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   Medical Necessity & Prior Authorization Forms/Criteria
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  Instructions
 
Your provider (the prescriber) must obtain authorization for some prescription medications to be filled. Listed below are the Quantity Limits, Prior Authorization and Medical Necessity Forms and Criteria you will need in order to request drugs that require authorization. You do not need to submit multiple forms because authorization approvals apply to both the mail-order and retail network pharmacy options.

To submit a request:

1. Select and print the proper form(s) from the listings below by scrolling down and clicking on the appropriate pdf icon. Drugs are listed by AHFS Therapeutic Class, Brand Name, and Generic Name.
2. Have your provider fill out the form completely.
3. Follow the directions on the completed form for delivery to Express Scripts, Inc.

If you are unable to find a particular form please forward a message to PECWEB@amedd.army.mil with your information and a POC representative will be in contact with you shortly.

The forms are provided here in Adobe Acrobat. If you cannot view a file, please download the appropriate free plug-in from the Adobe Acrobat Reader link below:

Download Adobe Acrobat Reader

  Generic Medications
 
The pharmacy benefits program mandates substitution of generic drugs listed with an "A" rating in the current Approved Drug Products with Therapeutic Equivalence Evaluations (Orange Book) published by the FDA unless sufficient clinical justification from the prescriber is submitted. Prescribers may call 1-866-684-4488 to submit a request for a brand name drug to be dispensed in lieu of a generic.

Brand over Generic Prior Authorization Request Form


AHFS Therapeutic Class   Brand Name   Generic Name   Medical Necessity Criteria Medical Necessity Form Prior Authorization Criteria Prior Authorization Form
Diabetes MellitusACCU-CHEK ACTIVE STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusACCU-CHEK COMFORT CURVE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusACCU-CHEK COMPACT STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusACCU-CHEK COMPACT TEST DRUMDIAGNOSTIC TEST






-


-

Diabetes MellitusACCU-CHEK INSTANT GLUCOSEDIAGNOSTIC TEST






-


-

Diabetes MellitusACCU-CHEK INSTANT PLUSDIAGNOSTIC TEST






-


-

Angiotensin-Converting Enzyme InhibitorsACEONPERINDOPRIL ERBUMINE






-


-

Proton-pump InhibitorsACIPHEXRABEPRAZOLE SODIUM











Diabetes MellitusACURA BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Phosphodiesterase InhibitorsADCIRCATADALAFIL











Diabetes MellitusADVANCE INTUITION TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusADVANCE MICRO-DRAW TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusADVOCATE REDI-CODEDIAGNOSTIC TEST






-


-

Diabetes MellitusADVOCATE TEST STRIPSDIAGNOSTIC TEST






-


-

AdrenalsAEROBIDFLUNISOLIDE






-


-

AdrenalsAEROBID-MFLUNISOLIDE






-


-

AdrenalsALVESCOCICLESONIDE






-


-

Anxiolytics, Sedatives, & Hypnotics MiscAMBIEN CRZOLPIDEM TARTRATE











Selective Serotonin AgonistsAMERGENARATRIPTAN HYDROCHLORIDE






-


-

Skin and Mucous Membrane Agents, MiscAMEVIVEALEFACEPT
-


-







Fibric Acid DerivativesANTARAFENOFIBRATE






-


-

5-HT3 Receptor AntagonistsANZEMETDOLASETRON MESYLATE






-


-

Miscellaneous AntidepressantsAPLENZINBUPROPION HYDROBROMIDE






-


-

Diabetes MellitusASCENSIA AUTODISC TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusASSURE 3 TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusASSURE 4 TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusASSURE IIDIAGNOSTIC TEST






-


-

Diabetes MellitusASSURE II CHECK STRIPDIAGNOSTIC TEST






-


-

Diabetes MellitusASSURE II TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusASSURE PRO TEST STRIPSDIAGNOSTIC TEST






