PRESCRIPTION DRUGS REQUIRING PRIOR AUTHORIZATION

Transcription

1 ABSTRAL fentanyl citrate oral tablet ACCU-CHEK TEST STRIPS blood glucose test strips Blood Glucose Test Strips ACTEMRA tocilizumab Monoclonal Antibody ACTHAR corticotropin Hormone ACTIMMUNE interferon gamma 1b Interferon ACTIQ fentanyl citrate OTFC ADCIRCA tadalafil Pulmonary Vasodilator ADEMPAS riociguat Pulmonary Vasodilator ADLYXIN lixisenatide Type 2 Diabetes ADVOCATE TEST STRIPS blood glucose test strips Blood Glucose Test Strips AEROSPAN flunisolide Corticosteroid (Inhaled) AFREZZA insulin Insulin (Inhaled) AIRDUO RESPICLICK fluticasone-salmeterol Beta Adrenergic/Corticosteroid (Inhaled) AKTIPAK benzoyl peroxide-erythromycin Acne Combination ALDARA** imiquimod Immunomodulators Imidazoquinolinamines - Topical ALOGLIPTIN alogliptin Type 2 Diabetes ALOGLIPTIN-METFORMIN alogliptin-metformin Type 2 Diabetes ALTOPREV lovastatin Cholesterol ALVESCO ciclesonide Corticosteroid (Inhaled) AMPYRA dalfampridine Multiple Sclerosis Agent AMRIX cyclobenzaprine Skeletal Muscle Relaxant ANAPROX DS** naproxen sodium Nonsteroidal Anti-inflammatory Agents ANAPROX** naproxen sodium Nonsteroidal Anti-inflammatory Agents ANDRODERM testosterone Topical Testosterone Drug ANDROGEL testosterone Topical Testosterone Drug APIDRA insulin glulisine [rdna origin] Human Insulin Analog APLENZIN bupropion Antidepressant ARANESP darbepoetin alfa Red Blood Cell Progenitor ARCAPTA NEOHALER indacaterol Beta Adrenergic (Inhaled) ARMONAIR RESPICLICK fluticasone propionate Corticosteroid (Inhaled) ARTHROTEC** diclofenac-misoprostol Nonsteroidal Anti-inflammatory Agent Combination ARYMO ER** morphine sulfate extended release 04HQ3249 R10/17 ** Addition to Prior Authorization list effective for 1/1/2018

2 ascomp with codeine** butalbital-aspirin-caffeine-codeine ASMANEX HFA/ TWISTHALER mometasone Corticosteroid (Inhaled) ATRALIN tretinoin Anti-Acne AURYXIA ferric citrate Phosphate Binder AUSTEDO deutetrabenazine Movement Disorder Therapy AUVI-Q epinephrine Non-selective α/β Adrenergic Receptor Agonist AVINZA** morphine sulfate extended release AVITA tretinoin Anti-Acne AXIRON testosterone Topical Testosterone Drug BASAGLAR insulin glargine Human Insulin Analog BELBUCA** buprenorphine hcl belladonna alkaloidsopium** belladonna alkaloids-opium Anticholinergic Combination BENLYSTA belimumab Systemic Lupus Erythematosus Agent BERINERT C1 esterase inhibitor Hereditary Angioedema BETASERON interferon beta-1b Multiple Sclerosis Agent BETHKIS tobramycin Cystic Fibrosis BEVESPI AEROSPHERE glycopyrrolate-formoterol fumarate Beta Adrenergic/Anticholinergic (Inhaled) BIVIGAM immune globulin-intravenous Intravenous Immune Globulin BONIVA SYRINGE ibandronate Osteoporosis/Bones BOTOX onabotulinumtoxina Specialty Drug BRINEURA cerliponase alfa Tripeptidyl Peptidase 1 Deficiency Treatment BRIVIACT Brivaracetam Anticonvulsant BROVANA arformoterol tartrate Beta Adrenergic (Nebulized) BUNAVAIL buprenorphine-naloxone Controlled Dangerous Substance BUPRENORPHINE PATCH** buprenorphine butalbital compoundcodeine** butalbital-aspirin-caffeine-codeine BUTRANS** buprenorphine BYDUREON exenatide extended release Incretin Mimetic Agent BYETTA exenatide Incretin Mimetic Agent CAFERGOT** ergotamine/caffiene Migraine - Ergot Combinations CARAC** fluorouracil Antineoplastic Antimetabolites - Topical

