MG/0.25GM 30 Packets Per 30 Days 24 Tablets Per 30 Days
Topical Estrogens DIVIGEL GEL 0.5MG/0.5GM 30 Packets Per 30 Days 18 Tablets Per 30 Days
Topical Estrogens DIVIGEL GEL 1MG/GM 30 Packets Per 30 Days 18 Tablets Per 30 Days
Topical Estrogens ELESTRIN GEL 1MG/GM 1 Pump Per 30 Days 18 Tablets Per 30 Days
Topical Estrogens ESTRING GEL 0.06% (0.75MG.1.25GM) 1 Ring Per 90 Days 15 Tablets Per 30 Days
Topical Estrogens ESTROGEL GEL 0.06% (0.75MG.1.25GM) 1 Pump Per 30 Days 36 mLs Per 30 Days
Topical Estrogens EVAMIST SPRAY 1.53MG 5 Vials Per 93 Days 18 Tablets Per 30 Days
Topical Estrogens FEMRING RING 0.05MG 1 Ring Per 90 Days 9 Tablets Per 30 Days
Topical Estrogens FEMRING RING 0.1MG 1 Ring Per 90 Days 3 Tablets Per 30 Days
Topical Estrogens IMVEXXY STARTER PACK SUPPOS 10MCG 18 Suppositories Per 28 Days N/A
Topical Estrogens IMVEXXY STARTER PACK SUPPOS 10MCG 8 Suppositories Per 28 Days N/A
Topical Estrogens IMVEXXY STARTER PACK SUPPOS 4MCG 18 Suppositories Per 28 Days 375 mLs Per 30 Days
Topical Estrogens IMVEXXY STARTER PACK SUPPOS 4MCG 8 Suppositories Per 28 Days 15 Tablets Per 30 Days
Topical Estrogens MENOSTAR PATCH 14MCG 4 Patches Per 28 Days 6 Tablets Per 30 Days
Topical Estrogens MINIVELLE PATCH 0.02MG 8 Patches Per 28 Days 338 mLs Per 30 Days
Topical Estrogens MINIVELLE PATCH .037MG 8 Patches Per 28 Days 150 mLs Per 30 Days
Topical Estrogens MINIVELLE PATCH 0.0MG 8 Patches Per 28 Days 15 Tablets Per 30 Days
Topical Estrogens MINIVELLE PATCH 0.07MG 8 Patches Per 28 Days 30 Tablets Per 30 Days
Topical Estrogens MINIVELLE PATCH 0.1MG 8 Patches Per 28 Days N/A
Topical Estrogens VIVELLE-DOT PATCH 0.02MG 8 Patches Per 28 Days N/A
Topical Estrogens VIVELLE-DOT PATCH .037MG 8 Patches Per 28 Days N/A
Topical Estrogens VIVELLE-DOT PATCH 0.0MG 8 Patches Per 28 Days N/A
Topical Estrogens VIVELLE-DOT PATCH 0.07MG 8 Patches Per 28 Days 18 Tablets Per 30 Days
Topical Estrogens VIVELLE-DOT PATCH 0.1MG 8 Patches Per 28 Days 24 Tablets Per 30 Days
Topical Estrogens dotti patch 0.02mg 8 Patches Per 28 Days 15 Tablets Per 30 Days
Topical Estrogens dotti patch .037mg 8 Patches Per 28 Days 36 Tablets Per 30 Days
Topical Estrogens dotti patch 0.0mg 8 Patches Per 28 Days 3 Tablets Per 30 Days
Topical Estrogens dotti patch 0.07mg 8 Patches Per 28 Days 6 Tablets Per 30 Days
Topical Estrogens dotti patch 0.1mg 8 Patches Per 28 Days 3 Tablets Per 30 Days
Topical Estrogens estradiol patch 0.02mg 8 Patches Per 28 Days 3 Tablets Per 30 Days
Topical Estrogens estradiol patch .037mg 8 Patches Per 28 Days 9 Tablets Per 30 Days
Topical Estrogens estradiol patch 0.0mg 8 Patches Per 28 Days 18 Tablets Per 30 Days
