Medical Necessity & Prior Authorization Forms/Criteria


  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 DOD.customer.relations@express-scripts.com with your information and a ESI 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 Form Prior Authorization Form
NARCOTIC ANALGESICS AND COMBINATIONSABSTRALFENTANYL CITRATE-


SELF MONITORING BLOOD GLUCOSE SYSTEMSACCU-CHEK ACTIVEBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSACCU-CHEK COMFORT CURVEBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSACCUTREND GLUCOSEBLOOD SUGAR DIAGNOSTIC


-
PROTON PUMP INHIBITORSACIPHEXRABEPRAZOLE SODIUM





PROTON PUMP INHIBITORSACIPHEX SPRINKLERABEPRAZOLE SODIUM-


TARGETED IMMUNOMODULATORY BIOLOGICSACTEMRATOCILIZUMAB-


NARCOTIC ANALGESICS AND COMBINATIONSACTIQFENTANYL CITRATE-


DIABETES NON-INSULINACTOPLUS METPIOGLITAZONE HCL/METFORMIN HCL-


DIABETES NON-INSULINACTOPLUS MET XRPIOGLITAZONE HCL/METFORMIN HCL-


DIABETES NON-INSULINACTOSPIOGLITAZONE HCL-


SELF MONITORING BLOOD GLUCOSE SYSTEMSACURA TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
PULMONARY ARTERIAL HYPERTENSIONADCIRCATADALAFIL





ANTILIPIDEMICS-1ADVICORNIACIN/LOVASTATIN





SELF MONITORING BLOOD GLUCOSE SYSTEMSADVOCATE REDI-CODEBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSADVOCATE REDI-CODE+BLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSADVOCATE TEST STRIPBLOOD SUGAR DIAGNOSTIC


-
ANTILIPIDEMICS-1ALTOPREVLOVASTATIN





PULMONARY-1 AGENTSALVESCOCICLESONIDE


-
SEDATIVE-HYPNOTIC AGENTSAMBIEN CRZOLPIDEM TARTRATE-


CORTICOSTEROIDS-IMMUNE MODULATORSAMCINONIDEAMCINONIDE


-
CORTICOSTEROIDS-IMMUNE MODULATORSAMCINONIDEAMCINONIDE


-
MIGRAINE AGENTSAMERGENARATRIPTAN HCL


-
CONTRACEPTIVE AGENTSAMETHIALEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL


-
CONTRACEPTIVE AGENTSAMETHIA LOLEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL


-
CONTRACEPTIVE AGENTSAMETHYSTLEVONORGESTREL-ETHINYL ESTRADIOL


-
RENIN-ANGIOTENSIN ANTIHYPERTENSIVESAMTURNIDEALISKIREN HEMIFUMARATE/AMLODIPINE/HYDROCHLOROTHIAZIDE-


ANDROGENS-ANABOLIC STEROIDSANDRODERMTESTOSTERONE-


ANDROGENS-ANABOLIC STEROIDSANDROGELTESTOSTERONE





ANTILIPIDEMICS-2ANTARAFENOFIBRATE,MICRONIZED-


ANTIEMETIC-ANTIVERTIGO AGENTSANZEMETDOLASETRON MESYLATE


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSAPLENZINBUPROPION HBR


-
ALZHEIMERS AGENTSARICEPTDONEPEZIL HCL


-
GASTROINTESTINAL-1 AGENTSASACOL HDMESALAMINE


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSASSURE 4BLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSASSURE PLATINUMBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSASSURE PROBLOOD SUGAR DIAGNOSTIC


-
RENIN-ANGIOTENSIN ANTIHYPERTENSIVESATACANDCANDESARTAN CILEXETIL-


RENIN-ANGIOTENSIN ANTIHYPERTENSIVESATACAND HCTCANDESARTAN CILEXETIL/HYDROCHLOROTHIAZIDE-


OSTEOPOROSIS AGENTSATELVIARISEDRONATE SODIUM


-
RENIN-ANGIOTENSIN ANTIHYPERTENSIVESAVALIDEIRBESARTAN/HYDROCHLOROTHIAZIDE-


DIABETES NON-INSULINAVANDAMETROSIGLITAZONE MALEATE/METFORMIN HCL


-
DIABETES NON-INSULINAVANDARYLROSIGLITAZONE MALEATE/GLIMEPIRIDE


-
DIABETES NON-INSULINAVANDIAROSIGLITAZONE MALEATE


-
RENIN-ANGIOTENSIN ANTIHYPERTENSIVESAVAPROIRBESARTAN-


NARCOTIC ANALGESICS AND COMBINATIONSAVINZAMORPHINE SULFATE-


BENIGN PROSTATIC HYPERPLASIA AGENTSAVODARTDUTASTERIDE





MIGRAINE AGENTSAXERTALMOTRIPTAN MALATE


-
ANDROGENS-ANABOLIC STEROIDSAXIRONTESTOSTERONE





GLAUCOMA AGENTSAZOPTBRINZOLAMIDE


-
RENIN-ANGIOTENSIN ANTIHYPERTENSIVESAZORAMLODIPINE BESYLATE/OLMESARTAN MEDOXOMIL-


CONTRACEPTIVE AGENTSBALZIVANORETHINDRONE-ETHINYL ESTRADIOL


-
NASAL ALLERGY AGENTSBECONASE AQBECLOMETHASONE DIPROPIONATE


-
RENIN-ANGIOTENSIN ANTIHYPERTENSIVESBENICAROLMESARTAN MEDOXOMIL-


RENIN-ANGIOTENSIN ANTIHYPERTENSIVESBENICAR HCTOLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE-


CORTICOSTEROIDS-IMMUNE MODULATORSBETAMETHASONE VALERATEBETAMETHASONE VALERATE


-
GLAUCOMA AGENTSBETIMOLTIMOLOL


-
CONTRACEPTIVE AGENTSBEYAZDROSPIRENONE/ETHINYL ESTRADIOL/LEVOMEFOLATE CALCIUM


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSBG-STARBLOOD SUGAR DIAGNOSTIC


