AHFS Therapeutic Class  |
Brand Name  |
Generic Name  |
Medical Necessity Criteria |
Medical Necessity Form |
Prior Authorization Criteria |
Prior Authorization Form |
| Diabetes Mellitus | ACCU-CHEK ACTIVE STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ACCU-CHEK COMFORT CURVE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ACCU-CHEK COMPACT STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ACCU-CHEK COMPACT TEST DRUM | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ACCU-CHEK INSTANT GLUCOSE | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ACCU-CHEK INSTANT PLUS | DIAGNOSTIC TEST |

|

| -
| -
|
| Angiotensin-Converting Enzyme Inhibitors | ACEON | PERINDOPRIL ERBUMINE |

|

| -
| -
|
| Proton-pump Inhibitors | ACIPHEX | RABEPRAZOLE SODIUM |

|

|

|

|
| Diabetes Mellitus | ACURA BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Phosphodiesterase Inhibitors | ADCIRCA | TADALAFIL |

|

|

|

|
| Diabetes Mellitus | ADVANCE INTUITION TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ADVANCE MICRO-DRAW TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ADVOCATE REDI-CODE | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ADVOCATE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Adrenals | AEROBID | FLUNISOLIDE |

|

| -
| -
|
| Adrenals | AEROBID-M | FLUNISOLIDE |

|

| -
| -
|
| Adrenals | ALVESCO | CICLESONIDE |

|

| -
| -
|
| Anxiolytics, Sedatives, & Hypnotics Misc | AMBIEN CR | ZOLPIDEM TARTRATE |

|

|

|

|
| Selective Serotonin Agonists | AMERGE | NARATRIPTAN HYDROCHLORIDE |

|

| -
| -
|
| Skin and Mucous Membrane Agents, Misc | AMEVIVE | ALEFACEPT | -
| -
|

|

|
| Fibric Acid Derivatives | ANTARA | FENOFIBRATE |

|

| -
| -
|
| 5-HT3 Receptor Antagonists | ANZEMET | DOLASETRON MESYLATE |

|

| -
| -
|
| Miscellaneous Antidepressants | APLENZIN | BUPROPION HYDROBROMIDE |

|

| -
| -
|
| Diabetes Mellitus | ASCENSIA AUTODISC TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ASSURE 3 TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ASSURE 4 TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ASSURE II | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ASSURE II CHECK STRIP | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ASSURE II TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ASSURE PRO TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Antiallergic Agents | ASTEPRO | AZELASTINE HYDROCHLORIDE |

|

| -
| -
|
| Diabetes Mellitus | AT LAST TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Angiotensin II Receptor Antagonists | AVALIDE | HYDROCHLOROTHIAZIDE; IRBESARTAN |

|

| -
| -
|
| Angiotensin II Receptor Antagonists | AVAPRO | IRBESARTAN |

|

| -
| -
|
| 5-alpha-Reductase Inhibitors | AVODART | DUTASTERIDE |

|

| -
| -
|
| Selective Serotonin Agonists | AXERT | ALMOTRIPTAN MALATE |

|

| -
| -
|
| Carbonic Anhydrase Inhibitors | AZOPT | BRINZOLAMIDE |

|

| -
| -
|
| Dihydropyridines | AZOR | AMLODIPINE BESYLATE; OLMESARTAN MEDOXOMIL |

|

| -
| -
|
| Contraceptives | BALZIVA | ETHINYL ESTRADIOL; NORETHINDRONE |

|

| -
| -
|
| Diabetes Mellitus | BAYER BREEZE 2 TEST DISC | |

|

| -
| -
|
| Corticosteroids | BECONASE AQ | BECLOMETHASONE DIPROPIONATE |

|

| -
| -
|
| Angiotensin II Receptor Antagonists | BENICAR | OLMESARTAN MEDOXOMIL |

|

| -
| -
|
| Angiotensin II Receptor Antagonists | BENICAR HCT | HYDROCHLOROTHIAZIDE; OLMESARTAN MEDOXOMIL |

|

| -
| -
|
| beta-Adrenergic Blocking Agents | BETIMOL | TIMOLOL |

|

| -
| -
|
| Diabetes Mellitus | BIOSCANNER GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Gonadotropins | BRAVELLE | UROFOLLITROPIN | -
| -
|