Topical Estrogens estradiol patch 0.07mg 8 Patches Per 28 Days 12 Tablets Per 30 Days
Topical Estrogens estradiol patch 0.1mg 8 Patches Per 28 Days 60mLs Per 30 Days
Topical Estrogens estradiol patch 0.02mg 4 Patches Per 28 Days 18 Tablets Per 30 Days
Topical Estrogens estradiol patch .037mg 4 Patches Per 28 Days 12 Tablets Per 30 Days
Topical Estrogens estradiol patch 0.0mg 4 Patches Per 28 Days 36 Tablets Per 30 Days
Topical Estrogens estradiol patch 0.0mg 4 Patches Per 28 Days 18 Tablets Per 30 Days
Topical Estrogens estradiol patch 0.07mg 4 Patches Per 28 Days 12 Tablets Per 30 Days
Topical Estrogens estradiol patch 0.1mg 4 Patches Per 28 Days 9 Tablets Per 30 Days
Topical Lidocaine 7t lido gel 2% 150mls 150 mLs Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine 7t lido gel 2% 150mls 900 mLs Per 30 Days 12 Tablets Per 30 Days
Topical Lidocaine LIDOCAINE AND TETRACAINE CREAM 7-7% 120 GRAMS 120 Grams Per 30 Days 9 Tablets Per 30 Days
Topical Lidocaine LIDOCAINE HCL JELLY GEL 2% 150MLS 150 mLs Per 30 Days 6 Tablets Per 30 Days
Topical Lidocaine LIDOCAINE HCL JELLY GEL 2% 150MLS 900 mLs Per 30 Days 3 Tablets Per 30 Days
Topical Lidocaine LIDODERM PATCH 5% 90 Patches Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine PLIAGLIS TETRACAINE Lidocain CREAM 7-7% 120 Grams Per 30 Days 120 Tablets Per 30 Days
Topical Lidocaine SYNERA PATCH 70-70MG 4 Patches Per 30 Days 30 Capsules Per 30 Days
Topical Lidocaine ZTLIDO PATCH 1.8% 36MG 90 Systems Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine glydo gel 2% 150mls 150 mLs Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine glydo gel 2% 150mls 900 mLs Per 30 Days 15 Tablets Per 30 Days
Topical Lidocaine lidocaine oint 5% 100grams 100 Grams Per 30 Days 24 Tablets Per 30 Days
Topical Lidocaine lidocaine oint 5% 100grams 600 Grams Per 30 Days 30 Tablets Per 30 Days
Topical Lidocaine lidocaine patch 5% 90 Patches Per 30 Days 30 Tablets Per 30 Days
Topical Lidocaine lidocaine soln 4% 150mls 150 mLs Per 30 Days 270 mLs Per 30 Days
Topical Lidocaine lidocaine soln 4% 150mls 400 mLs Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine lidocaine hcl gel 2% 150 mls 150 mLs Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine lidocaine hcl gel 2% 150 mls 900 mLs Per 30 Days 15 Tablets Per 30 Days
Topical Lidocaine lidocaine hcl jelly gel 2% 150 mls 150 mLs Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine lidocaine hcl jelly gel 2% 150 mls 900 mLs Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine lidocaine hcl jelly 2% 150 mls 150 mLs Per 30 Days 15 Tablets Per 30 Days
Topical Lidocaine lidocaine hcl jelly 2% 150 mls 900 mLs Per 30 Days 0 mLs Per 30 Days