-
OSTEOPOROSIS AGENTSBINOSTOALENDRONATE SODIUM


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSBLOOD GLUCOSE TESTBLOOD SUGAR DIAGNOSTIC


-
FOLLICLE-STIMULATING HORMONE-LUTEINIZING HORMONE FERTILITY AGENTSBRAVELLEUROFOLLITROPIN-


PULMONARY-1 AGENTSBREO ELLIPTAFLUTICASONE FUROATE/VILANTEROL TRIFENATATE





CONTRACEPTIVE AGENTSBRIELLYNNORETHINDRONE-ETHINYL ESTRADIOL


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSBRINTELLIXVORTIOXETINE HYDROBROMIDE





NASAL ALLERGY AGENTSBUDESONIDEBUDESONIDE


-
TOBACCO CESSATION AGENTSBUPROBANBUPROPION HCL-


TOBACCO CESSATION AGENTSBUPROPION HCL SRBUPROPION HCL-


NARCOTIC ANALGESICS AND COMBINATIONSBUTRANSBUPRENORPHINE-


DIABETES NON-INSULINBYDUREONEXENATIDE MICROSPHERES-


DIABETES NON-INSULINBYETTAEXENATIDE-


BETA BLOCKERS AND HYDROCHLOROTHIAZIDE COMBINATIONSBYSTOLICNEBIVOLOL HCL


-
OSTEOPOROSIS AGENTSCALCITONIN-SALMONCALCITONIN,SALMON,SYNTHETIC


-
PAIN AGENTSCAMBIADICLOFENAC POTASSIUM


-
CONTRACEPTIVE AGENTSCAMRESELEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL


-
CONTRACEPTIVE AGENTSCAMRESE LOLEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL


-
RENIN-ANGIOTENSIN ANTIHYPERTENSIVESCANDESARTAN CILEXETILCANDESARTAN CILEXETIL-


RENIN-ANGIOTENSIN ANTIHYPERTENSIVESCANDESARTAN-HYDROCHLOROTHIAZIDCANDESARTAN CILEXETIL/HYDROCHLOROTHIAZIDE-


CORTICOSTEROIDS-IMMUNE MODULATORSCAPEX SHAMPOOFLUOCINOLONE ACETONIDE


-
CALCIUM CHANNEL BLOCKING AGENTSCARDENE SRNICARDIPINE HCL


-
CALCIUM CHANNEL BLOCKING AGENTSCARDIZEM LADILTIAZEM HCL


-
BENIGN PROSTATIC HYPERPLASIA AGENTSCARDURA XLDOXAZOSIN MESYLATE


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSCARESENS NBLOOD SUGAR DIAGNOSTIC


-
TOBACCO CESSATION AGENTSCHANTIXVARENICLINE TARTRATE-


SELF MONITORING BLOOD GLUCOSE SYSTEMSCHOICEDM CLARUS TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
PHOSPHODIESTERASE-5 INHIBITORSCIALISTADALAFIL





ANTIFUNGALSCICLODANCICLOPIROX OLAMINE


-
ANTIFUNGALSCICLOPIROXCICLOPIROX


-
ANTIFUNGALSCICLOPIROXCICLOPIROX OLAMINE


-
TARGETED IMMUNOMODULATORY BIOLOGICSCIMZIACERTOLIZUMAB PEGOL





ANTIHISTAMINE-1CLARINEXDESLORATADINE


-
ANTIHISTAMINE-1CLARINEX-D 12 HOURDESLORATADINE/PSEUDOEPHEDRINE SULFATE


-
ANTIHISTAMINE-1CLARINEX-D 24 HOURDESLORATADINE/PSEUDOEPHEDRINE SULFATE


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSCLEVER CHOICE TALKBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSCLEVER CHOICE TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSCLEVER CHOICE VOICE+ TST STRIPBLOOD SUGAR DIAGNOSTIC


-
CORTICOSTEROIDS-IMMUNE MODULATORSCLOCORTOLONE PIVALATECLOCORTOLONE PIVALATE


-
CORTICOSTEROIDS-IMMUNE MODULATORSCLODERMCLOCORTOLONE PIVALATE


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSCONTOUR NEXTBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSCONTROLBLOOD SUGAR DIAGNOSTIC


-
ANTILIPIDEMICS-1CRESTORROSUVASTATIN CALCIUM-


ANTILIPIDEMICS-1CRESTORROSUVASTATIN CALCIUM-


DIABETES NON-INSULINCYCLOSETBROMOCRIPTINE MESYLATE





ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSCYMBALTADULOXETINE HCL





CONTRACEPTIVE AGENTSDAYSEELEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL


-
ATTENTION DEFICIT HYPERACTIVITY DISORDER-WAKEFULNESS PROMOTING AGENTSDAYTRANAMETHYLPHENIDATE


-
ANTIHISTAMINE-1DESLORATADINEDESLORATADINE


-
CORTICOSTEROIDS-IMMUNE MODULATORSDESONATEDESONIDE


-
CORTICOSTEROIDS-IMMUNE MODULATORSDESONIDEDESONIDE


-
CORTICOSTEROIDS-IMMUNE MODULATORSDESOWENDESONIDE


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSDESVENLAFAXINE ERDESVENLAFAXINE





ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSDESVENLAFAXINE FUMARATE ERDESVENLAFAXINE FUMARATE-


OVERACTIVE BLADDER AGENTSDETROLTOLTERODINE TARTRATE-


PROTON PUMP INHIBITORSDEXILANTDEXLANSOPRAZOLE





ATTENTION DEFICIT HYPERACTIVITY DISORDER-WAKEFULNESS PROMOTING AGENTSDEXMETHYLPHENIDATE HCL ERDEXMETHYLPHENIDATE HCL


-
ANTIEMETIC-ANTIVERTIGO AGENTSDICLEGISDOXYLAMINE SUCCINATE/PYRIDOXINE HCL-


PAIN AGENTSDICLOFENAC SODIUMDICLOFENAC SODIUM


-
CORTICOSTEROIDS-IMMUNE MODULATORSDIFLORASONE DIACETATEDIFLORASONE DIACETATE


-
CALCIUM CHANNEL BLOCKING AGENTSDILTIAZEM ERDILTIAZEM HCL


-
ALZHEIMERS AGENTSDONEPEZIL HCLDONEPEZIL HCL


-
PAIN AGENTSDUEXISIBUPROFEN/FAMOTIDINE


-
PULMONARY-1 AGENTSDULERAMOMETASONE FUROATE/FORMOTEROL FUMARATE





ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSDULOXETINE HCLDULOXETINE HCL





SELF MONITORING BLOOD GLUCOSE SYSTEMSEASY CHECK TEST STRIPBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEASY GLUCO G2BLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEASY STEPBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEASY TRAKBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEASYGLUCOBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEASYGLUCO PLUSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEASYMAXBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEASYPLUSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSECLIPSEBLOOD SUGAR DIAGNOSTIC


-
ANTIFUNGALSECONAZOLE NITRATEECONAZOLE NITRATE


-
RENIN-ANGIOTENSIN ANTIHYPERTENSIVESEDARBIAZILSARTAN MEDOXOMIL-


RENIN-ANGIOTENSIN ANTIHYPERTENSIVESEDARBYCLORAZILSARTAN MEDOXOMIL/CHLORTHALIDONE-


SEDATIVE-HYPNOTIC AGENTSEDLUARZOLPIDEM TARTRATE





SELF MONITORING BLOOD GLUCOSE SYSTEMSELEMENT TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSEMSAMSELEGILINE


-
OVERACTIVE BLADDER AGENTSENABLEXDARIFENACIN HYDROBROMIDE





TARGETED IMMUNOMODULATORY BIOLOGICSENBRELETANERCEPT





RENIN-ANGIOTENSIN ANTIHYPERTENSIVESEPROSARTAN MESYLATEEPROSARTAN MESYLATE-


ANTIFUNGALSERTACZOSERTACONAZOLE NITRATE


-
CONTRACEPTIVE AGENTSESTROSTEP FENORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
SEDATIVE-HYPNOTIC AGENTSESZOPICLONEESZOPICLONE-


SELF MONITORING BLOOD GLUCOSE SYSTEMSEVENCAREBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEVENCARE G2BLOOD SUGAR DIAGNOSTIC


-
NARCOTIC ANALGESICS AND COMBINATIONSEXALGOHYDROMORPHONE HCL-


ANTIFUNGALSEXELDERMSULCONAZOLE NITRATE


-
MULTIPLE SCLEROSIS AGENTSEXTAVIAINTERFERON BETA-1B


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEZ SMARTBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSEZ SMART PLUSBLOOD SUGAR DIAGNOSTIC


-
ANTIPSYCHOTIC AGENTSFANAPTILOPERIDONE


-
DIABETES NON-INSULINFARXIGADAPAGLIFLOZIN PROPANEDIOL-


CONTRACEPTIVE AGENTSFEMCON FENORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
ANTILIPIDEMICS-2FENOFIBRATEFENOFIBRATE-


ANTILIPIDEMICS-2FENOFIBRATEFENOFIBRATE,MICRONIZED-


ANTILIPIDEMICS-2FENOFIBRIC ACIDFENOFIBRIC ACID-


ANTILIPIDEMICS-2FENOFIBRIC ACIDFENOFIBRIC ACID (CHOLINE)-


NARCOTIC ANALGESICS AND COMBINATIONSFENTANYL CITRATEFENTANYL CITRATE-


NARCOTIC ANALGESICS AND COMBINATIONSFENTORAFENTANYL CITRATE-


ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSFETZIMALEVOMILNACIPRAN HYDROCHLORIDE





ANTILIPIDEMICS-2FIBRICORFENOFIBRIC ACID-


PAIN AGENTSFLECTORDICLOFENAC EPOLAMINE


-
CORTICOSTEROIDS-IMMUNE MODULATORSFLUOCINONIDEFLUOCINONIDE


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSFLUOXETINE DRFLUOXETINE HCL


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSFLUOXETINE HCLFLUOXETINE HCL


-
ATTENTION DEFICIT HYPERACTIVITY DISORDER-WAKEFULNESS PROMOTING AGENTSFOCALIN XRDEXMETHYLPHENIDATE HCL


-
FOLLICLE-STIMULATING HORMONE-LUTEINIZING HORMONE FERTILITY AGENTSFOLLISTIM AQFOLLITROPIN BETA,RECOMB-


SELF MONITORING BLOOD GLUCOSE SYSTEMSFORA G30ABLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSFORA G90BLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSFORA TEST STRIPBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSFORA V10BLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSFORA V30ABLOOD SUGAR DIAGNOSTIC


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSFORFIVO XLBUPROPION HCL


-
DIABETES NON-INSULINFORTAMETMETFORMIN HCL


-
ANDROGENS-ANABOLIC STEROIDSFORTESTATESTOSTERONE-


SELF MONITORING BLOOD GLUCOSE SYSTEMSFREESTYLE INSULINXBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSFREESTYLE INSULINX TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSFREESTYLE TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
MIGRAINE AGENTSFROVAFROVATRIPTAN SUCCINATE


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSG-4BLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSGE100 BLOOD GLUCOSE TEST STRIPBLOOD SUGAR DIAGNOSTIC