|

|
| Incretin Mimetics | BYETTA | EXENATIDE | -
| -
|

|

|
| beta-Adrenergic Blocking Agents | BYSTOLIC | NEBIVOLOL HYDROCHLORIDE |

|

| -
| -
|
| Parathyroid | CALCITONIN-SALMON | CALCITONIN,SALMON |

|

| -
| -
|
| Dihydropyridines | CARDENE SR | NICARDIPINE HCL |

|

| -
| -
|
| Calcium-Channel Blocking Agents, Misc | CARDIZEM LA | DILTIAZEM HYDROCHLORIDE |

|

| -
| -
|
| Phosphodiesterase Inhibitors | CIALIS | TADALAFIL |

|

|

|

|
| Hydroxypyridones | CICLOPIROX | CICLOPIROX |

|

| -
| -
|
| Hydroxypyridones | CICLOPIROX | CICLOPIROX OLAMINE |

|

| -
| -
|
| Hydroxypyridones | CICLOPIROX OLAMINE | CICLOPIROX OLAMINE |

|

| -
| -
|
| GI Drugs, Miscellaneous | CIMZIA | CERTOLIZUMAB PEGOL |

|

|

|

|
| GI Drugs, Miscellaneous | CIMZIA STARTER KIT | CERTOLIZUMAB PEGOL |

|

|

|

|
| Second Generation Antihistamines | CLARINEX | DESLORATADINE |

|

| -
| -
|
| Second Generation Antihistamines | CLARINEX REDITABS | DESLORATADINE |

|

| -
| -
|
| Second Generation Antihistamines | CLARINEX-D 12 HOUR | DESLORATADINE; PSEUDOEPHEDRINE SULFATE |

|

| -
| -
|
| Second Generation Antihistamines | CLARINEX-D 24 HOUR | DESLORATADINE; PSEUDOEPHEDRINE SULFATE |

|

| -
| -
|
| Diabetes Mellitus | CLEVER CHEK AUTO-CODE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | CLEVER CHEK AUTO-CODE VOICE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | CLEVER CHEK TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | CONTROL TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Calcium-Channel Blocking Agents, Misc | COVERA-HS | VERAPAMIL HYDROCHLORIDE |

|

| -
| -
|
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | CYMBALTA | DULOXETINE HYDROCHLORIDE |

|

| -
| -
|
| Anorexigenics & Resp & Cereb Stim, Misc | DAYTRANA | METHYLPHENIDATE |

|

| -
| -
|
| Genitourinary Smooth Muscle Relaxants | DETROL | TOLTERODINE TARTRATE |

|

| -
| -
|
| Proton-pump Inhibitors | DEXILANT | DEXLANSOPRAZOLE |

|

|

|

|
| Anorexigenics & Resp & Cereb Stim, Misc | DEXMETHYLPHENIDATE HCL | DEXMETHYLPHENIDATE HYDROCHLORIDE |

|

| -
| -
|
| Calcium-Channel Blocking Agents, Misc | DILTIAZEM HCL ER | DILTIAZEM HYDROCHLORIDE |

|

| -
| -
|
| Angiotensin II Receptor Antagonists | DIOVAN | VALSARTAN |

|

| -
| -
|
| Angiotensin II Receptor Antagonists | DIOVAN HCT | HYDROCHLOROTHIAZIDE; VALSARTAN |

|

| -
| -
|
| Diabetes Mellitus | DUO-CARE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Opiate Agonists | DURAGESIC | FENTANYL | -
| -
|

| -
|
| Dihydropyridines | DYNACIRC CR | ISRADIPINE |

|

| -
| -
|
| Diabetes Mellitus | EASY CHECK GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EASY STEP TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EASY TALK BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EASY TRAK BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EASYGLUCO | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EASYPRO BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EASYPRO PLUS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ECLIPSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Azoles | ECONAZOLE NITRATE | ECONAZOLE NITRATE |

|

| -
| -
|
| Anxiolytics, Sedatives, & Hypnotics Misc | EDLUAR | ZOLPIDEM TARTRATE |