-


-

Antiallergic AgentsASTEPROAZELASTINE HYDROCHLORIDE






-


-

Diabetes MellitusAT LAST TEST STRIPSDIAGNOSTIC TEST






-


-

Angiotensin II Receptor AntagonistsAVALIDEHYDROCHLOROTHIAZIDE; IRBESARTAN






-


-

Angiotensin II Receptor AntagonistsAVAPROIRBESARTAN






-


-

5-alpha-Reductase InhibitorsAVODARTDUTASTERIDE






-


-

Selective Serotonin AgonistsAXERTALMOTRIPTAN MALATE






-


-

Carbonic Anhydrase InhibitorsAZOPTBRINZOLAMIDE






-


-

DihydropyridinesAZORAMLODIPINE BESYLATE; OLMESARTAN MEDOXOMIL






-


-

ContraceptivesBALZIVAETHINYL ESTRADIOL; NORETHINDRONE






-


-

Diabetes MellitusBAYER BREEZE 2 TEST DISC






-


-

CorticosteroidsBECONASE AQBECLOMETHASONE DIPROPIONATE






-


-

Angiotensin II Receptor AntagonistsBENICAROLMESARTAN MEDOXOMIL






-


-

Angiotensin II Receptor AntagonistsBENICAR HCTHYDROCHLOROTHIAZIDE; OLMESARTAN MEDOXOMIL






-


-

beta-Adrenergic Blocking AgentsBETIMOLTIMOLOL






-


-

Diabetes MellitusBIOSCANNER GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

GonadotropinsBRAVELLEUROFOLLITROPIN
-


-







Incretin MimeticsBYETTAEXENATIDE
-


-







beta-Adrenergic Blocking AgentsBYSTOLICNEBIVOLOL HYDROCHLORIDE






-


-

ParathyroidCALCITONIN-SALMONCALCITONIN,SALMON






-


-

DihydropyridinesCARDENE SRNICARDIPINE HCL






-


-

Calcium-Channel Blocking Agents, MiscCARDIZEM LADILTIAZEM HYDROCHLORIDE






-


-

Phosphodiesterase InhibitorsCIALISTADALAFIL











HydroxypyridonesCICLOPIROXCICLOPIROX






-


-

HydroxypyridonesCICLOPIROXCICLOPIROX OLAMINE






-


-

HydroxypyridonesCICLOPIROX OLAMINECICLOPIROX OLAMINE






-


-

GI Drugs, MiscellaneousCIMZIACERTOLIZUMAB PEGOL











GI Drugs, MiscellaneousCIMZIA STARTER KITCERTOLIZUMAB PEGOL











Second Generation AntihistaminesCLARINEXDESLORATADINE






-


-

Second Generation AntihistaminesCLARINEX REDITABSDESLORATADINE






-


-

Second Generation AntihistaminesCLARINEX-D 12 HOURDESLORATADINE; PSEUDOEPHEDRINE SULFATE






-


-

Second Generation AntihistaminesCLARINEX-D 24 HOURDESLORATADINE; PSEUDOEPHEDRINE SULFATE






-


-

Diabetes MellitusCLEVER CHEK AUTO-CODE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusCLEVER CHEK AUTO-CODE VOICE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusCLEVER CHEK TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusCONTROL TEST STRIPSDIAGNOSTIC TEST






-


-

Calcium-Channel Blocking Agents, MiscCOVERA-HSVERAPAMIL HYDROCHLORIDE






-


-

Selective Serotonin- and Norepinephrine-reuptake InhibitorsCYMBALTADULOXETINE HYDROCHLORIDE






-


-

Anorexigenics & Resp & Cereb Stim, MiscDAYTRANAMETHYLPHENIDATE






-


-

Genitourinary Smooth Muscle RelaxantsDETROLTOLTERODINE TARTRATE






-


-

Proton-pump InhibitorsDEXILANTDEXLANSOPRAZOLE











Anorexigenics & Resp & Cereb Stim, MiscDEXMETHYLPHENIDATE HCLDEXMETHYLPHENIDATE HYDROCHLORIDE