-
OVERACTIVE BLADDER AGENTSGELNIQUEOXYBUTYNIN





OVERACTIVE BLADDER AGENTSGELNIQUEOXYBUTYNIN CHLORIDE





GROWTH STIMULATING AGENTSGENOTROPINSOMATROPIN





GASTROINTESTINAL-1 AGENTSGIAZOBALSALAZIDE DISODIUM


-
CONTRACEPTIVE AGENTSGILDAGIANORETHINDRONE-ETHINYL ESTRADIOL


-
MULTIPLE SCLEROSIS AGENTSGILENYAFINGOLIMOD HCL-


SELF MONITORING BLOOD GLUCOSE SYSTEMSGLUCOCARD 01 SENSORBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSGLUCOCARD EXPRESSIONBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSGLUCOCOM GLUCOSEBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSGLUCOLABBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSGLUCOSE TEST STRIPBLOOD SUGAR DIAGNOSTIC


-
DIABETES NON-INSULINGLUMETZAMETFORMIN HCL


-
FOLLICLE-STIMULATING HORMONE-LUTEINIZING HORMONE FERTILITY AGENTSGONAL-FFOLLITROPIN ALFA, RECOMB-


FOLLICLE-STIMULATING HORMONE-LUTEINIZING HORMONE FERTILITY AGENTSGONAL-F RFFFOLLITROPIN ALFA, RECOMB-


FOLLICLE-STIMULATING HORMONE-LUTEINIZING HORMONE FERTILITY AGENTSGONAL-F RFF REDI-JECTFOLLITROPIN ALFA, RECOMB-


ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSGRALISEGABAPENTIN





ENDOCRINE AGENTS MISCELLANEOUSH.P. ACTHARCORTICOTROPIN-


CORTICOSTEROIDS-IMMUNE MODULATORSHALOGHALCINONIDE


-
PROTON PUMP INHIBITORSHEARTBURN RELIEF 24 HOURLANSOPRAZOLE





PROTON PUMP INHIBITORSHEARTBURN TREATMENT 24 HOURLANSOPRAZOLE





SEDATIVE-HYPNOTIC AGENTSHETLIOZTASIMELTEON-


ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSHORIZANTGABAPENTIN ENACARBIL





NEUROLOGICAL AGENTS MISCELLANEOUSHORIZANTGABAPENTIN ENACARBIL-


GROWTH STIMULATING AGENTSHUMATROPESOMATROPIN-


TARGETED IMMUNOMODULATORY BIOLOGICSHUMIRAADALIMUMAB-


CORTICOSTEROIDS-IMMUNE MODULATORSHYDROCORTISONE BUTYRATEHYDROCORTISONE BUTYRATE


-
NARCOTIC ANALGESICS AND COMBINATIONSHYDROMORPHONE ERHYDROMORPHONE HCL-


HEPATITIS C AGENTSINCIVEKTELAPREVIR-


EXCLUDED FROM THE PHARMACY BENEFITINCRELEXMECASERMIN-


HEPATITIS C AGENTSINFERGENINTERFERON ALFACON-1


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSINFINITY TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
SEDATIVE-HYPNOTIC AGENTSINTERMEZZOZOLPIDEM TARTRATE





CONTRACEPTIVE AGENTSINTROVALELEVONORGESTREL-ETHINYL ESTRADIOL


-
DIABETES NON-INSULININVOKAMETCANAGLIFLOZIN/METFORMIN HCL-


DIABETES NON-INSULININVOKANACANAGLIFLOZIN





RENIN-ANGIOTENSIN ANTIHYPERTENSIVESIRBESARTANIRBESARTAN-


RENIN-ANGIOTENSIN ANTIHYPERTENSIVESIRBESARTAN-HYDROCHLOROTHIAZIDEIRBESARTAN/HYDROCHLOROTHIAZIDE-


GLAUCOMA AGENTSISTALOLTIMOLOL MALEATE


-
BENIGN PROSTATIC HYPERPLASIA AGENTSJALYNDUTASTERIDE/TAMSULOSIN HCL





DIABETES NON-INSULINJANUMETSITAGLIPTIN PHOSPHATE/METFORMIN HCL-


DIABETES NON-INSULINJANUMET XRSITAGLIPTIN PHOSPHATE/METFORMIN HCL-


DIABETES NON-INSULINJANUVIASITAGLIPTIN PHOSPHATE-


DIABETES NON-INSULINJARDIANCEEMPAGLIFLOZIN-


DIABETES NON-INSULINJENTADUETOLINAGLIPTIN/METFORMIN HCL-


DIABETES NON-INSULINJUVISYNCSITAGLIPTIN PHOSPHATE/SIMVASTATIN-


NARCOTIC ANALGESICS AND COMBINATIONSKADIANMORPHINE SULFATE-


CYSTIC FIBROSIS AGENTSKALYDECOIVACAFTOR-


DIABETES NON-INSULINKAZANOALOGLIPTIN BENZOATE/METFORMIN HCL





ANTIBIOTICSKETEKTELITHROMYCIN


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSKEYNOTEBLOOD SUGAR DIAGNOSTIC


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSKHEDEZLADESVENLAFAXINE





TARGETED IMMUNOMODULATORY BIOLOGICSKINERETANAKINRA





DIABETES NON-INSULINKOMBIGLYZE XRSAXAGLIPTIN HCL/METFORMIN HCL





PROTON PUMP INHIBITORSLANSOPRAZOLELANSOPRAZOLE





ANTIPSYCHOTIC AGENTSLATUDALURASIDONE HCL


-
NARCOTIC ANALGESICS AND COMBINATIONSLAZANDAFENTANYL CITRATE-


ANTILIPIDEMICS-1LESCOL XLFLUVASTATIN SODIUM





INSULINSLEVEMIR FLEXPENINSULIN DETEMIR


-
INSULINSLEVEMIR FLEXTOUCHINSULIN DETEMIR


-
PHOSPHODIESTERASE-5 INHIBITORSLEVITRAVARDENAFIL HCL





ANTIHISTAMINE-1LEVOCETIRIZINE DIHYDROCHLORIDELEVOCETIRIZINE DIHYDROCHLORIDE


-
CONTRACEPTIVE AGENTSLEVONORG-ETH ESTRAD ETH ESTRADLEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL


-
CONTRACEPTIVE AGENTSLEVONORGESTREL-ETH ESTRADIOLLEVONORGESTREL-ETHINYL ESTRADIOL


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSLIBERTY TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
PAIN AGENTSLIDOCAINELIDOCAINE-