Topical Lidocaine lidocaine hydrochloride soln 4% 150mls 150 mLs Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine lidocaine hydrochloride soln 4% 150mls 400 mLs Per 30 Days 15 Tablets Per 30 Days
Topical Lidocaine lidocaine oint 5% 100 grams 100 Grams Per 30 Days 36 Tablets Per 30 Days
Topical Lidocaine lidocaine oint 5% 100 grams 600 Grams Per 30 Days 18 Tablets Per 30 Days
Topical Lidocaine lidocaine-prilocaine-cream base cream 2.5-2.5% 30 Grams Per 30 Days 120 Tablets Per 30 Days
Topical Lidocaine lidocaine-prilocaine cream 2.5-2.5% 30 Grams Per 30 Days 9 Tablets Per 30 Days
Topical Lidocaine lidocaine oint 5% 100 Grams Per 30 Days 270 mLs Per 30 Days
Topical Lidocaine lidocaine oint 5% 600 Grams Per 30 Days 24 Tablets Per 30 Days
Topical NSAID DICLOFENAC EPOLAMINE PATCH 1.3% 60 Patches Per 30 Days 18 Tablets Per 30 Days
Topical NSAID FLECTOR PATCH 1.3% 60 Patches Per 30 Days 15 Tablets Per 30 Days
Topical NSAID PENNSAID SOLN 2% 2 Bottles Per 28 Days 18 Tablets Per 30 Days
Topical NSAID VOLTAREN GEL 1% 10 Tubes Per 30 Days 24 Tablets Per 30 Days
Topical NSAID diclofenac sodium gel 1% 10 Tubes Per 30 Days 18 Tablets Per 30 Days
Topical NSAID diclofenac sodium soln 1.5% 2 Bottles Per 30 Days 18 Tablets Per 30 Days
Topical NSAID klofensaid ii soln 1.5% 2 Bottles Per 30 Days 36 Tablets Per 30 Days
Topiramate ER QUDEXY XR CAP 100MG 30 Capsules Per 30 Days 15 Tablets Per 30 Days
Topiramate ER QUDEXY XR CAP 150MG 30 Capsules Per 30 Days 15 Tablets Per 30 Days
Topiramate ER QUDEXY XR CAP 200MG 60 Capsules Per 30 Days 15 Tablets Per 30 Days
Topiramate ER QUDEXY XR CAP 25MG 30 Capsules Per 30 Days 36 mLs Per 30 Days
Topiramate ER QUDEXY XR CAP 50MG 30 Capsules Per 30 Days 18 Tablets Per 30 Days
Topiramate ER TOPIRAMATE ER CAP 100MG 30 Capsules Per 30 Days 9 Tablets Per 30 Days
Topiramate ER TOPIRAMATE ER CAP 150MG 30 Capsules Per 30 Days 3 Tablets Per 30 Days
Topiramate ER TOPIRAMATE ER CAP 200MG 60 Capsules Per 30 Days 15 Tablets Per 30 Days
Topiramate ER TOPIRAMATE ER CAP 25MG 30 Capsules Per 30 Days 6 Tablets Per 30 Days
Topiramate ER TOPIRAMATE ER CAP 50MG 30 Capsules Per 30 Days 24 Tablets Per 30 Days
Topiramate ER TROKENDI XR CAP 100MG 30 Capsules Per 30 Days 18 Tablets Per 30 Days
Topiramate ER TROKENDI XR CAP 200MG 60 Capsules Per 30 Days N/A
Topiramate ER TROKENDI XR CAP 25MG 30 Capsules Per 30 Days N/A