3 CARIMUNE NF immune globulin-intravenous Intravenous Immune Globulin carisoprodol compoundcodeine** carisoprodol-aspirin-codeine Muscle Relaxant Combination carisoprodol-aspirincodeine** carisoprodol-aspirin-codeine Muscle Relaxant Combination CAYSTON aztreonam Cystic Fibrosis CELEBREX** celecoxib Nonsteroidal Anti-inflammatory Agents - COX-2 Inhibitor CHOLBAM cholic acid Bile Acid CIALIS tadalafil Benign Prostatic Hyperplasia CIMZIA certolizumab pegol Anti-Tumor Necrosis Factor Drug CINQAIR reslizumab Monoclonal Antibody CINRYZE C1 esterase inhibitor Hereditary Angioedema codeine sulfate** codeine sulfate COSENTYX secukinumab Interleukin-17 Receptor Antagonist COTEMPLA XR-ODT methylphenidate Stimulant CRESTOR rosuvastatin Cholesterol CUPRIMINE penicillamine Wilson s Disease/Cystinuria/Rheumatoid Arthritis CUVITRU immune globulin-subcutaneous Subcutaneous Immune Globulin D.H.E. 45** dihydroergotamine mesylate Migraine - Ergot Alkaloids and Derivatives DAKLINZA daclatasvir dihydrochloride Hepatitis C DARAPRIM pyrimethamine Antimalarial DAXBIA cephalexin Cephalosporin DAYPRO** oxaprozin Nonsteroidal Anti-inflammatory Agents DEMEROL** meperidine DENAVIR penciclovir Antiviral/Herpes DILAUDID** hydromorphone DOLOPHINE** methadone hcl DUEXIS ibuprofen-famotidine Nonsteroidal Anti-inflammatory Agent Combination DULERA mometasone-formoterol Beta Adrenergic/Corticosteroid (Inhaled) DUPIXENT dupilumab Atopic Dermatitis Monoclonal Antibody DURAGESIC PATCH** fentanyl DURLAZA aspirin extended release Antiplatelet DUZALLO lesinurad-allopurinol Gout Agent

4 DYSPORT abobotulinumtoxina Specialty Drug EC-NAPROSYN** naproxen Nonsteroidal Anti-inflammatory Agents ECOZA econazole Antifungal EFUDEX** fluorouracil Antineoplastic Antimetabolites - Topical EGRIFTA tesamorelin HIV Associated Lipodystrophy ELIDEL pimecrolimus Immunomodulator EMBEDA ** morphine-naltrexone EMBRACE PRO TEST STRIPS blood glucose test strips Blood Glucose Test Strips EMFLAZA deflazacort Corticosteroid EMLA** lidocaine-prilocaine Local Anesthetics - Topical ENBREL etanercept Anti-Tumor Necrosis Factor Drug ENDARI glutamine Amino Acids Sickle Cell endocet** oxycodone-acetaminophen ENDODAN** oxycodone-aspirin ENTYVIO vedolizumab Monoclonal Antibody EPCLUSA sofosbuvir-velpatasvir Hepatitis C EPOGEN epoetin alfa Red Blood Cell Progenitor ERGOMAR** ergotamine Migraine - Ergot Alkaloids and Derivatives ERTACZO sertaconazole Antifungal ESBRIET pirfenidone Pulmonary Fibrosis EUCRISA crisaborole Phosphodiesterase 4 Inhibitor EUFLEXXA sodium hyaluronate Hyaluronic Acid Derivatives for Joint Injection EVENCARE MINI GLUCOSE TEST STRIPS blood glucose test strips Blood Glucose Test Strips EVZIO naloxone hcl injection Opiate Reversal Agent EXALGO** hydromorphone hcl extended release EXELDERM sulconazole Antifungal EXONDYS 51 eteplirsen Duchenne Muscular Dystrophy EXTINA ketoconazole Antifungal FELDENE** piroxicam Nonsteroidal Anti-inflammatory Agents FENOPROFEN CALCIUM** fenoprofen calcium Nonsteroidal Anti-inflammatory Agents FENORTHO** fenoprofen calcium Nonsteroidal Anti-inflammatory Agents FENTANYL PATCH** fentanyl