PAIN AGENTSLIDODERMLIDOCAINE-


ANTILIPIDEMICS-2LIPOFENFENOFIBRATE-


ANTILIPIDEMICS-1LIPTRUZETEZETIMIBE/ATORVASTATIN CALCIUM





ANTILIPIDEMICS-1LIVALOPITAVASTATIN CALCIUM





CONTRACEPTIVE AGENTSLO LOESTRIN FENORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
CORTICOSTEROIDS-IMMUNE MODULATORSLOCOIDHYDROCORTISONE BUTYRATE


-
CONTRACEPTIVE AGENTSLOESTRIN 24 FENORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
ANTILIPIDEMICS-2LOFIBRAFENOFIBRATE-


ANTILIPIDEMICS-2LOFIBRAFENOFIBRATE,MICRONIZED-


CONTRACEPTIVE AGENTSLOMEDIA 24 FENORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
ANTIFUNGALSLOPROXCICLOPIROX


-
CONTRACEPTIVE AGENTSLOSEASONIQUELEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL


-
ANTILIPIDEMICS-2LOVAZAOMEGA-3 ACID ETHYL ESTERS-


SEDATIVE-HYPNOTIC AGENTSLUNESTAESZOPICLONE-


CORTICOSTEROIDS-IMMUNE MODULATORSLUXIQBETAMETHASONE VALERATE


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSLYRICAPREGABALIN





CALCIUM CHANNEL BLOCKING AGENTSMATZIM LADILTIAZEM HCL


-
PULMONARY-1 AGENTSMAXAIR AUTOHALERPIRBUTEROL ACETATE


-
PAIN AGENTSMEFENAMIC ACIDMEFENAMIC ACID


-
FOLLICLE-STIMULATING HORMONE-LUTEINIZING HORMONE FERTILITY AGENTSMENOPURMENOTROPINS-


DIABETES NON-INSULINMETFORMIN HCL ERMETFORMIN HCL


-
OSTEOPOROSIS AGENTSMIACALCINCALCITONIN,SALMON,SYNTHETIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSMICROBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSMICRODOTBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSMICRODOT XTRABLOOD SUGAR DIAGNOSTIC


-
ATTENTION DEFICIT HYPERACTIVITY DISORDER-WAKEFULNESS PROMOTING AGENTSMODAFINILMODAFINIL-


HEPATITIS C AGENTSMODERIBARIBAVIRIN


-
NARCOTIC ANALGESICS AND COMBINATIONSMORPHINE SULFATE CRMORPHINE SULFATE-


NARCOTIC ANALGESICS AND COMBINATIONSMORPHINE SULFATE ERMORPHINE SULFATE-


NARCOTIC ANALGESICS AND COMBINATIONSMS CONTINMORPHINE SULFATE-


SELF MONITORING BLOOD GLUCOSE SYSTEMSMYGLUCOHEALTHBLOOD SUGAR DIAGNOSTIC


-
OVERACTIVE BLADDER AGENTSMYRBETRIQMIRABEGRON-


PAIN AGENTSNAPRELANNAPROXEN SODIUM


-
MIGRAINE AGENTSNARATRIPTANNARATRIPTAN HCL


-
MIGRAINE AGENTSNARATRIPTAN HCLNARATRIPTAN HCL


-
NASAL ALLERGY AGENTSNASACORT AQTRIAMCINOLONE ACETONIDE


-
CONTRACEPTIVE AGENTSNATAZIAESTRADIOL VALERATE/DIENOGEST


-
DIABETES NON-INSULINNESINAALOGLIPTIN BENZOATE





SELF MONITORING BLOOD GLUCOSE SYSTEMSNEUTEK 2TEK TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
ANTILIPIDEMICS-1NIACIN ERNIACIN-


CALCIUM CHANNEL BLOCKING AGENTSNICARDIPINE HCLNICARDIPINE HCL


-
TOBACCO CESSATION AGENTSNICODERM CQNICOTINE-


TOBACCO CESSATION AGENTSNICORELIEFNICOTINE POLACRILEX-


TOBACCO CESSATION AGENTSNICORETTENICOTINE POLACRILEX-


TOBACCO CESSATION AGENTSNICOTINE GUMNICOTINE POLACRILEX-


TOBACCO CESSATION AGENTSNICOTINE LOZENGENICOTINE POLACRILEX-


TOBACCO CESSATION AGENTSNICOTINE PATCHNICOTINE-


TOBACCO CESSATION AGENTSNICOTROLNICOTINE-


TOBACCO CESSATION AGENTSNICOTROL NSNICOTINE-


CALCIUM CHANNEL BLOCKING AGENTSNISOLDIPINENISOLDIPINE


-
GROWTH STIMULATING AGENTSNORDITROPIN FLEXPROSOMATROPIN-


GROWTH STIMULATING AGENTSNORDITROPIN NORDIFLEXSOMATROPIN-


CONTRACEPTIVE AGENTSNORETHINDRONE-ETHIN ESTRADIOLNORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSNOVA MAX GLUCOSE TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
TOBACCO CESSATION AGENTSNTSNICOTINE-