-


-

Calcium-Channel Blocking Agents, MiscDILTIAZEM HCL ERDILTIAZEM HYDROCHLORIDE






-


-

Angiotensin II Receptor AntagonistsDIOVANVALSARTAN






-


-

Angiotensin II Receptor AntagonistsDIOVAN HCTHYDROCHLOROTHIAZIDE; VALSARTAN






-


-

Diabetes MellitusDUO-CARE TEST STRIPSDIAGNOSTIC TEST






-


-

Opiate AgonistsDURAGESICFENTANYL
-


-





-

DihydropyridinesDYNACIRC CRISRADIPINE






-


-

Diabetes MellitusEASY CHECK GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusEASY STEP TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusEASY TALK BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusEASY TRAK BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusEASYGLUCODIAGNOSTIC TEST






-


-

Diabetes MellitusEASYPRO BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusEASYPRO PLUSDIAGNOSTIC TEST






-


-

Diabetes MellitusECLIPSE TEST STRIPSDIAGNOSTIC TEST






-


-

AzolesECONAZOLE NITRATEECONAZOLE NITRATE






-


-

Anxiolytics, Sedatives, & Hypnotics MiscEDLUARZOLPIDEM TARTRATE











Diabetes MellitusELEMENT TEST STRIPSDIAGNOSTIC TEST






-


-

Monoamine Oxidase B InhibitorsEMSAMSELEGILINE






-


-

Disease-modifying Antirheumatic AgentsENBRELETANERCEPT











Disease-modifying Antirheumatic AgentsENBREL SURECLICKETANERCEPT











Diabetes MellitusENVISION AUTOCODE TEST STRIPSDIAGNOSTIC TEST






-


-

AzolesERTACZOSERTACONAZOLE NITRATE






-


-

ContraceptivesESTROSTEP FEETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE ACETATE






-


-

Diabetes MellitusEVENCARE + BLOOD GLUCOSE TEST STRIPDIAGNOSTIC TEST






-


-

Diabetes MellitusEVENCARE BLOOD GLUCOSE TEST STRIPDIAGNOSTIC TEST






-


-

Diabetes MellitusEVOLUTION AUTOCODEDIAGNOSTIC TEST






-


-

Diabetes MellitusEXACTECH R-S-G TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusEXACTECH TEST STRIPSDIAGNOSTIC TEST






-


-

AzolesEXELDERMSULCONAZOLE NITRATE






-


-

DihydropyridinesEXFORGEAMLODIPINE BESYLATE; VALSARTAN






-


-

Biologic Response ModifiersEXTAVIAINTERFERON BETA-1B
-





-


-

Diabetes MellitusEZ SMART BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusEZ SMART PLUS BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusFASTTAKE TEST STRIPSDIAGNOSTIC TEST






-


-

ContraceptivesFEMCON FEETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE
-


-


-


-

Opiate AgonistsFENTANYLFENTANYL
-


-





-

Selective Serotonin-reuptake InhibitorsFLUOXETINE DRFLUOXETINE HCL






-


-

Anorexigenics & Resp & Cereb Stim, MiscFOCALINDEXMETHYLPHENIDATE HYDROCHLORIDE






-


-

Anorexigenics & Resp & Cereb Stim, MiscFOCALIN XRDEXMETHYLPHENIDATE HYDROCHLORIDE






-


-

GonadotropinsFOLLISTIM AQFOLLITROPIN BETA
-


-







Diabetes MellitusFORA D20 BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusFORA V10 BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusFORA V20 BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusFORA V22 BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

ParathyroidFORTICALCALCITONIN, SALMON (RDNA)






-


-

Diabetes MellitusFREESTYLE TEST STRIPSDIAGNOSTIC TEST






-


-

Selective Serotonin AgonistsFROVAFROVATRIPTAN SUCCINATE MONOHYDRATE






-


-

Genitourinary Smooth Muscle RelaxantsGELNIQUEOXYBUTYNIN CHLORIDE






-


-

Somatotropin AgonistsGENOTROPINSOMATROPIN











Somatotropin AgonistsGENOTROPIN MINIQUICKSOMATROPIN











Diabetes MellitusGLUCOCARD 01 SENSORDIAGNOSTIC TEST






-


-

Diabetes MellitusGLUCOCARD 01 TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusGLUCOCARD VITAL TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusGLUCOCARD X-SENSORDIAGNOSTIC TEST