Topiramate ER TROKENDI XR CAP 50MG 30 Capsules Per 30 Days 15 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl ABSTRAL TAB 100MCG 120 Tablets Per 30 Days 30 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl ABSTRAL TAB 200MCG 120 Tablets Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ABSTRAL TAB 300MCG 120 Tablets Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ABSTRAL TAB 400MCG 120 Tablets Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ABSTRAL TAB 500MCG 120 Tablets Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ABSTRAL TAB 600MCG 120 Tablets Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ACTIQ LOZENGE 1200MCG 120 Lozenges Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ACTIQ LOZENGE 1600MCG 120 Lozenges Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ACTIQ LOZENGE 200MCG 120 Lozenges Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ACTIQ LOZENGE 400MCG 120 Lozenges Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ACTIQ LOZENGE 600MCG 120 Lozenges Per 30 Days N/A
Transmucosal Immediate Release Fentanyl ACTIQ LOZENGE 800MCG 120 Lozenges Per 30 Days 75 mLs Per 30 Days
Transmucosal Immediate Release Fentanyl FENTANYL CITRATE TAB 100MCG 120 Tablets Per 30 Days 36 mLs Per 30 Days
Transmucosal Immediate Release Fentanyl FENTANYL CITRATE TAB 200MCG 120 Tablets Per 30 Days 36 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl FENTANYL CITRATE TAB 400MCG 120 Tablets Per 30 Days 18 Capsules Per 30 Days
Transmucosal Immediate Release Fentanyl FENTANYL CITRATE TAB 600MCG 120 Tablets Per 30 Days 18 Capsules Per 30 Days
Transmucosal Immediate Release Fentanyl FENTANYL CITRATE TAB 800MCG 120 Tablets Per 30 Days 99 mLs Per 30 Days
Transmucosal Immediate Release Fentanyl FENTORA TAB 100MCG 120 Tablets Per 30 Days 9 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl FENTORA TAB 200MCG 120 Tablets Per 30 Days 6 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl FENTORA TAB 400MCG 120 Tablets Per 30 Days 3 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl FENTORA TAB 600MCG 120 Tablets Per 30 Days 3 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl FENTORA TAB 800MCG 120 Tablets Per 30 Days 9 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl LAZANDA 100MCG/ACT 30 Bottles Per 30 Days 36 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl LAZANDA 300MCG/ACT 30 Bottles Per 30 Days 36 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl LAZANDA 400MCG/ACT 30 Bottles Per 30 Days 18 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl SUBSYS SPRAY 100MCG 120 SPRAYS Per 30 Days 10 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl SUBSYS SPRAY 1200MCG 240 SPRAYS Per 30 Days 9 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl SUBSYS SPRAY 1600MCG 240 SPRAYS Per 30 Days 18 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl SUBSYS SPRAY 200MCG 120 SPRAYS Per 30 Days 3 