NARCOTIC ANALGESICS AND COMBINATIONSNUCYNTATAPENTADOL HCL


-
GROWTH STIMULATING AGENTSNUTROPINSOMATROPIN-


GROWTH STIMULATING AGENTSNUTROPIN AQSOMATROPIN-


GROWTH STIMULATING AGENTSNUTROPIN AQ NUSPINSOMATROPIN-


ATTENTION DEFICIT HYPERACTIVITY DISORDER-WAKEFULNESS PROMOTING AGENTSNUVIGILARMODAFINIL-


ATTENTION DEFICIT HYPERACTIVITY DISORDER-WAKEFULNESS PROMOTING AGENTSNUVIGILARMODAFINIL





ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSOLEPTRO ERTRAZODONE HCL


-
ANTILIPIDEMICS-2OMEGA-3 ACID ETHYL ESTERSOMEGA-3 ACID ETHYL ESTERS-


PROTON PUMP INHIBITORSOMEPRAZOLE-SODIUM BICARBONATEOMEPRAZOLE/SODIUM BICARBONATE





NASAL ALLERGY AGENTSOMNARISCICLESONIDE


-
GROWTH STIMULATING AGENTSOMNITROPESOMATROPIN





SELF MONITORING BLOOD GLUCOSE SYSTEMSONE TOUCH ULTRA TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSONE TOUCH VERIOBLOOD SUGAR DIAGNOSTIC


-
DIABETES NON-INSULINONGLYZASAXAGLIPTIN HCL





NARCOTIC ANALGESICS AND COMBINATIONSONSOLISFENTANYL CITRATE-


SELF MONITORING BLOOD GLUCOSE SYSTEMSOPTIUMBLOOD SUGAR DIAGNOSTIC


-
TARGETED IMMUNOMODULATORY BIOLOGICSORENCIAABATACEPT





DIABETES NON-INSULINOSENIALOGLIPTIN BENZOATE/PIOGLITAZONE HCL





CONTRACEPTIVE AGENTSOVCON-35NORETHINDRONE-ETHINYL ESTRADIOL


-
NARCOTIC ANALGESICS AND COMBINATIONSOXECTAOXYCODONE HCL


-
ANTIFUNGALSOXISTATOXICONAZOLE NITRATE


-
NARCOTIC ANALGESICS AND COMBINATIONSOXYCONTINOXYCODONE HCL-


OVERACTIVE BLADDER AGENTSOXYTROLOXYBUTYNIN





CORTICOSTEROIDS-IMMUNE MODULATORSPANDELHYDROCORTISONE PROBUTATE


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSPAROXETINE HCLPAROXETINE HCL


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSPAXIL CRPAROXETINE HCL


-
CORTICOSTEROIDS-IMMUNE MODULATORSPEDIADERM HCHYDROCORTISONE/EMOLLIENT COMBINATION NO.45


-
CORTICOSTEROIDS-IMMUNE MODULATORSPEDIADERM TATRIAMCINOLONE ACETONIDE/EMOLLIENT COMBINATION NO.45


-
PAIN AGENTSPENNSAIDDICLOFENAC SODIUM


-
GASTROINTESTINAL-1 AGENTSPENTASAMESALAMINE


-
PULMONARY-2 AGENTSPERFOROMISTFORMOTEROL FUMARATE


-
PANCREATIC ENZYME AGENTSPERTZYELIPASE/PROTEASE/AMYLASE


-
CONTRACEPTIVE AGENTSPHILITHNORETHINDRONE-ETHINYL ESTRADIOL


-
DIABETES NON-INSULINPIOGLITAZONE HCLPIOGLITAZONE HCL-


DIABETES NON-INSULINPIOGLITAZONE-METFORMINPIOGLITAZONE HCL/METFORMIN HCL-


PAIN AGENTSPONSTELMEFENAMIC ACID


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSPRECISION PCXBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSPRECISION PCX PLUSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSPRECISION POINT OF CAREBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSPRECISION Q-I-DBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSPRECISION XTRABLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSPREMIUM BLOOD GLUCOSE TESTBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSPREMIUM V10BLOOD SUGAR DIAGNOSTIC


-
PROTON PUMP INHIBITORSPREVACIDLANSOPRAZOLE





PROTON PUMP INHIBITORSPREVACID 24HRLANSOPRAZOLE





ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSPRISTIQ ERDESVENLAFAXINE SUCCINATE





SELF MONITORING BLOOD GLUCOSE SYSTEMSPRODIGY AUTOCODEBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSPRODIGY NO CODINGBLOOD SUGAR DIAGNOSTIC


-
PROTON PUMP INHIBITORSPROTONIXPANTOPRAZOLE SODIUM-


PULMONARY-1 AGENTSPROVENTIL HFAALBUTEROL SULFATE


-
ATTENTION DEFICIT HYPERACTIVITY DISORDER-WAKEFULNESS PROMOTING AGENTSPROVIGILMODAFINIL-


ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSPROZAC WEEKLYFLUOXETINE HCL


-
PULMONARY-1 AGENTSPULMICORT FLEXHALERBUDESONIDE


-
ANTIMALARIALSQUALAQUINQUININE SULFATE-


CONTRACEPTIVE AGENTSQUASENSELEVONORGESTREL-ETHINYL ESTRADIOL


-
ANTIMALARIALSQUININE SULFATEQUININE SULFATE-


SELF MONITORING BLOOD GLUCOSE SYSTEMSQUINTET ACBLOOD SUGAR DIAGNOSTIC


-
TOBACCO CESSATION AGENTSQUIT 2NICOTINE POLACRILEX-


TOBACCO CESSATION AGENTSQUIT 4NICOTINE POLACRILEX-


PULMONARY-1 AGENTSQVARBECLOMETHASONE DIPROPIONATE


-
PROTON PUMP INHIBITORSRABEPRAZOLE SODIUMRABEPRAZOLE SODIUM





BENIGN PROSTATIC HYPERPLASIA AGENTSRAPAFLOSILODOSIN





SELF MONITORING BLOOD GLUCOSE SYSTEMSREFUAH PLUSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSRELION PRIME TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
FOLLICLE-STIMULATING HORMONE-LUTEINIZING HORMONE FERTILITY AGENTSREPRONEXMENOTROPINS-