5 FENTORA fentanyl buccal tablet FEXMID cyclobenzaprine Skeletal Muscle Relaxant FIORICET-CODEINE** bultabital-acetaminophen-caffeinecodeine FIORINAL-CODEINE** butalbital-aspirin-caffiene-codeine FIRAZYR icatibant Hereditary Angioedema FLEBOGAMMA immune globulin-intravenous Intravenous Immune Globulin FLECTOR** diclofenac epolamine Anti-inflammatory Agents - Topical FLEXERIL cyclobenzaprine Skeletal Muscle Relaxant FLOLAN epoprostenol sodium Pulmonary Vasodilator FLOLIPID simvastatin-suspension Cholesterol FLUOROPLEX** fluorouracil Antineoplastic Antimetabolites - Topical FLUOROURACIL 0.5% cream** fluorouracil Antineoplastic Antimetabolites - Topical FORADIL AEROLIZER formoterol Beta Adrenergic (Inhaled) FORFIVO XL bupropion Antidepressant FORTAMET metformin Type 2 Diabetes FORTEO teriparatide Osteoporosis/Bones FORTESTA testosterone Topical Testosterone Drug FOSRENOL lanthanum carbonate Phosphate Binder FREESTYLE TEST STRIPS blood glucose test strips Blood Glucose Test Strips GAMIMUNE N immune globulin-intravenous Intravenous Immune Globulin GAMMAGARD LIQUID immune globulin-intravenous Intravenous Immune Globulin GAMMAGARD S/D immune globulin-intravenous Intravenous Immune Globulin GAMMAKED immune globulin-intravenous Intravenous Immune Globulin GAMMAPLEX immune globulin-intravenous Intravenous Immune Globulin GAMMAR-P IV immune globulin-intravenous Intravenous Immune Globulin GAMUNEX immune globulin-intravenous Intravenous Immune Globulin GAMUNEX-C immune globulinintravenous/subcutaneous Intravenous/Subcutaneous Immune Globulin GATTEX teduglutide [rdna origin] Short Bowel Syndrome GEL-ONE sodium hyaluronate Hyaluronic Acid Derivative for Joint Injection GEL-SYN sodium hyaluronate Hyaluronic Acid Derivative for Joint Injection GENOTROPIN somatropin Growth Hormone GENSTRIP TEST STRIPS blood glucose test strips Blood Glucose Test Strips

6 GENVISC 850 sodium hyaluronate Hyaluronic Acid Derivatives for Joint Injection GLUCOPHAGE XR metformin Type 2 Diabetes GLUCOSE TEST STRIP blood glucose test strips Blood Glucose Test Strips GLUMETZA metformin Type 2 Diabetes GOCOVRI amantadine Antiparkinson Dopaminergics GRALISE gabapentin Postherpetic Neuralgia Agent GRASTEK timothy grass pollen allergen extract Allergy Immunotherapy HAEGARDA C1 esterase inhibitor Hereditary Angioedema HARVONI ledipasvir-sofosbuvir Hepatitis C HETLIOZ tasimelteon Non-24-Hour Sleep-Wake Disorder HIZENTRA immune globulin-subcutaneous Subcutaneous Immune Globulin HORIZANT gabapentin enacarbil Restless Legs Syndrome/Postherpetic Neuralgia HUMALOG insulin lispro [rdna origin] Human Insulin Analog HUMATROPE somatropin Growth Hormone HUMIRA adalimumab Monoclonal Antibody HUMULIN insulin human [rdna origin] Human Insulin HYALGAN sodium hyaluronate Hyaluronic Acid Derivative for Joint Injection HYCET** hydrocodone-acetaminophen HYMOVIS sodium hyaluronate Hyaluronic Acid Derivative for Joint Injection HYQVIA immune globulin-subcutaneous Subcutaneous Immune Globulin HYSINGLA ER** hydrocodone bitartrate extended release IBUDONE** hydrocodone-ibuprofen ILUVIEN fluocinolone acetonide Ophthalmic Steroids IMPAVIDO miltefosine Antileishmanial INCRELEX mecasermin Growth Hormone INDOCIN** indomethacin Nonsteroidal Anti-inflammatory Agents INFLECTRA infliximab-dyyb Monoclonal Antibody INGREZZA valbenazine Movement Disorder Therapy IVEEGAM EN immune globulin-intravenous Intravenous Immune Globulin IVIG OR IGIV immune globulin-intravenous Intravenous Immune Globulin JUBLIA efinaconazole Antifungal JUXTAPID lomitapide Homozygous Familial Hypercholesterolemia

