Quantity Limit Drug List

Transcription

1 Quantity Limit Drug List Quantity limits define the maximum amount of medication covered by your drug benefit for one prescription or copayment. This means your benefit covers a limited number of doses per prescription based on the medication s recommended dosing guidelines. If you or your physician requests an amount greater than the quantity limit of a medication, a prior authorization review may be required. The goal of the PreferredOne Quantity Limit Program is to promote appropriate and cost-effective use of medications based on U.S. Food and Drug Administration (FDA) dosing guidelines, the medical literature and other factors. This list is subject to change throughout the year. The presence of a drug on this list does not guarantee coverage and not all drugs included on this list may be covered by your pharmacy benefit plan. Coverage of medications is determined your benefit plan. ABILIFY (2 MG TABLET, 5 MG TABLET, 10 MG TABLET, 15 MG TABLET, 20 MG TABLET, 30 MG TABLET) A ABILIFY 1 MG/ML SOLUTION 5 BOTTLES (750 ML) / 30 ABILIFY DISCMELT (TAB RAPDIS) ABSTRAL (TAB SUBL) ACIPHEX (TABLET DR) ACIPHEX SPRINKLE (CAP DR SPR) ACTEMRA 162 MG/0.9 ML SYRINGE 4 SYRINGES (3.6 ML) / 28 ACTIQ (LOZENGE HD) ACTONEL 150 MG TABLET ACTONEL 35 MG TABLET ADCIRCA (TABLET) ADDERALL (TABLET) ADDERALL XR (CAP ER 24H) ADDYI (TABLET) ADEMPAS (0.5 MG TABLET, 1 MG TABLET, 1.5 MG TABLET, 2 MG TABLET, 2.5 MG TABLET) 1 / 28 4 / 28

2 ADLYXIN MCG STARTER PACK ADLYXIN 20 MCG MAINTENANCE PK A 2 PACKS / PENS (6 ML) / 28 ADVAIR DISKUS (BLST W/DEV) 1 INHALER (60 BLISTERS) / 30 ADVAIR HFA (HFA AER AD) 1 INHALER (12 G) / 30 ADZENYS XR-ODT (TAB RAP BP) AEROSPAN (HFA AER AD) 2 INHALERS (17.8 G) / 30 AFINITOR (TABLET) AIRDUO RESPICLICK (AER POW BA) AKYNZEO (CAPSULE) albuterol 2.5 mg/0.5 ml sol albuterol 5 mg/ml solution 1 INHALER / 30 2 / VIALS / ML / 30 albuterol sul 2.5 mg/3 ml soln 180 VIALS (540 ML) / 30 albuterol sulfate (0.63 ml, 1.25 ml) 125 VIALS (375 ML) / 30 ALECENSA (CAPSULE) alendronate sodium (35 mg tab, 70 mg tab) almotriptan malate (tablet) alprazolam (0.25 mg tablet, 0.5 mg tablet, 1 mg tablet) alprazolam 2 mg tablet alprazolam er (er 0.5 mg tablet, er 1 mg tablet) alprazolam er 2 mg tablet alprazolam er 3 mg tablet 8 / DAY 4 / / 30 5 / DAY 5 / DAY alprazolam intensol (oral conc) 10 BOTTLES (300 ML) / 30 alprazolam odt (odt 0.25 mg tab, odt 0.5 mg tab, odt 1 mg tab) alprazolam odt 2 mg tab alprazolam xr (0.5 mg tablet, 1 mg tablet) alprazolam xr 2 mg tablet alprazolam xr 3 mg tablet 5 / DAY 5 / DAY ALSUMA (PEN INJCTR) 10 SYRINGES (5 ML) / 30

3 ALUNBRIG (TABLET) A ALVESCO (HFA AER AD) 2 INHALERS (12.2 G) / 30 AMBIEN (TABLET) AMBIEN CR (TAB MPHASE) AMERGE (TABLET) AMITIZA (CAPSULE) AMPYRA (TAB ER 12H) 9 / 30 ANORO ELLIPTA (BLST W/DEV) 1 INHALER (60 BLISTERS) / 30 ANZEMET (50 MG TABLET, 100 MG TABLET) APLENZIN (TAB ER 24H) 2 / 30 APOKYN (CARTRIDGE) 20 CARTRIDGES (60 ML) / 30 aprepitant 125 mg capsule aprepitant mg pack aprepitant 40 mg capsule aprepitant 80 mg capsule APTENSIO XR (CSBP 40-60) ARCAPTA NEOHALER (CAP W/DEV) aripiprazole (2 mg tablet, 5 mg tablet, 10 mg tablet, 15 mg tablet, 20 mg tablet, 30 mg tablet) 2 / 30 2 TRIPACKS (6 CAPSULES) / 30 1 / 30 4 / 30 4 CAPSULES / DAY aripiprazole 1 mg/ml solution 5 BOTTLES (750 ML) / 30 aripiprazole odt (tab rapdis) ARIXTRA (2.5 MG/0.5 ML, 5 MG/0.4 ML, 7.5 MG/0.6 ML, 10 MG/0.8 ML) 35 DAY SUPPLY / 180 armodafinil (150 mg tablet, 200 mg tablet, 250 mg tablet) armodafinil 50 mg tablet ARMONAIR RESPICLICK (AER POW BA) 1 INHALER / 30 ARNUITY ELLIPTA (BLST W/DEV) 1 INHALER (30 BLISTERS) / 30 ARYMO ER (TAB PO ER) ASMANEX (AER POW BA) 1 INHALER / 30