|

|

|

|
| Diabetes Mellitus | ELEMENT TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Monoamine Oxidase B Inhibitors | EMSAM | SELEGILINE |

|

| -
| -
|
| Disease-modifying Antirheumatic Agents | ENBREL | ETANERCEPT |

|

|

|

|
| Disease-modifying Antirheumatic Agents | ENBREL SURECLICK | ETANERCEPT |

|

|

|

|
| Diabetes Mellitus | ENVISION AUTOCODE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Azoles | ERTACZO | SERTACONAZOLE NITRATE |

|

| -
| -
|
| Contraceptives | ESTROSTEP FE | ETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE ACETATE |

|

| -
| -
|
| Diabetes Mellitus | EVENCARE + BLOOD GLUCOSE TEST STRIP | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EVENCARE BLOOD GLUCOSE TEST STRIP | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EVOLUTION AUTOCODE | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EXACTECH R-S-G TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EXACTECH TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Azoles | EXELDERM | SULCONAZOLE NITRATE |

|

| -
| -
|
| Dihydropyridines | EXFORGE | AMLODIPINE BESYLATE; VALSARTAN |

|

| -
| -
|
| Biologic Response Modifiers | EXTAVIA | INTERFERON BETA-1B | -
|

| -
| -
|
| Diabetes Mellitus | EZ SMART BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | EZ SMART PLUS BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | FASTTAKE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Contraceptives | FEMCON FE | ETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE | -
| -
| -
| -
|
| Opiate Agonists | FENTANYL | FENTANYL | -
| -
|

| -
|
| Selective Serotonin-reuptake Inhibitors | FLUOXETINE DR | FLUOXETINE HCL |

|

| -
| -
|
| Anorexigenics & Resp & Cereb Stim, Misc | FOCALIN | DEXMETHYLPHENIDATE HYDROCHLORIDE |

|

| -
| -
|
| Anorexigenics & Resp & Cereb Stim, Misc | FOCALIN XR | DEXMETHYLPHENIDATE HYDROCHLORIDE |

|

| -
| -
|
| Gonadotropins | FOLLISTIM AQ | FOLLITROPIN BETA | -
| -
|

|

|
| Diabetes Mellitus | FORA D20 BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | FORA V10 BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | FORA V20 BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | FORA V22 BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Parathyroid | FORTICAL | CALCITONIN, SALMON (RDNA) |

|

| -
| -
|
| Diabetes Mellitus | FREESTYLE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Selective Serotonin Agonists | FROVA | FROVATRIPTAN SUCCINATE MONOHYDRATE |

|

| -
| -
|
| Genitourinary Smooth Muscle Relaxants | GELNIQUE | OXYBUTYNIN CHLORIDE |

|

| -
| -
|
| Somatotropin Agonists | GENOTROPIN | SOMATROPIN |

|

|

|

|
| Somatotropin Agonists | GENOTROPIN MINIQUICK | SOMATROPIN |

|

|

|

|
| Diabetes Mellitus | GLUCOCARD 01 SENSOR | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | GLUCOCARD 01 TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | GLUCOCARD VITAL TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | GLUCOCARD X-SENSOR | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | GLUCOCOM TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | GLUCOLAB TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Gonadotropins | GONAL-F | FOLLITROPIN ALFA | -
| -
|

|

|
| Gonadotropins | GONAL-F RFF | FOLLITROPIN ALFA | -
| -
|

|

|
| Gonadotropins | GONAL-F RFF PEN | FOLLITROPIN ALFA | -
| -
|

|

|
| Somatotropin Agonists | HUMATROPE | SOMATROPIN |

|

|

|

|
| Somatotropin Agonists | HUMATROPE | SOMATROPIN (SERONO) |

|

|

|

|
| Somatotropin Agonists | HUMATROPE COMBO PACK | SOMATROPIN |

|

|

|

|
| Disease-modifying Antirheumatic Agents | HUMIRA | ADALIMUMAB | -
| -
|

|

|
| Disease-modifying Antirheumatic Agents | HUMIRA PEN | ADALIMUMAB | -
| -
|

|

|
| Disease-modifying Antirheumatic Agents | HUMIRA PEN-CROHNS DISEASESTARTER | ADALIMUMAB | -
| -
|