PULMONARY ARTERIAL HYPERTENSIONREVATIOSILDENAFIL CITRATE-


NASAL ALLERGY AGENTSRHINOCORT AQUABUDESONIDE


-
HEPATITIS C AGENTSRIBAPAKRIBAVIRIN


-
HEPATITIS C AGENTSRIBATABRIBAVIRIN


-
SEDATIVE-HYPNOTIC AGENTSROZEREMRAMELTEON





CONTRACEPTIVE AGENTSSAFYRALDROSPIRENONE/ETHINYL ESTRADIOL/LEVOMEFOLATE CALCIUM


-
GROWTH STIMULATING AGENTSSAIZENSOMATROPIN-


GROWTH STIMULATING AGENTSSAIZENSOMATROPIN





OVERACTIVE BLADDER AGENTSSANCTURA XRTROSPIUM CHLORIDE-


ANTIEMETIC-ANTIVERTIGO AGENTSSANCUSOGRANISETRON


-
ANTIPSYCHOTIC AGENTSSAPHRISASENAPINE MALEATE


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSSARAFEMFLUOXETINE HCL


-
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSSAVELLAMILNACIPRAN HCL





CONTRACEPTIVE AGENTSSEASONIQUELEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL


-
GROWTH STIMULATING AGENTSSEROSTIMSOMATROPIN-


PULMONARY ARTERIAL HYPERTENSIONSILDENAFILSILDENAFIL CITRATE-


SEDATIVE-HYPNOTIC AGENTSSILENORDOXEPIN HCL-


ANTILIPIDEMICS-1SIMCORNIACIN/SIMVASTATIN





TARGETED IMMUNOMODULATORY BIOLOGICSSIMPONIGOLIMUMAB





SELF MONITORING BLOOD GLUCOSE SYSTEMSSMART CARESENS NBLOOD SUGAR DIAGNOSTIC


-
PAIN AGENTSSPRIXKETOROLAC TROMETHAMINE


-
PHOSPHODIESTERASE-5 INHIBITORSSTAXYNVARDENAFIL HCL





TARGETED IMMUNOMODULATORY BIOLOGICSSTELARAUSTEKINUMAB-


PHOSPHODIESTERASE-5 INHIBITORSSTENDRAAVANAFIL-


TOBACCO CESSATION AGENTSSTOP SMOKING AIDNICOTINE POLACRILEX-


ANDROGENS-ANABOLIC STEROIDSSTRIANTTESTOSTERONE-


NARCOTIC ANALGESICS AND COMBINATIONSSUBSYSFENTANYL-


CALCIUM CHANNEL BLOCKING AGENTSSULARNISOLDIPINE


-
MIGRAINE AGENTSSUMAVEL DOSEPROSUMATRIPTAN SUCCINATE


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSSURE EDGE TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSSURE-TEST EASYPLUS MINIBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSSURECHEK TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSSURESTEP PROBLOOD SUGAR DIAGNOSTIC


-
PULMONARY-1 AGENTSSYMBICORTBUDESONIDE/FORMOTEROL FUMARATE





DIABETES NON-INSULINSYMLINPEN 120PRAMLINTIDE ACETATE-


DIABETES NON-INSULINSYMLINPEN 60PRAMLINTIDE ACETATE-


DIABETES NON-INSULINTANZEUMALBIGLUTIDE-


MULTIPLE SCLEROSIS AGENTSTECFIDERADIMETHYL FUMARATE-


RENIN-ANGIOTENSIN ANTIHYPERTENSIVESTEKAMLOALISKIREN HEMIFUMARATE/AMLODIPINE BESYLATE





RENIN-ANGIOTENSIN ANTIHYPERTENSIVESTEKTURNAALISKIREN HEMIFUMARATE-


RENIN-ANGIOTENSIN ANTIHYPERTENSIVESTEKTURNA HCTALISKIREN HEMIFUMARATE/HYDROCHLOROTHIAZIDE-


ANDROGENS-ANABOLIC STEROIDSTESTIMTESTOSTERONE-


ANDROGENS-ANABOLIC STEROIDSTESTOSTERONETESTOSTERONE-


ANDROGENS-ANABOLIC STEROIDSTESTOSTERONETESTOSTERONE





GROWTH STIMULATING AGENTSTEV-TROPINSOMATROPIN-


RENIN-ANGIOTENSIN ANTIHYPERTENSIVESTEVETENEPROSARTAN MESYLATE-


RENIN-ANGIOTENSIN ANTIHYPERTENSIVESTEVETEN HCTEPROSARTAN MESYLATE/HYDROCHLOROTHIAZIDE-


CONTRACEPTIVE AGENTSTILIA FENORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
OVERACTIVE BLADDER AGENTSTOLTERODINE TARTRATETOLTERODINE TARTRATE-


OVERACTIVE BLADDER AGENTSTOVIAZFESOTERODINE FUMARATE





DIABETES NON-INSULINTRADJENTALINAGLIPTIN-


NARCOTIC ANALGESICS AND COMBINATIONSTRAMADOL HCL ERTRAMADOL HCL


-
GLAUCOMA AGENTSTRAVATAN ZTRAVOPROST


-
GLAUCOMA AGENTSTRAVOPROSTTRAVOPROST (BENZALKONIUM)


-
CONTRACEPTIVE AGENTSTRI-LEGEST FENORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
NASAL ALLERGY AGENTSTRIAMCINOLONE ACETONIDETRIAMCINOLONE ACETONIDE


-
RENIN-ANGIOTENSIN ANTIHYPERTENSIVESTRIBENZOROLMESARTAN MEDOXOMIL/AMLODIPINE BESYLATE/HYDROCHLOROTHIAZIDE





ANTILIPIDEMICS-2TRIGLIDEFENOFIBRATE NANOCRYSTALLIZED-


ANTILIPIDEMICS-2TRILIPIXFENOFIBRIC ACID (CHOLINE)-


OVERACTIVE BLADDER AGENTSTROSPIUM CHLORIDE ERTROSPIUM CHLORIDE-


SELF MONITORING BLOOD GLUCOSE SYSTEMSTRUETEST TEST STRIPSBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSTRUETRACK SMART SYSTEMBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSTRUETRACK TEST STRIPBLOOD SUGAR DIAGNOSTIC