-


-

Diabetes MellitusGLUCOCOM TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusGLUCOLAB TEST STRIPSDIAGNOSTIC TEST






-


-

GonadotropinsGONAL-FFOLLITROPIN ALFA
-


-







GonadotropinsGONAL-F RFFFOLLITROPIN ALFA
-


-







GonadotropinsGONAL-F RFF PENFOLLITROPIN ALFA
-


-







Somatotropin AgonistsHUMATROPESOMATROPIN











Somatotropin AgonistsHUMATROPESOMATROPIN (SERONO)











Somatotropin AgonistsHUMATROPE COMBO PACKSOMATROPIN











Disease-modifying Antirheumatic AgentsHUMIRAADALIMUMAB
-


-







Disease-modifying Antirheumatic AgentsHUMIRA PENADALIMUMAB
-


-







Disease-modifying Antirheumatic AgentsHUMIRA PEN-CROHNS DISEASESTARTERADALIMUMAB
-


-







Disease-modifying Antirheumatic AgentsHUMIRA PEN-PSORIASIS STARTERADALIMUMAB
-


-







Somatotropin AgonistsINCRELEXMECASERMIN
-


-







Diabetes MellitusINFINITY BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

DihydropyridinesISRADIPINEISRADIPINE






-


-

beta-Adrenergic Blocking AgentsISTALOLTIMOLOL MALEATE






-


-

5-alpha-Reductase InhibitorsJALYNDUTASTERIDE; TAMSULOSIN HYDROCHLORIDE
-


-







ContraceptivesJOLESSAETHINYL ESTRADIOL; LEVONORGESTREL






-


-

KetolidesKETEKTELITHROMYCIN






-


-

Disease-modifying Antirheumatic AgentsKINERETANAKINRA











Diabetes MellitusKROGER BLOOD GLUCOSE TESTSTRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusKROGER TEST STRIPSDIAGNOSTIC TEST






-


-

Proton-pump InhibitorsLANSOPRAZOLELANSOPRAZOLE











InsulinsLEVEMIR FLEXPENINSULIN DETEMIR






-


-

Phosphodiesterase InhibitorsLEVITRAVARDENAFIL HYDROCHLORIDE
-


-







Selective Serotonin-reuptake InhibitorsLEXAPROESCITALOPRAM OXALATE






-


-

Diabetes MellitusLIBERTY TEST STRIPSDIAGNOSTIC TEST






-


-

ContraceptivesLOESTRIN 24 FEETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE ACETATE






-


-

HydroxypyridonesLOPROXCICLOPIROX






-


-

HydroxypyridonesLOPROX SHAMPOOCICLOPIROX






-


-

Antilipemic Agents, MiscellaneousLOVAZADHA ETHYL ESTER; EPA ETHYL ESTER; OMEGA-3-ACID ETHYL ESTERS






-


-

Anxiolytics, Sedatives, & Hypnotics MiscLUNESTAESZOPICLONE
-


-







ContraceptivesLYBRELETHINYL ESTRADIOL; LEVONORGESTREL






-


-

Anticonvulsants, MiscellaneousLYRICAPREGABALIN






-


-

Selective beta-2-Adrenergic AgonistsMAXAIR AUTOHALERPIRBUTEROL ACETATE






-


-

Diabetes MellitusMAXIMA BLOOD GLUCOSE TESTSTRIPSDIAGNOSTIC TEST






-


-

GonadotropinsMENOPURMENOTROPINS
-


-







ParathyroidMIACALCINCALCITONIN,SALMON






-


-

Diabetes MellitusMICRODOT TEST STRIPSDIAGNOSTIC TEST






-


-

Angiotensin-Converting Enzyme InhibitorsMOEXIPRIL /HYDROCHLOROTHIAZIDEHYDROCHLOROTHIAZIDE; MOEXIPRIL HYDROCHLORIDE