4 ASMANEX HFA (HFA AER AD) 1 INHALER (13 G) / 30 ASTEPRO (SPRAY/PUMP) 2 BOTTLES (60 ML) / 30 ATELVIA (TABLET DR) ATIVAN (0.5 MG TABLET, 1 MG TABLET) ATIVAN 2 MG TABLET atomoxetine hcl (10 mg capsule, 18 mg capsule, 25 mg capsule, 40 mg capsule) atomoxetine hcl (60 mg capsule, 80 mg capsule, 100 mg capsule) A 4 / 28 5 / DAY ATROVENT HFA (HFA AER AD) 2 INHALERS (25.8 G) / 30 AUBAGIO (TABLET) AUSTEDO (TABLET) AVINZA (30 MG CAPSULE, 45 MG CAPSULE, 60 MG CAPSULE, 75 MG CAPSULE, 90 MG CAPSULE) AVINZA 120 MG CAPSULE AVONEX 30 MCG VIAL KIT AVONEX PEN (PEN IJ KIT) AVONEX PREFILLED SYR 30 MCG KT AXERT (TABLET) 4 KITS (4 VIALS) / 28 1 KIT / 28 1 KIT / / 30 azelastine hcl (0.1% (137 mcg) spry, 0.15% nasal spray) 2 BOTTLES (60 ML) / 30 BARACLUDE 0.05 MG/ML SOLUTION 3 BOTTLES (630 ML) / 30 BECONASE AQ (SPRAY) 1 BOTTLE (25 G) / 25 BELBUCA (FILM) BELSOMRA (TABLET) BETASERON (KIT) B 1 KIT (15 VIALS) / 30 BEVESPI AEROSPHERE (HFA AER AD) 1 INHALER (10.7 G) / 30 BEVYXXA (CAPSULE) bimatoprost 0.03% eye drops BINOSTO (TABLET EFF) 44 / ML / 25 4 / 28

5 BONIVA 150 MG TABLET B 1 / 28 BONIVA 3 MG/3 ML SYRINGE 1 SYRINGE (3 ML) / 90 BREO ELLIPTA (BLST W/DEV) 1 INHALER (60 BLISTERS) / 30 BRINTELLIX (TABLET) BRISDELLE (CAPSULE) bromfenac sodium (drops) 1 BOTTLE / RX BROMSITE (DROPS) 4 BOTTLES (20 ML) / 365 BROVANA (VIAL-NEB) 60 VIALS (120 ML) / 30 budesonide (0.25 ml, 0.5 ml, 1 ml inh) 60 AMPULES (120 ML) / 30 budesonide 32 mcg nasal spray 2 BOTTLES (17.2 G) / 30 BUNAVAIL MG FILM BUNAVAIL MG FILM BUNAVAIL MG FILM buprenorphin-naloxon 8-2 mg sl buprenorphine (patch tdwk) buprenorphine 2 mg tablet sl buprenorphine 8 mg tablet sl buprenorphn-naloxn mg sl buproban (tab er 12h) bupropion hcl sr (100 mg tablet, 200 mg tablet) bupropion hcl sr 150 mg tablet bupropion hcl xl 150 mg tablet bupropion hcl xl 300 mg tablet BUTRANS (PATCH TDWK) BYDUREON (VIAL) 4 / / 28 4 VIALS / 28 BYDUREON BCISE (AUTO INJCT) 4 AUTO-INJECTOR / 28 BYDUREON PEN (PEN INJCTR) BYETTA 10 MCG DOSE PEN INJ 4 PENS / 28 1 PEN (2.4 ML) / 30