-
ANTIGOUT AGENTSULORICFEBUXOSTAT





SELF MONITORING BLOOD GLUCOSE SYSTEMSULTIMABLOOD SUGAR DIAGNOSTIC


-
NARCOTIC ANALGESICS AND COMBINATIONSULTRAM ERTRAMADOL HCL


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSULTRATRAKBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSULTRATRAK ULTIMATEBLOOD SUGAR DIAGNOSTIC


-
PANCREATIC ENZYME AGENTSULTRESALIPASE/PROTEASE/AMYLASE


-
CORTICOSTEROIDS-IMMUNE MODULATORSVANOSFLUOCINONIDE


-
ANTILIPIDEMICS-2VASCEPAICOSAPENT ETHYL-


PULMONARY-1 AGENTSVENTOLIN HFAALBUTEROL SULFATE


-
NASAL ALLERGY AGENTSVERAMYSTFLUTICASONE FUROATE


-
CALCIUM CHANNEL BLOCKING AGENTSVERAPAMIL ERVERAPAMIL HCL


-
CALCIUM CHANNEL BLOCKING AGENTSVERAPAMIL ER PMVERAPAMIL HCL


-
CALCIUM CHANNEL BLOCKING AGENTSVERAPAMIL HCLVERAPAMIL HCL


-
CALCIUM CHANNEL BLOCKING AGENTSVERAPAMIL SRVERAPAMIL HCL


-
CORTICOSTEROIDS-IMMUNE MODULATORSVERDESODESONIDE


-
CALCIUM CHANNEL BLOCKING AGENTSVERELANVERAPAMIL HCL


-
CALCIUM CHANNEL BLOCKING AGENTSVERELAN PMVERAPAMIL HCL


-
OVERACTIVE BLADDER AGENTSVESICARESOLIFENACIN SUCCINATE-


PHOSPHODIESTERASE-5 INHIBITORSVIAGRASILDENAFIL CITRATE-


DIABETES NON-INSULINVICTOZA 2-PAKLIRAGLUTIDE-


DIABETES NON-INSULINVICTOZA 3-PAKLIRAGLUTIDE-


HEPATITIS C AGENTSVICTRELISBOCEPREVIR-


ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTSVIIBRYDVILAZODONE HYDROCHLORIDE


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSVOCAL POINTBLOOD SUGAR DIAGNOSTIC


-
ANDROGENS-ANABOLIC STEROIDSVOGELXOTESTOSTERONE-


ANTIFUNGALSVUSIONMICONAZOLE NITRATE/ZINC OXIDE/PETROLATUM,WHITE


-
CONTRACEPTIVE AGENTSVYFEMLANORETHINDRONE-ETHINYL ESTRADIOL


-
ANTILIPIDEMICS-1VYTORINEZETIMIBE/SIMVASTATIN





ATTENTION DEFICIT HYPERACTIVITY DISORDER-WAKEFULNESS PROMOTING AGENTSVYVANSELISDEXAMFETAMINE DIMESYLATE


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSWAVESENSE JAZZBLOOD SUGAR DIAGNOSTIC


-
SELF MONITORING BLOOD GLUCOSE SYSTEMSWAVESENSE PRESTOBLOOD SUGAR DIAGNOSTIC


-
ANTILIPIDEMICS-2WELCHOLCOLESEVELAM HCL


-
CONTRACEPTIVE AGENTSWYMZYA FENORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
ONCOLOGICAL AGENTSXALKORICRIZOTINIB-


GASTROINTESTINAL-2 AGENTSXIFAXANRIFAXIMIN-


GASTROINTESTINAL-2 AGENTSXIFAXANRIFAXIMIN-


PULMONARY-1 AGENTSXOPENEX HFALEVALBUTEROL TARTRATE


-
ONCOLOGICAL AGENTSXTANDIENZALUTAMIDE-


ATTENTION DEFICIT HYPERACTIVITY DISORDER-WAKEFULNESS PROMOTING AGENTSXYREMSODIUM OXYBATE-


ANTIHISTAMINE-1XYZALLEVOCETIRIZINE DIHYDROCHLORIDE


-
PROTON PUMP INHIBITORSZEGERIDOMEPRAZOLE/SODIUM BICARBONATE





ONCOLOGICAL AGENTSZELBORAFVEMURAFENIB-


CONTRACEPTIVE AGENTSZENCHENTNORETHINDRONE-ETHINYL ESTRADIOL


-
CONTRACEPTIVE AGENTSZENCHENT FENORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
CONTRACEPTIVE AGENTSZEOSANORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE


-
GLAUCOMA AGENTSZIOPTANTAFLUPROST/PF


-
PAIN AGENTSZIPSORDICLOFENAC POTASSIUM


-
ANTIBIOTICSZMAXAZITHROMYCIN


-
SEDATIVE-HYPNOTIC AGENTSZOLPIDEM TARTRATE ERZOLPIDEM TARTRATE-


SEDATIVE-HYPNOTIC AGENTSZOLPIMISTZOLPIDEM TARTRATE





GROWTH STIMULATING AGENTSZORBTIVESOMATROPIN-


ANTIEMETIC-ANTIVERTIGO AGENTSZUPLENZONDANSETRON


-
TOBACCO CESSATION AGENTSZYBANBUPROPION HCL-


LEUKOTRIENE MODIFYING AGENTSZYFLOZILEUTON


-
LEUKOTRIENE MODIFYING AGENTSZYFLO CRZILEUTON


-
ONCOLOGICAL AGENTSZYTIGAABIRATERONE ACETATE-


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