|

|
| Disease-modifying Antirheumatic Agents | HUMIRA PEN-PSORIASIS STARTER | ADALIMUMAB | -
| -
|

|

|
| Somatotropin Agonists | INCRELEX | MECASERMIN | -
| -
|

|

|
| Diabetes Mellitus | INFINITY BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Dihydropyridines | ISRADIPINE | ISRADIPINE |

|

| -
| -
|
| beta-Adrenergic Blocking Agents | ISTALOL | TIMOLOL MALEATE |

|

| -
| -
|
| 5-alpha-Reductase Inhibitors | JALYN | DUTASTERIDE; TAMSULOSIN HYDROCHLORIDE | -
| -
|

|

|
| Contraceptives | JOLESSA | ETHINYL ESTRADIOL; LEVONORGESTREL |

|

| -
| -
|
| Ketolides | KETEK | TELITHROMYCIN |

|

| -
| -
|
| Disease-modifying Antirheumatic Agents | KINERET | ANAKINRA |

|

|

|

|
| Diabetes Mellitus | KROGER BLOOD GLUCOSE TESTSTRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | KROGER TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Proton-pump Inhibitors | LANSOPRAZOLE | LANSOPRAZOLE |

|

|

|

|
| Insulins | LEVEMIR FLEXPEN | INSULIN DETEMIR |

|

| -
| -
|
| Phosphodiesterase Inhibitors | LEVITRA | VARDENAFIL HYDROCHLORIDE | -
| -
|

|

|
| Selective Serotonin-reuptake Inhibitors | LEXAPRO | ESCITALOPRAM OXALATE |

|

| -
| -
|
| Diabetes Mellitus | LIBERTY TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Contraceptives | LOESTRIN 24 FE | ETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE ACETATE |

|

| -
| -
|
| Hydroxypyridones | LOPROX | CICLOPIROX |

|

| -
| -
|
| Hydroxypyridones | LOPROX SHAMPOO | CICLOPIROX |

|

| -
| -
|
| Antilipemic Agents, Miscellaneous | LOVAZA | DHA ETHYL ESTER; EPA ETHYL ESTER; OMEGA-3-ACID ETHYL ESTERS |

|

| -
| -
|
| Anxiolytics, Sedatives, & Hypnotics Misc | LUNESTA | ESZOPICLONE | -
| -
|

|

|
| Contraceptives | LYBREL | ETHINYL ESTRADIOL; LEVONORGESTREL |

|

| -
| -
|
| Anticonvulsants, Miscellaneous | LYRICA | PREGABALIN |

|

| -
| -
|
| Selective beta-2-Adrenergic Agonists | MAXAIR AUTOHALER | PIRBUTEROL ACETATE |

|

| -
| -
|
| Diabetes Mellitus | MAXIMA BLOOD GLUCOSE TESTSTRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Gonadotropins | MENOPUR | MENOTROPINS | -
| -
|

|

|
| Parathyroid | MIACALCIN | CALCITONIN,SALMON |

|

| -
| -
|
| Diabetes Mellitus | MICRODOT TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Angiotensin-Converting Enzyme Inhibitors | MOEXIPRIL /HYDROCHLOROTHIAZIDE | HYDROCHLOROTHIAZIDE; MOEXIPRIL HYDROCHLORIDE |

|

| -
| -
|
| Angiotensin-Converting Enzyme Inhibitors | MOEXIPRIL HCL | MOEXIPRIL HYDROCHLORIDE |

|

| -
| -
|
| Selective Serotonin Agonists | NARATRIPTAN HCL | NARATRIPTAN HYDROCHLORIDE |

|

| -
| -
|
| Corticosteroids | NASACORT AQ | TRIAMCINOLONE ACETONIDE |

|

| -
| -
|
| Diabetes Mellitus | NEXGEN TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Dihydropyridines | NICARDIPINE HCL | NICARDIPINE HCL |