-


-

Angiotensin-Converting Enzyme InhibitorsMOEXIPRIL HCLMOEXIPRIL HYDROCHLORIDE






-


-

Selective Serotonin AgonistsNARATRIPTAN HCLNARATRIPTAN HYDROCHLORIDE






-


-

CorticosteroidsNASACORT AQTRIAMCINOLONE ACETONIDE






-


-

Diabetes MellitusNEXGEN TEST STRIPSDIAGNOSTIC TEST






-


-

DihydropyridinesNICARDIPINE HCLNICARDIPINE HCL






-


-

DihydropyridinesNISOLDIPINENISOLDIPINE






-


-

Somatotropin AgonistsNORDITROPIN CARTRIDGESOMATROPIN











Somatotropin AgonistsNORDITROPIN FLEXPROSOMATROPIN











Somatotropin AgonistsNORDITROPIN NORDIFLEX PENSOMATROPIN











Opiate AgonistsNUCYNTATAPENTADOL HYDROCHLORIDE






-


-

Somatotropin AgonistsNUTROPINSOMATROPIN











Somatotropin AgonistsNUTROPIN AQSOMATROPIN











Somatotropin AgonistsNUTROPIN AQ NUSPIN 10SOMATROPIN











Somatotropin AgonistsNUTROPIN AQ NUSPIN 20SOMATROPIN











Somatotropin AgonistsNUTROPIN AQ NUSPIN 5SOMATROPIN











Somatotropin AgonistsNUTROPIN AQ PENSOMATROPIN











Anorexigenics & Resp & Cereb Stim, MiscNUVIGILARMODAFINIL
-


-







Proton-pump InhibitorsOMEPRAZOLE/SODIUM BICARBONATEOMEPRAZOLE; SODIUM BICARBONATE











CorticosteroidsOMNARISCICLESONIDE






-


-

Somatotropin AgonistsOMNITROPESOMATROPIN











Diabetes MellitusONETOUCH BASIC/PROFILE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusONETOUCH BASIC/PROFILE/ONE TOUCH II TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusONETOUCH ULTRA TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusOPTIUM TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusOPTIUMEZ TEST STRIPSDIAGNOSTIC TEST






-


-

ContraceptivesOVCON-35ETHINYL ESTRADIOL; NORETHINDRONE






-


-

ContraceptivesOVCON-50 28ETHINYL ESTRADIOL; NORETHINDRONE






-


-

AzolesOXISTATOXICONAZOLE NITRATE






-


-

Proton-pump InhibitorsPANTOPRAZOLE SODIUMPANTOPRAZOLE SODIUM SESQUIHYDRATE











Selective Serotonin-reuptake InhibitorsPAROXETINE HCL ERPAROXETINE HYDROCHLORIDE






-


-

Antiallergic AgentsPATANASEOLOPATADINE HYDROCHLORIDE






-


-

Selective Serotonin-reuptake InhibitorsPAXIL CRPAROXETINE HYDROCHLORIDE






-


-

Selective beta-2-Adrenergic AgonistsPERFOROMISTFORMOTEROL FUMARATE DIHYDRATE






-


-

Angiotensin-Converting Enzyme InhibitorsPERINDOPRIL ERBUMINEPERINDOPRIL ERBUMINE






-


-

Diabetes MellitusPOCKETCHEM EZ BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusPRECISION PCXDIAGNOSTIC TEST






-


-

Diabetes MellitusPRECISION PCX PLUS TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusPRECISION POINT OF CARE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusPRECISION QID TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusPRECISION SOF-TACT TEST STRIPSDIAGNOSTIC TEST






-


-

Proton-pump InhibitorsPREVACIDLANSOPRAZOLE











Proton-pump InhibitorsPREVACID 24HRLANSOPRAZOLE











Proton-pump InhibitorsPREVACID SOLUTABLANSOPRAZOLE











Selective Serotonin- and Norepinephrine-reuptake InhibitorsPRISTIQDESVENLAFAXINE SUCCINATE MONOHYDRATE






-


-

Diabetes MellitusPRODIGY AUTOCODE BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusPRODIGY BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusPRODIGY EJECT BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusPRODIGY NO CODING BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusPRODIGY VOICE BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Proton-pump InhibitorsPROTONIXPANTOPRAZOLE SODIUM SESQUIHYDRATE