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl SUBSYS SPRAY 400MCG 120 SPRAYS Per 30 Days 9 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl SUBSYS SPRAY 600MCG 120 SPRAYS Per 30 Days 30 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl SUBSYS SPRAY 800MCG 120 SPRAYS Per 30 Days 6 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl fentanyl citrate oral transmucosal lozenge 1200mcg 120 Lozenges Per 30 Days 30 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl fentanyl citrate oral transmucosal lozenge 1600mcg 120 Lozenges Per 30 Days 24 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl fentanyl citrate oral transmucosal lozenge 200mcg 120 Lozenges Per 30 Days N/A
Transmucosal Immediate Release Fentanyl fentanyl citrate oral transmucosal lozenge 200mcg 120 Lozenges Per 30 Days N/A
Transmucosal Immediate Release Fentanyl fentanyl citrate oral transmucosal lozenge 600mcg 120 Lozenges Per 30 Days 9 Tablets Per 30 Days
Transmucosal Immediate Release Fentanyl fentanyl citrate oral transmucosal lozenge 800mcg 120 Lozenges Per 30 Days 35 Tablets Per 30 Days
Vascepa VASCEPA CAP 0.5GM 240 Capsules Per 30 Days N/A
Vascepa VASCEPA CAP 1GM 120 Capsules Per 30 Days N/A
VMAT2 Inhibitor AUSTEDO TAB 12MG 120 Tablets Per 30 Days N/A
VMAT2 Inhibitor AUSTEDO TAB 6MG 60 Tablets Per 30 Days N/A
VMAT2 Inhibitor AUSTEDO TAB 9MG 120 Tablets Per 30 Days N/A
VMAT2 Inhibitor INGREZZA CAP 40MG 30 Capsules Per 30 Days N/A
VMAT2 Inhibitor INGREZZA CAP 80MG 30 Capsules Per 30 Days N/A
VMAT2 Inhibitor INGREZZA CAP 40MG 28 Capsules Per 180 Days N/A
VMAT2 Inhibitor XENAZINE TAB 12.MG 240 Tablets Per 30 Days N/A
VMAT2 Inhibitor XENAZINE TAB 25MG 120 Tablets Per 30 Days N/A
VMAT2 Inhibitor tetrabenazine tab 12.mg 240 Tablets Per 30 Days N/A
VMAT2 Inhibitor tetrabenazine tab 25mg 120 Tablets Per 30 Days N/A
Weight Loss Agents ADIPEX-P CAP 37.MG 30 Capsules Per 30 Days N/A
Weight Loss Agents ADIPEX-P TAB 37.MG 30 Tablets Per 30 Days N/A
Weight Loss Agents BELVIQ TAB 10MG 60 Tablets Per 30 Days N/A
Weight Loss Agents BELVIQ XR TAB 20MG 30 Tablets Per 30 Days N/A
Weight Loss Agents BENZPHETAMINE HCL TAB 25MG 90 Tablets Per 30 Days N/A
Weight Loss Agents CONTRAVE TAB -90MG 120 Tablets Per 30 Days N/A
Weight Loss Agents DIETHYLPROPION HCL TAB 25MG 90 Tablets Per 30 Days N/A
Weight Loss Agents DIETHYLPROPION HCL ER TAB 75MG 30 Tablets Per 30 Days N/A
Weight Loss Agents LOMAIRA TAB 8MG 90 Tablets Per 30 Days N/A
Weight Loss Agents PHENDIMETRAZINE TARTRATE ER CAP 105MG 30 Capsules Per 30 Days N/A
Weight Loss Agents QSYMIA CAP -69MG 30 Capsules Per 30 Days N/A
Weight Loss Agents QSYMIA CAP -92MG 30 Capsules Per 30 Days N/A