7 KADIAN** morphine sulfate extended release KALBITOR ecallantide Hereditary Angioedema KALYDECO ivacaftor Cystic Fibrosis KANUMA sebelipase alfa Enzyme KAZANO alogliptin-metformin Type 2 Diabetes KERYDIN tavaborole Antifungal ketoprofen er** ketoprofen extended release Nonsteroidal Anti-inflammatory Agents KEVEYIS dichlorphenamide Carbonic Anhydrase Inhibitor KEVZARA sarilumab Monoclonal Antibody KINERET** anakinra Interleukin-1 Receptor Antagonist KOMBIGLYZE XR saxagliptin-metformin Type 2 Diabetes KORLYM mifepristone Endocrine/Cushing s Disease KRYSTEXXA pegloticase Gout KUVAN sapropterin Phenylketonuria KYMRIAH tisagenlecleucel Oncology KYNAMRO mipomersen Homozygous Familial Hypercholesterolemia LAZANDA NASAL SPRAY fentanyl citrate LEMTRADA alemtuzumab Multiple Sclerosis LETAIRIS ambrisentan Pulmonary Vasodilator LEVALBUTEROL HFA levalbuterol tartrate Short Acting Beta Adrenergic (Inhaled) levorphanol** levorphanol tartrate LIBERTY TEST STRIP blood glucose test strips Blood Glucose Test Strips lidocaine ointment 5%** lidocaine Local Anesthetics - Topical LIDODERM lidocaine Topical Anesthetic LIVALO pitavastatin calcium Cholesterol LOCORT dexamethasone Glucocorticosteroid LODINE** etodolac Nonsteroidal Anti-inflammatory Agents lorcet (hd/plus)** hydrocodone-acetaminophen LORTAB** hydrocodone-acetaminophen LOVAZA omega-3-acid ethyl esters Omega-3 Fatty Acid LUMIGAN bimatoprost Anti-Glaucoma LUZU luliconazole Antifungal MAKENA hydroxyprogesterone Hormone

8 MAVYRET glecaprevir-pibrentasvir Hepatitis C MENTAX butenafine Antifungal methadose** methadone hcl migergot** ergotamine/caffiene Migraine - Ergot Combinations MIGRANAL** dihydroergotamine mesy Migraine - Ergot Alkaloids and Derivatives MIRCERA pegylated epoetin beta Red Blood Cell Progenitor MOBIC** meloxicam Nonsteroidal Anti-inflammatory Agents MONOVISC sodium hyaluronate Hyaluronic Acid Derivatives for Joint Injection MORPHABOND ER** morphine sulfate extended release morphine sulfate** morphine sulfate MS CONTIN** morphine sulfate controlled and extended release MYALEPT metreleptin Leptin Analog MYOBLOC rimabotulinumtoxinb Specialty Drug NAFTIN naftifine Antifungal NALFON** fenoprofen calcium Nonsteroidal Anti-inflammatory Agents NAPRELAN CR** naproxen sodium controlled and extended release Nonsteroidal Anti-inflammatory Agents NAPRELAN** naproxen sodium Nonsteroidal Anti-inflammatory Agents NAPROSYN** naproxen Nonsteroidal Anti-inflammatory Agents NATESTO testosterone Topical Testosterone Drug NESINA alogliptin Type 2 Diabetes NEURONTIN gabapentin Postherpetic Neuralgia/Anticonvulsant NITYR nitisinone Heredeitary Tyrosinemia Type 1 NORCO** hydrocodone-acetaminophen NORDITROPIN somatropin Growth Hormone NORTHERA droxidopa Neurogenic Orthostatic Hypotension NUCALA mepolizumab Monoclonal Antibody NUCYNTA ER** tapentadol hcl extended release NUCYNTA** tapentadol hcl NUTROPIN somatropin Growth Hormone NUTROPIN AQ somatropin Growth Hormone NUVIGIL armodafinil CNS Stimulant OCALIVA obeticholic acid Bile Acid Analog