Anorexigenics & Resp & Cereb Stim, MiscPROVIGILMODAFINIL
-


-







Selective Serotonin-reuptake InhibitorsPROZAC WEEKLYFLUOXETINE HCL






-


-

Diabetes MellitusPTS PANELS GLUCOSE TESTDIAGNOSTIC TEST






-


-

AdrenalsPULMICORT FLEXHALERBUDESONIDE






-


-

ContraceptivesQUASENSEETHINYL ESTRADIOL; LEVONORGESTREL






-


-

Diabetes MellitusQUICKTEK TEST STRIPSDIAGNOSTIC TEST






-


-

AdrenalsQVARBECLOMETHASONE DIPROPIONATE






-


-

Selective alpha-1-Adrenergic Blocking AgentsRAPAFLOSILODOSIN











Diabetes MellitusREFUAH PLUS BLOOD GLUCOSETEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusRELION BLOOD GLUCOSE TESTSTRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusRELION MICRO BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusRELION ULTIMA BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

GonadotropinsREPRONEXMENOTROPINS
-


-







Phosphodiesterase InhibitorsREVATIOSILDENAFIL CITRATE
-


-







CorticosteroidsRHINOCORT AQUABUDESONIDE






-


-

Diabetes MellitusRIGHTEST GS300 BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusRIGHTEST GS550 BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Anxiolytics, Sedatives, & Hypnotics MiscROZEREMRAMELTEON











Opiate AgonistsRYZOLTTRAMADOL HCL






-


-

Somatotropin AgonistsSAIZENSOMATROPIN (SERONO)











Somatotropin AgonistsSAIZEN CLICK.EASYSOMATROPIN (SERONO)











Genitourinary Smooth Muscle RelaxantsSANCTURATROSPIUM CHLORIDE






-


-

5-HT3 Receptor AntagonistsSANCUSOGRANISETRON






-


-

Selective Serotonin-reuptake InhibitorsSARAFEMFLUOXETINE HCL






-


-

Fibromyalgia AgentsSAVELLAMILNACIPRAN HYDROCHLORIDE






-


-

Fibromyalgia AgentsSAVELLA TITRATION PACKMILNACIPRAN HYDROCHLORIDE






-


-

ContraceptivesSEASONALEETHINYL ESTRADIOL; LEVONORGESTREL






-


-

ContraceptivesSEASONIQUEETHINYL ESTRADIOL; LEVONORGESTREL






-


-

Selective Serotonin-reuptake InhibitorsSELFEMRAFLUOXETINE HCL






-


-

Somatotropin AgonistsSEROSTIMSOMATROPIN (SERONO)











Disease-modifying Antirheumatic AgentsSIMPONIGOLIMUMAB











Diabetes MellitusSMARTEST BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Anxiolytics, Sedatives, & Hypnotics MiscSONATAZALEPLON











DihydropyridinesSULARNISOLDIPINE






-


-

Diabetes MellitusSUPREME TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusSURE EDGE BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusSURECHEK BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusSURESTEP PRO TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusSURESTEP TEST STRIPSDIAGNOSTIC TEST






-


-

Diabetes MellitusSURE-TEST EASYPLUS MINI BLOOD GLUCOSE TEST STRIPSDIAGNOSTIC TEST






-


-

AmylinomimeticsSYMLINPRAMLINTIDE ACETATE
-


-







AmylinomimeticsSYMLINPEN 120PRAMLINTIDE ACETATE
-


-







AmylinomimeticsSYMLINPEN 60PRAMLINTIDE ACETATE
-


-







Calcium-Channel Blocking Agents, MiscTARKATRANDOLAPRIL; VERAPAMIL HYDROCHLORIDE






-


-

Angiotensin II Receptor AntagonistsTEVETENEPROSARTAN MESYLATE






-


-

Angiotensin II Receptor AntagonistsTEVETEN HCTEPROSARTAN MESYLATE; HYDROCHLOROTHIAZIDE