|

| -
| -
|
| Dihydropyridines | NISOLDIPINE | NISOLDIPINE |

|

| -
| -
|
| Somatotropin Agonists | NORDITROPIN CARTRIDGE | SOMATROPIN |

|

|

|

|
| Somatotropin Agonists | NORDITROPIN FLEXPRO | SOMATROPIN |

|

|

|

|
| Somatotropin Agonists | NORDITROPIN NORDIFLEX PEN | SOMATROPIN |

|

|

|

|
| Opiate Agonists | NUCYNTA | TAPENTADOL HYDROCHLORIDE |

|

| -
| -
|
| Somatotropin Agonists | NUTROPIN | SOMATROPIN |

|

|

|

|
| Somatotropin Agonists | NUTROPIN AQ | SOMATROPIN |

|

|

|

|
| Somatotropin Agonists | NUTROPIN AQ NUSPIN 10 | SOMATROPIN |

|

|

|

|
| Somatotropin Agonists | NUTROPIN AQ NUSPIN 20 | SOMATROPIN |

|

|

|

|
| Somatotropin Agonists | NUTROPIN AQ NUSPIN 5 | SOMATROPIN |

|

|

|

|
| Somatotropin Agonists | NUTROPIN AQ PEN | SOMATROPIN |

|

|

|

|
| Anorexigenics & Resp & Cereb Stim, Misc | NUVIGIL | ARMODAFINIL | -
| -
|

|

|
| Proton-pump Inhibitors | OMEPRAZOLE/SODIUM BICARBONATE | OMEPRAZOLE; SODIUM BICARBONATE |

|

|

|

|
| Corticosteroids | OMNARIS | CICLESONIDE |

|

| -
| -
|
| Somatotropin Agonists | OMNITROPE | SOMATROPIN |

|

|

|

|
| Diabetes Mellitus | ONETOUCH BASIC/PROFILE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ONETOUCH BASIC/PROFILE/ONE TOUCH II TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | ONETOUCH ULTRA TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | OPTIUM TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | OPTIUMEZ TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Contraceptives | OVCON-35 | ETHINYL ESTRADIOL; NORETHINDRONE |

|

| -
| -
|
| Contraceptives | OVCON-50 28 | ETHINYL ESTRADIOL; NORETHINDRONE |

|

| -
| -
|
| Azoles | OXISTAT | OXICONAZOLE NITRATE |

|

| -
| -
|
| Proton-pump Inhibitors | PANTOPRAZOLE SODIUM | PANTOPRAZOLE SODIUM SESQUIHYDRATE |

|

|

|

|
| Selective Serotonin-reuptake Inhibitors | PAROXETINE HCL ER | PAROXETINE HYDROCHLORIDE |

|

| -
| -
|
| Antiallergic Agents | PATANASE | OLOPATADINE HYDROCHLORIDE |

|

| -
| -
|
| Selective Serotonin-reuptake Inhibitors | PAXIL CR | PAROXETINE HYDROCHLORIDE |

|

| -
| -
|
| Selective beta-2-Adrenergic Agonists | PERFOROMIST | FORMOTEROL FUMARATE DIHYDRATE |

|

| -
| -
|
| Angiotensin-Converting Enzyme Inhibitors | PERINDOPRIL ERBUMINE | PERINDOPRIL ERBUMINE |

|

| -
| -
|
| Diabetes Mellitus | POCKETCHEM EZ BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

|

| -
| -
|
| Diabetes Mellitus | PRECISION PCX | DIAGNOSTIC TEST |

|

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| Diabetes Mellitus | PRECISION PCX PLUS TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | PRECISION POINT OF CARE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | PRECISION QID TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | PRECISION SOF-TACT TEST STRIPS | DIAGNOSTIC TEST |

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| Proton-pump Inhibitors | PREVACID | LANSOPRAZOLE |

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| Proton-pump Inhibitors | PREVACID 24HR | LANSOPRAZOLE |

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| Proton-pump Inhibitors | PREVACID SOLUTAB | LANSOPRAZOLE |

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| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | PRISTIQ | DESVENLAFAXINE SUCCINATE MONOHYDRATE |

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| Diabetes Mellitus | PRODIGY AUTOCODE BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | PRODIGY BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | PRODIGY EJECT BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | PRODIGY NO CODING BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | PRODIGY VOICE BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Proton-pump Inhibitors | PROTONIX | PANTOPRAZOLE SODIUM SESQUIHYDRATE |