9 OCREVUS ocrelizumab Monoclonal Antibody OCTAGAM immune globulin-intravenous Intravenous Immune Globulin OFEV nintedanib Pulmonary Fibrosis OLYSIO simeprevir Hepatitis C OMNITROPE somatropin Growth Hormone ONE TOUCH TEST STRIPS blood glucose test strips Blood Glucose Test Strips ONE TOUCH ULTRA TEST STRIPS blood glucose test strips Blood Glucose Test Strips ONGLYZA saxagliptin Type 2 Diabetes ONMEL itraconazole Antifungal ONSOLIS fentanyl soluble film ONZETRA XSAIL sumatriptan succinate Migraine Therapy Selective Serotonin Agonists OPANA ER** oxymorphone hcl extended release OPANA** oxymorphone hcl OPSUMIT macitentan Pulmonary Vasodilator sweet vernal-orchard-perennial rye- ORALAIR timothy-kentucky blue grass mixed Allergy Immunotherapy pollens allergen extract ORAVIG miconazole Antifungal ORENCIA/CLICKJECT abatacept Selective Co-Stimulation Modulator for RA ORENITRAM/ER treprostinil Pulmonary Vasodilator ORFADIN** nitisinone Heredeitary Tyrosinemia Type 1 ORKAMBI lumacaftor-ivacaftor Cystic Fibrosis ORTHOVISC high molecular weight hyaluronan Hyaluronic Acid Derivative for Joint Injection OTEZLA apremilast Phosphodiesterase Inhibitor OTREXUP methotrexate Rheumatoid Arthritis/Polyarticular Juvenile Idiopathic Arthritis/Psoriasis OXAYDO** oxycodone hcl OXISTAT oxiconazole Antifungal OXYCODONE ER** oxycodone hcl extended release oxycodone-ibuprofen** oxycodone-ibuprofen OXYCONTIN** oxycodone hcl extended release OZURDEX dexamethasone Ophthalmic Steroids PEGASYS peginterferon alfa-2a Interferon PEG-INTRON peginterferon alfa-2b Interferon

10 PENNSAID** diclofenac sodium Anti-inflammatory Agents - Topical PERCOCET** oxycodone-acetaminophen PERCODAN** oxycodone-aspirin PERFOROMIST formoterol fumarate Beta Adrenergic (Nebulized) PHOSLO calcium acetate Phosphate Binder PHOSLYRA calcium acetate Phosphate Binder POLYGAM S/D immune globulin-intravenous Intravenous Immune Globulin PONSTEL** mefenamic acid Nonsteroidal Anti-inflammatory Agents PRADAXA dabigatran etexilate Anticoagulant PRALUENT alirocumab Cholesterol PRECISION SOF-TACT TEST STRIPS blood glucose test strips Blood Glucose Test Strips PRECISION XTRA TEST STRIPS blood glucose test strips Blood Glucose Test Strips PRILOSEC DR** Omeprazole Proton Pump Inhibitor PRIMLEV** oxycodone-acetaminophen PRIVIGEN immune globulin-intravenous Intravenous Immune Globulin PROCRIT epoetin alfa Red Blood Cell Progenitor PROCYSBI cysteamine bitartrate Nephropathic Cystinosis Agent PRODIGY TEST STRIPS blood glucose test strips Blood Glucose Test Strips PROLIA denosumab Osteoporosis/Bones PROTOPIC tacrolimus Immunomodulator PROVENGE sipuleucel-t Oncology PROVENTIL HFA albuterol Short Acting Beta Adrenergic (Inhaled) PROVIGIL modafinil CNS Stimulant prudoxin** doxepin Antipruritics - Topical PULMICORT FLEXHALER budesonide Corticosteroid (Inhaled) QUDEXY XR topiramate extended release Anticonvulsant QUTENZA capsaicin Topical Anesthetic RADICAVA edaravone Amyotrophic Lateral Sclerosis (ALS) Agent RAGWITEK short ragweed pollen allergen extract Allergy Immunotherapy RAYALDEE calcifediol Vitamin D3 analog RAYOS prednisone Corticosteroid RECLAST zoledronic acid Osteoporosis/Bones