Weight Loss Agents QSYMIA CAP -23MG 30 Capsules Per 30 Days N/A
Weight Loss Agents QSYMIA CAP -46MG 30 Capsules Per 30 Days N/A
Weight Loss Agents REGIMEX TAB 25MG 90 Tablets Per 30 Days N/A
Weight Loss Agents SAXENDA SOLN PE-INJ 18MG/3ML 15 mLs Per 30 Days N/A
Weight Loss Agents XENICAL CAP 120MG 90 Capsules Per 30 Days N/A
Weight Loss Agents benzphetamine hcl tab 50mg 90 Tablets Per 30 Days N/A
Weight Loss Agents diethylpropion hcl tab 25mg 90 Tablets Per 30 Days N/A
Weight Loss Agents diethylpropion hcl er tab 75mg 30 Tablets Per 30 Days N/A
Weight Loss Agents phendimetrazine tartrate tab 35mg 180 Tablets Per 30 Days N/A
Weight Loss Agents phentermine hcl tab 37.mg 30 Tablets Per 30 Days N/A
Weight Loss Agents phentermine hydrochloride cap 15mg 30 Capsules Per 30 Days N/A
Weight Loss Agents phentermine hydrochloride cap 30mg 30 Capsules Per 30 Days N/A
Weight Loss Agents phentermine hydrochloride cap 37.mg 30 Capsules Per 30 Days N/A
Xermelo XERMELO TAB 250MG 90 Tablets Per 30 Days N/A

Drug Name(s)

Tier

abiraterone acetate tab GN
ACTEMRA BP
ACTEMRA ACTPEN BP
ACTHAR BN
ACTIMMUNE BP
ADEMPAS BN
ADVATE BP
ADYNOVATE BP
AFINITOR BP
AFINITOR DISPERZ BP
AFSTYLA BP
AIMOVIG BP
ALECENSA BP
ALPHANATE/VON WILLEBRAND BP
ALPHANINE SD BP
ALPROLIX BP
ALUNBRIG BP
ambrisentan tab GN
APOKYN BN
ARANESP ALBUMIN FREE BP
ARCALYST BN
ARIKAYCE BN
AUBAGIO BP
AUSTEDO BN
AVONEX BP
AYVAKIT BP
BALVERSA BN
BARACLUDE BP
BENEFIX BP
BENLYSTA BN
BERINERT BN
BETASERON BP
BETHKIS BN
bexarotene cap GN
bosentan tab GN
BOSULIF BP
BRAFTOVI BN
BRUKINSA BN
CABOMETYX BP
CALQUENCE BN
capecitabine tab GN
CAPRELSA BP
CARBAGLU BN
CAYSTON BN
CERDELGA BN
CHENODAL BP
CHOLBAM BN
CHORIONIC GONADOTROPIN BP
CIMZIA BN
cinacalcet hcl tab GN
COAGADEX BP
COMETRIQ BP
COPIKTRA BN
CORIFACT BP
COSENTYX BP
COTELLIC BP
CYSTADANE BP
CYSTAGON BP
CYSTARAN BN
dalfampridine tab er GN
DAURISMO BN
deferasirox tab GN
DIACOMIT BN
dofetilide cap GN
DOPTELET BP
DUPIXENT BN
ELIGARD BN
ELOCTATE BP
EMGALITY BP
ENBREL BP
ENBREL MINI BP
ENBREL SURECLICK BP
ENDARI BN
entecavir tab GN
EPIDIOLEX BP
EPOGEN BN
ERIVEDGE BP
ERLEADA BP
erlotinib hcl tab GN
ESBRIET BN
everolimus tab GN
FARYDAK BP
FEIBA BP
FERRIPROX BN
FIRDAPSE BN
FOLLISTIM AQ BP
FULPHILA BP
FUZEON BN
GALAFOLD BN
ganirelix acetate soln prefilled syringe GN
GATTEX BN
GILENYA BP
GILOTRIF BP
glatiramer acetate soln prefilled syringe 40 mg/ml GN
GRANIX BP
HAEGARDA BP
HARVONI BP
HEMLIBRA BP
HEMOFIL M BP
HETLIOZ BN
HUMATE-P BP
HUMIRA BP
HUMIRA PEDIATRIC CROHNS D BP
HYCAMTIN BP
IBRANCE BP
icatibant acetate inj GN
ICLUSIG BP
IDELVION BP
IDHIFA BN
imatinib mesylate tab GN
IMBRUVICA BP
INBRIJA BP
INCRELEX BP
INGREZZA BN