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| Anorexigenics & Resp & Cereb Stim, Misc | PROVIGIL | MODAFINIL | -
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| Selective Serotonin-reuptake Inhibitors | PROZAC WEEKLY | FLUOXETINE HCL |

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| Diabetes Mellitus | PTS PANELS GLUCOSE TEST | DIAGNOSTIC TEST |

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| Adrenals | PULMICORT FLEXHALER | BUDESONIDE |

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| Contraceptives | QUASENSE | ETHINYL ESTRADIOL; LEVONORGESTREL |

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| Diabetes Mellitus | QUICKTEK TEST STRIPS | DIAGNOSTIC TEST |

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| Adrenals | QVAR | BECLOMETHASONE DIPROPIONATE |

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| Selective alpha-1-Adrenergic Blocking Agents | RAPAFLO | SILODOSIN |

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| Diabetes Mellitus | REFUAH PLUS BLOOD GLUCOSETEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | RELION BLOOD GLUCOSE TESTSTRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | RELION MICRO BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | RELION ULTIMA BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Gonadotropins | REPRONEX | MENOTROPINS | -
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| Phosphodiesterase Inhibitors | REVATIO | SILDENAFIL CITRATE | -
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| Corticosteroids | RHINOCORT AQUA | BUDESONIDE |

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| Diabetes Mellitus | RIGHTEST GS300 BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | RIGHTEST GS550 BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Anxiolytics, Sedatives, & Hypnotics Misc | ROZEREM | RAMELTEON |

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| Opiate Agonists | RYZOLT | TRAMADOL HCL |

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| Somatotropin Agonists | SAIZEN | SOMATROPIN (SERONO) |

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| Somatotropin Agonists | SAIZEN CLICK.EASY | SOMATROPIN (SERONO) |

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| Genitourinary Smooth Muscle Relaxants | SANCTURA | TROSPIUM CHLORIDE |

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| 5-HT3 Receptor Antagonists | SANCUSO | GRANISETRON |

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| Selective Serotonin-reuptake Inhibitors | SARAFEM | FLUOXETINE HCL |

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| Fibromyalgia Agents | SAVELLA | MILNACIPRAN HYDROCHLORIDE |

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| Fibromyalgia Agents | SAVELLA TITRATION PACK | MILNACIPRAN HYDROCHLORIDE |

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| Contraceptives | SEASONALE | ETHINYL ESTRADIOL; LEVONORGESTREL |

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| Contraceptives | SEASONIQUE | ETHINYL ESTRADIOL; LEVONORGESTREL |

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| Selective Serotonin-reuptake Inhibitors | SELFEMRA | FLUOXETINE HCL |

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| Somatotropin Agonists | SEROSTIM | SOMATROPIN (SERONO) |

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| Disease-modifying Antirheumatic Agents | SIMPONI | GOLIMUMAB |

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| Diabetes Mellitus | SMARTEST BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Anxiolytics, Sedatives, & Hypnotics Misc | SONATA | ZALEPLON |

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| Dihydropyridines | SULAR | NISOLDIPINE |

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| Diabetes Mellitus | SUPREME TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | SURE EDGE BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | SURECHEK BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | SURESTEP PRO TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | SURESTEP TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | SURE-TEST EASYPLUS MINI BLOOD GLUCOSE TEST STRIPS | DIAGNOSTIC TEST |

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| Amylinomimetics | SYMLIN | PRAMLINTIDE ACETATE | -
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| Amylinomimetics | SYMLINPEN 120 | PRAMLINTIDE ACETATE | -
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| Amylinomimetics | SYMLINPEN 60 | PRAMLINTIDE ACETATE | -
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| Calcium-Channel Blocking Agents, Misc | TARKA | TRANDOLAPRIL; VERAPAMIL HYDROCHLORIDE |

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| Angiotensin II Receptor Antagonists | TEVETEN | EPROSARTAN MESYLATE |

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| Angiotensin II Receptor Antagonists | TEVETEN HCT | EPROSARTAN MESYLATE; HYDROCHLOROTHIAZIDE |

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| Somatotropin Agonists | TEV-TROPIN | SOMATROPIN |

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| Contraceptives | TILIA FE | ETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE ACETATE |