11 RELION TEST STRIPS blood glucose test strips Blood Glucose Test Strips REMICADE infliximab Monoclonal Antibody REMODULIN treprostinil sodium Pulmonary Vasodilator RENAGEL sevelamer Phosphate Binder RENFLEXIS infliximab-abda Monoclonal Antibody RENVELA sevelamer carbonate Phosphate Binder REPATHA evolocumab Cholesterol reprexain** hydrocodone-ibuprofen RESCULA unoprostone isopropyl Anti-Glaucoma RETIN-A tretinoin Anti-Acne RETIN-A MICRO tretinoin Anti-Acne RETISERT fluocinolone acetonide Ophthalmic Steroids REVATIO sildenafil citrate Pulmonary Vasodilator RHOFADE oxymetazoline Rosacea Agent RITUXAN rituximab Monoclonal Antibody RITUXAN HYCELA rituximab-hyaluronidase Monoclonal Antibody roxicet** oxycodone-acetaminophen ROXICODONE** oxycodone hcl RUCONEST C1 esterase inhibitor (recombinant) Hereditary Angioedema RYVENT carbinoxamine Antihistamine SABRIL vigabatrin Anticonvulsant SAIZEN/SAIZENPREP somatropin Growth Hormone SAVAYSA edoxaban Anticoagulant SEEBRI NEOHALER glycopyrrolate Anticholinergic SEROSTIM somatropin Growth Hormone SIGNIFOR pasireotide Somatostatin/Cushing s Disease SIGNIFOR LAR pasireotide Somatostatin/Acromegaly SILIQ brodalumab Monoclonal Antibody SIMPONI golimumab Anti-Tumor Necrosis Factor Drug SITAVIG acyclovir Antiviral/Herpes SOLARAZE** diclofenac Antineoplastic or Premalignant Lesions - Topical NSAID SOLIQUA insulin glargine-lixisenatide Human Insulin Analog SOVALDI sofosbuvir Hepatitis C

12 SPINRAZA nusinersen Exon Inclusion Antisense Oglionucleotide SPRITAM levetiracetam Anticonvulsant SPRIX** ketorolac tromethamine Nonsteroidal Anti-inflammatory Agents STELARA ustekinumab Anti-Tumor Necrosis Factor Drug STRENSIQ asfotase alfa Hypophosphatasia STRIANT testosterone Topical Testosterone Drug SUBOXONE SL FILM buprenorphine-naloxone Controlled Dangerous Substance SUBOXONE SL TABLETS buprenorphine-naloxone Controlled Dangerous Substance SUBSYS fentanyl sublingual spray Controlled Dangerous Substance SUBUTEX buprenorphine Controlled Dangerous Substance SUPARTZ sodium hyaluronate Hyaluronic Acid Derivatives for Joint Injection SYMLIN pramlintide Amylin Analogue SYNAGIS palivizumab Monoclonal Antibody SYNALGOS-DC** aspirin-caffeine-dihydrocodeine SYNDROS dronabinol Antiemetics SYNVISC hylan GF 20 Hyaluronic Acid Derivatives for Joint Injection SYNVISC-ONE hylan GF 20 Hyaluronic Acid Derivatives for Joint Injection SYPRINE trientine Wilson s Disease TALTZ ixekizumab Monoclonal Antibody TANZEUM albiglutide Incretin Mimetic Agent TECHNIVIE ombitasvir-paritaprevir-ritonavir Hepatitis C TESTIM testosterone Topical Testosterone Drug TESTOSTERONE testosterone Topical Testosterone Drug TEV-TROPIN somatropin Growth Hormone TIVORBEX** indomethacin Nonsteroidal Anti-inflammatory Agents TOBI/TOBI PODHALER tobramycin Cystic Fibrosis TOLAK** fluorouracil Antineoplastic Antimetabolites - Topical tolmetin** tolmetin sodium Nonsteroidal Anti-inflammatory Agents TOPIRAMATE ER topiramate extended release Anticonvulsant TRACLEER bosentan Pulmonary Vasodilator TRAVATAN Z travoprost Anti-Glaucoma TREMFYA guselkumab Monoclonal Antibody TRETIN-X tretinoin Anti-Acne