-


-

Somatotropin AgonistsTEV-TROPINSOMATROPIN











ContraceptivesTILIA FEETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE ACETATE






-


-

Genitourinary Smooth Muscle RelaxantsTOVIAZFESOTERODINE FUMARATE






-


-

Opiate AgonistsTRAMADOL HCL ERTRAMADOL HCL






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Calcium-Channel Blocking Agents, MiscTRANDOLAPRIL/VERAPAMIL HCLTRANDOLAPRIL; VERAPAMIL HYDROCHLORIDE






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Prostaglandin AnalogsTRAVATAN ZTRAVOPROST






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Fibric Acid DerivativesTRICORFENOFIBRATE






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ContraceptivesTRI-LEGEST FEETHINYL ESTRADIOL; FERROUS FUMARATE; NORETHINDRONE ACETATE






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Fibric Acid DerivativesTRILIPIXCHOLINE FENOFIBRATE






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Genitourinary Smooth Muscle RelaxantsTROSPIUM CHLORIDETROSPIUM CHLORIDE






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Diabetes MellitusTRUETRACK TESTDIAGNOSTIC TEST






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DihydropyridinesTWYNSTAAMLODIPINE BESYLATE; TELMISARTAN






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Diabetes MellitusULTIMA TEST STRIPSDIAGNOSTIC TEST






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Opiate AgonistsULTRAM ERTRAMADOL HCL






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Diabetes MellitusULTRATRAK PRO TEST STRIPSDIAGNOSTIC TEST






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Angiotensin-Converting Enzyme InhibitorsUNIRETICHYDROCHLOROTHIAZIDE; MOEXIPRIL HYDROCHLORIDE






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Angiotensin-Converting Enzyme InhibitorsUNIVASCMOEXIPRIL HYDROCHLORIDE






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Renin InhibitorsVALTURNAALISKIREN FUMARATE; VALSARTAN






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CorticosteroidsVERAMYSTFLUTICASONE FUROATE






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Calcium-Channel Blocking Agents, MiscVERAPAMIL HCL ERVERAPAMIL HYDROCHLORIDE






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Calcium-Channel Blocking Agents, MiscVERAPAMIL HCL SRVERAPAMIL HYDROCHLORIDE






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Calcium-Channel Blocking Agents, MiscVERELANVERAPAMIL HYDROCHLORIDE






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Calcium-Channel Blocking Agents, MiscVERELAN PMVERAPAMIL HYDROCHLORIDE






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Phosphodiesterase InhibitorsVIAGRASILDENAFIL CITRATE











Incretin MimeticsVICTOZALIRAGLUTIDE
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AzolesVUSIONMICONAZOLE NITRATE; PETROLATUM; ZINC OXIDE






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AmphetaminesVYVANSELISDEXAMFETAMINE DIMESYLATE






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Diabetes MellitusWAVESENSE AMP TEST STRIPSDIAGNOSTIC TEST






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Diabetes MellitusWAVESENSE JAZZ TEST STRIPSDIAGNOSTIC TEST






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Diabetes MellitusWAVESENSE KEYNOTE TEST STRIPSDIAGNOSTIC TEST






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Diabetes MellitusWAVESENSE PRESTO TEST STRIPSDIAGNOSTIC TEST






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Bile Acid SequestrantsWELCHOLCOLESEVELAM HYDROCHLORIDE






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Second Generation AntihistaminesXYZALLEVOCETIRIZINE DIHYDROCHLORIDE






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Anxiolytics, Sedatives, & Hypnotics MiscZALEPLONZALEPLON











Proton-pump InhibitorsZEGERIDOMEPRAZOLE; SODIUM BICARBONATE











Proton-pump InhibitorsZEGERID OTCOMEPRAZOLE; SODIUM BICARBONATE











ContraceptivesZENCHENTETHINYL ESTRADIOL; NORETHINDRONE






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Other MacrolidesZMAXAZITHROMYCIN DIHYDRATE






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Somatotropin AgonistsZORBTIVESOMATROPIN











Leukotriene ModifiersZYFLOZILEUTON






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Leukotriene ModifiersZYFLO CRZILEUTON






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