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| Genitourinary Smooth Muscle Relaxants | TOVIAZ | FESOTERODINE FUMARATE |

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| Opiate Agonists | TRAMADOL HCL ER | TRAMADOL HCL |

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| Calcium-Channel Blocking Agents, Misc | TRANDOLAPRIL/VERAPAMIL HCL | TRANDOLAPRIL; VERAPAMIL HYDROCHLORIDE |

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| Prostaglandin Analogs | TRAVATAN Z | TRAVOPROST |

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| Fibric Acid Derivatives | TRICOR | FENOFIBRATE |

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| Contraceptives | TRI-LEGEST FE | ETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE ACETATE |

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| Fibric Acid Derivatives | TRILIPIX | CHOLINE FENOFIBRATE |

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| Genitourinary Smooth Muscle Relaxants | TROSPIUM CHLORIDE | TROSPIUM CHLORIDE |

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| Diabetes Mellitus | TRUETRACK TEST | DIAGNOSTIC TEST |

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| Dihydropyridines | TWYNSTA | AMLODIPINE BESYLATE; TELMISARTAN |

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| Diabetes Mellitus | ULTIMA TEST STRIPS | DIAGNOSTIC TEST |

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| Opiate Agonists | ULTRAM ER | TRAMADOL HCL |

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| Diabetes Mellitus | ULTRATRAK PRO TEST STRIPS | DIAGNOSTIC TEST |

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| Angiotensin-Converting Enzyme Inhibitors | UNIRETIC | HYDROCHLOROTHIAZIDE; MOEXIPRIL HYDROCHLORIDE |

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| Angiotensin-Converting Enzyme Inhibitors | UNIVASC | MOEXIPRIL HYDROCHLORIDE |

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| Renin Inhibitors | VALTURNA | ALISKIREN FUMARATE; VALSARTAN |

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| Corticosteroids | VERAMYST | FLUTICASONE FUROATE |

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| Calcium-Channel Blocking Agents, Misc | VERAPAMIL HCL ER | VERAPAMIL HYDROCHLORIDE |

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| Calcium-Channel Blocking Agents, Misc | VERAPAMIL HCL SR | VERAPAMIL HYDROCHLORIDE |

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| Calcium-Channel Blocking Agents, Misc | VERELAN | VERAPAMIL HYDROCHLORIDE |

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| Calcium-Channel Blocking Agents, Misc | VERELAN PM | VERAPAMIL HYDROCHLORIDE |

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| Phosphodiesterase Inhibitors | VIAGRA | SILDENAFIL CITRATE |

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| Incretin Mimetics | VICTOZA | LIRAGLUTIDE | -
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| Azoles | VUSION | MICONAZOLE NITRATE; PETROLATUM; ZINC OXIDE |

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| Amphetamines | VYVANSE | LISDEXAMFETAMINE DIMESYLATE |

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| Diabetes Mellitus | WAVESENSE AMP TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | WAVESENSE JAZZ TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | WAVESENSE KEYNOTE TEST STRIPS | DIAGNOSTIC TEST |

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| Diabetes Mellitus | WAVESENSE PRESTO TEST STRIPS | DIAGNOSTIC TEST |

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| Bile Acid Sequestrants | WELCHOL | COLESEVELAM HYDROCHLORIDE |

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| Second Generation Antihistamines | XYZAL | LEVOCETIRIZINE DIHYDROCHLORIDE |

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| Anxiolytics, Sedatives, & Hypnotics Misc | ZALEPLON | ZALEPLON |

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| Proton-pump Inhibitors | ZEGERID | OMEPRAZOLE; SODIUM BICARBONATE |

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| Proton-pump Inhibitors | ZEGERID OTC | OMEPRAZOLE; SODIUM BICARBONATE |

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| Contraceptives | ZENCHENT | ETHINYL ESTRADIOL; NORETHINDRONE |

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| Other Macrolides | ZMAX | AZITHROMYCIN DIHYDRATE |

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| Somatotropin Agonists | ZORBTIVE | SOMATROPIN |

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| Leukotriene Modifiers | ZYFLO | ZILEUTON |

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| Leukotriene Modifiers | ZYFLO CR | ZILEUTON |

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