13 TREZIX** acetaminophen-caffeinedihydrocodeine TRIMPEX trimethoprim Anti-Infective Agents TROKENDI XR topiramate extended release Anticonvulsant TRULANCE plecanatide Chronic Idiopathic Constipation Agents TRULICITY dulaglutide Incretin Mimetic Agent TUDORZA PRESSAIR aclidinium Anticholinergic (Inhaled) TYLENOL WITH CODEINE** acetaminophen-codeine TYMLOS abaloparatide Osteoporosis/Bones TYSABRI natalizumab Monoclonal Antibody TYVASO treprostinil Pulmonary Vasodilator UNISTRIP1 blood glucose test strips Blood Glucose Test Strips UPTRAVI selexipag Pulmonary Vasodilator UTIBRON NEOHALER Indacaterol-glycopyrrolate Beta Adrenergic/Anticholinergic (Inhaled) VASCEPA icosapent ethyl Omega-3 Fatty Acid VECAMYL mecamylamine hydrochloride Hypertension VELETRI epoprostenol sodium Pulmonary Vasodilator VELPHORO sucroferric oxyhydroxide Phosphate Binder VELTIN tretinoin-clindamycin Anti-Acne VENTAVIS iloprost Pulmonary Vasodilator verdrocet** hydrocodone-acetaminophen vicodin (es/hp)** hydrocodone-acetaminophen VICOPROFEN** hydrocodone-ibuprofen VICTOZA liraglutide Incretin Mimetic Agent VIEKIRA PAK/XR ombitasvir-paritaprevir-ritonavirdasabuvir Hepatitis C VIMOVO naproxen-esomeprazole Nonsteroidal Anti-inflammatory Agent magnesium Combination VIVLODEX** meloxicam Nonsteroidal Anti-inflammatory Agents VOGELXO testosterone Topical Testosterone Drug VOLTAREN** diclofenac sodium Anti-inflammatory Agents - Topical VOLTAREN-XR** diclofenac sodium Nonsteroidal Anti-inflammatory Agents VOSEVI sofosbuvir-velpatasvir-voxilaprevir Hepatitis C

14 WAVESENSE TEST STRIPS blood glucose test strips Blood Glucose Test Strips WELLBUTRIN SR/XL bupropion Antidepressant XADAGO safinamide mesylate Antiparkinson Monoamine Oxidase Inhibitor XALATAN latanoprost Anti-Glaucoma XARTEMIS XR** oxycodone-acetaminophen XATMEP methotrexate Acute Lymphoblastic Leukemia/Polyarticular Jevnile Idiopathic Arthritis XELJANZ/XR tofacitinib Janus Kinase Inhibitor XENAZINE tetrabenazine Huntington s Chorea XEOMIN incobotulinumtoxina Specialty Drug XERMELO telotristat etiprate Carcinoid Syndrome Diarrhea XGEVA denosumab Oncology/Bones XIAFLEX collagenase clostridium Cord Injection XODOL** hydrocodone-acetaminophen XOLAIR omalizumab Monoclonal Antibody XOLEGEL ketoconazole Antifungal XOLOX** oxycocodone-acetaminophen XOPENEX HFA levalbuterol Short Acting Beta Adrenergic (Inhaled) XTAMPZA ER** oxycodone extended release XULTOPHY insulin degludec-liraglutide Insulin/Incretin Mimetic Agent XURIDEN uridine triacetate granule Hereditary Orotic Aciduria xylon** hydrocodone-ibuprofen XYREM sodium oxybate Narcolepsy zamicet** hydrocodone-acetaminophen ZEMBRACE SYMTOUCH sumatriptan injection Migraine Therapy Selective Serotonin Agonists ZEPATIER elbasvir-grazoprevir Hepatitis C ZIANA tretinoin-clindamycin Anti-Acne ZINBRYTA daclizumab Monoclonal Antibody ZINPLAVA bezlotoxumab Bacterial Monoclonal Antibodies ZIOPTAN tafluprost Anti-Glaucoma ZIPSOR** diclofenac potassium Nonsteroidal Anti-inflammatory Agents ZODEX dexamethasone Glucocorticosteroid ZOHYDRO ER** hydrocodone bitartrate extended release

15 ZOMACTON somatropin Growth Hormone ZOMETA zoledronic acid Oncology/Bones ZONACORT dexamethasone Glucocorticosteroid ZONALON** doxepin Antipruritics - Topical ZORBTIVE somatropin Growth Hormone ZORVOLEX** diclofenac Nonsteroidal Anti-inflammatory Agents ZOVIRAX CREAM/OINTMENT acyclovir Antiviral/Herpes ZUBSOLV buprenorphine-naloxone Controlled Dangerous Substance ZURAMPIC lesinurad Uric Acid Transporter 1 inhibitor ZYFLO zileuton Asthma Therapy ZYFLO CR zileuton controlled release Asthma Therapy