INLYTA BP
INREBIC BN
INTRON A BP
IRESSA BP
IXINITY BP
JADENU BN
JADENU SPRINKLE BN
JAKAFI BP
JUXTAPID BN
JYNARQUE BN
KALYDECO BP
KEVZARA BN
KISQALI BP
KISQALI FEMARA BP
KITABIS PAK BN
KOATE BP
KOATE-DVI BP
KOGENATE FS BP
KORLYM BN
KOVALTRY BP
KUVAN BN
LEDIPASVIR/SOFOSBUVIR BP
LENVIMA BP
LEUKINE BN
leuprolide acetate inj kit GN
LONSURF BP
LORBRENA BN
LUPANETA PACK BN
LUPRON DEPOT BP
LYNPARZA BP
MATULANE BP
MAVENCLAD BP
MAVYRET BP
MAYZENT BP
MEKINIST BP
MEKTOVI BN
MENOPUR BP
miglustat cap GN
MIRCERA BN
MONONINE BP
MULPLETA BP
MYALEPT BN
NATPARA BN
NERLYNX BN
NEULASTA BP
NEULASTA ONPRO KIT BP
NEUPOGEN BP
NEXAVAR BP
NINLARO BP
nitisinone cap GN
NITYR BP
NIVESTYM BP
NORDITROPIN FLEXPRO BP
NOVAREL BP
NOVOEIGHT BP
NOVOSEVEN RT BP
NUBEQA BP
NUWIQ BP
OBIZUR BP
CALIVA BN
octreotide acetate inj GN
ODOMZO BP
OFEV BN
OPSUMIT BP
ORENITRAM BN
ORFADIN BP
ORKAMBI BN
OTEZLA BP
OTREXUP BP
OXBRYTA BN
OXERVATE BN
PALYNZIQ BN
PEGASYS BP
PEGASYS PROCLICK BP
PEGINTRON BN
PIQRAY BP
PLEGRIDY BP
POMALYST BP
PREGNYL W/DILUENT BENZYL BP
PROCRIT BP
PROCYSBI BN
PROFILNINE BP
PROFILNINE SD BP
PROMACTA BN
PULMOZYME BP
RAVICTI BN
REBIF BP
REBIF REBIDOSE BP
REBINYN BP
RECOMBINATE BP
REPATHA BP
REPATHA PUSHTRONEX SYSTEM BP
REPATHA SURECLICK BP
RETACRIT BP
REVCOVI BP
REVLIMID BP
ribavirin cap GN
ribavirin for inhal soln GN
ribavirin tab GN
RINVOQ BP
RIXUBIS BP
ROZLYTREK BP
RUBRACA BP
RUCONEST BN
RUZURGI BN
RYDAPT BP
SAMSCA BN
SIGNIFOR BN
SIKLOS BN
sildenafil citrate for suspension GN
sildenafil citrate tab GN
SIMPONI BP
SKYRIZI BP
sodium phenylbutyrate oral powder GN
sodium phenylbutyrate tab GN
SOFOSBUVIR/VELPATASVIR BP
SOMAVERT BN
SOVALDI BP
SPRYCEL BP
STELARA BP
STIMATE BP
STIVARGA BP
STRENSIQ BP
SUTENT BP
SYLATRON BP
SYMDEKO BP
SYNAREL BN
SYNRIBO BP
tadalafil tab 20 mg (pah) GN
TAFINLAR BP
TAGRISSO BP
TALZENNA BN
TASIGNA BP
TAVALISSE BN
TAZVERIK BN
TECFIDERA BP
TEGSEDI BN
temozolomide cap GN
THALOMID BP
THIOLA BN
THIOLA EC BN
TIBSOVO BN
TOBI PODHALER BN
TOBRAMYCIN BN
tobramycin nebu soln GN
tobramycin ophth soln GP
TRACLEER BP
TREMFYA BP
TRETTEN BP
TRIKAFTA BP
TURALIO BN
TYKERB BP
TYMLOS BP
TYVASO BN
UDENYCA BP
UPTRAVI BP
VALCHLOR BP
VELTASSA BP
VENCLEXTA BP
VENTAVIS BN
VERZENIO BP
vigabatrin powd pack GN
vigabatrin tab GN
VITRAKVI BP
VIZIMPRO BN
VONVENDI BP
VOSEVI BP
VOTRIENT BP
VUMERITY BP
VYNDAMAX BP
VYNDAQEL BP
WILATE BP
XALKORI BP
XELJANZ BP
XELJANZ XR BP
XERMELO BN
XOSPATA BN
XPOVIO 100 MG ONCE WEEKLY BN
XPOVIO 60 MG ONCE WEEKLY BN
XPOVIO 80 MG ONCE WEEKLY BN
XPOVIO 80 MG TWICE WEEKLY BN
XTANDI BP
XYNTHA BP
XYNTHA SOLOFUSE BP
XYREM BN
YONSA BP
ZARXIO BP
ZEJULA BN
ZELBORAF BP
ZOLINZA BP
ZYDELIG BP
ZYKADIA BP
ZYTIGA BP