6 BYETTA 5 MCG DOSE PEN INJ calcipotriene-betamethasone dp (oint. (g)) B C 1 PEN (1.2 ML) / G / 30 calcitonin-salmon (spray/pump) 1 BOTTLE (3.7 ML) / 30 CALQUENCE (CAPSULE) CAPRELSA 100 MG TABLET CAVERJECT (IMPULSE 10 MCG KIT, 20 MCG VIAL, IMPULSE 20 MCG KIT, 40 MCG VIAL) CELEBREX (CAPSULE) celecoxib (capsule) CESAMET (CAPSULE) CHANTIX (0.5 MG TABLET, 1 MG CONT MONTH BOX, 1 MG TABLET) 2 CAPSULES / DAY 6 VIALS / / RX CHANTIX STARTING MONTH BOX 1 BOX (53 TABLETS) / 28 chlordiazepoxide 10 mg capsule chlordiazepoxide 25 mg capsule chlordiazepoxide 5 mg capsule CIALIS (10 MG TABLET, 20 MG TABLET) CIALIS (2.5 MG TABLET, 5 MG TABLET) clonazepam (0.125 mg odt, mg dis tab, 0.25 mg odt, 0.5 mg tablet, 0.5 mg dis tablet, 0.5 mg odt, 1 mg tablet, 1 mg odt, 1 mg dis tablet) clonazepam 2 mg odt clonazepam 2 mg tablet clorazepate 15 mg tablet clorazepate 3.75 mg tablet clorazepate 7.5 mg tablet clozapine (25 mg tablet, 100 mg tablet) clozapine 200 mg tablet clozapine 50 mg tablet clozapine odt (odt 25 mg tablet, odt 100 mg tablet) clozapine odt 12.5 mg tablet clozapine odt 150 mg tablet clozapine odt 200 mg tablet 30 / DAY 1 6 / / DAY 3 / / DAY 9 / DAY

7 CLOZARIL (TABLET) C 9 / DAY COMBIVENT RESPIMAT (MIST INHAL) 2 INHALERS (8 G) / 30 CONCERTA (ER 18 MG TABLET, ER 27 MG TABLET, ER 54 MG TABLET) CONCERTA ER 36 MG TABLET CONZIP (100 MG CAPSULE, 200 MG CAPSULE, 300 MG CAPSULE) COPAXONE 20 MG/ML SYRINGE 1 KIT (30 SYRINGES) / 30 COPAXONE 40 MG/ML SYRINGE 1 KIT (12 SYRINGES) / 28 CORLANOR (TABLET) COTELLIC (TABLET) COTEMPLA XR-ODT 17.3 MG TABLET COTEMPLA XR-ODT 25.9 MG TABLET COTEMPLA XR-ODT 8.6 MG TABLET CRINONE (GEL/PF APP) 15 APPLICATORS (16.9 G) / 30 CYMBALTA (20 MG CAPSULE, 60 MG CAPSULE) CYMBALTA 30 MG CAPSULE CYSTARAN (DROPS) 4 BOTTLES (60 ML) / 28 d-amphetamine er 10 mg capsule d-amphetamine er 15 mg capsule d-amphetamine er 5 mg capsule DAKLINZA (TABLET) DAYTRANA (PATCH TD24) DESOXYN (TABLET) desvenlafaxine er (er 50 mg tablet, er 50 mg tab) desvenlafaxine er 100 mg tab desvenlafaxine fum er 100 mg desvenlafaxine fum er 50 mg desvenlafaxine suc er 100 mg desvenlafaxine succinate er (er 25 mg, er 50 mg) D 5 / DAY

8 DEXEDRINE 10 MG TABLET DEXEDRINE 5 MG TABLET DEXEDRINE SPANSULE 10 MG DEXEDRINE SPANSULE 15 MG DEXEDRINE SPANSULE 5 MG DEXILANT (CAP DR BP) dexmethylphenidate er 20 mg cp dexmethylphenidate hcl (tablet) dexmethylphenidate hcl er (er 25 mg, er 35 mg) dexmethylphenidate hcl er (er 5 mg cap, er 10 mg cp, er 15 mg cp, er 30 mg cp, er 40 mg cp) dextroamphetamine 10 mg tab dextroamphetamine 5 mg tab dextroamphetamine 5 mg/5 ml dextroamphetamine-amphet er (cap er 24h) dextroamphetamine-amphetamine (tablet) DIASTAT (KIT) DIASTAT ACUDIAL (KIT) diazepam (2.5 mg gel sys, 10 mg gel syst, 20 mg gel syst) DICLEGIS (TABLET DR) diclofenac sodium 1% gel diclofenac sodium 3% gel D 1800 ML / 30 2 PACKAGES / RX 2 PACKAGES / RX 2 PACKAGES / RX 10 / 30 3 TUBES (300G) / 30 dihydroergotamine 4 mg/ml spry 1 BOX (8 UNITS) / 30 DORAL (TABLET) dronabinol (capsule) DUEXIS (TABLET) DULERA (HFA AER AD) 1 INHALER (13 G) / 30 duloxetine hcl (dr 20 mg cap, dr 60 mg cap) duloxetine hcl dr 30 mg cap duloxetine hcl dr 40 mg cap DUPIXENT (SYRINGE) 4 SYRINGES / 28

9 DURAGESIC (12, 25, 50) DURAGESIC (75, 100) DYANAVEL XR (SUS BP 24H) D 15 / / ML / 30 DYMISTA (SPRAY/PUMP) 1 BOTTLE (23 G) / 30 EDEX (KIT) EDLUAR (TAB SUBL) EGRIFTA 1 MG VIAL EGRIFTA 2 MG VIAL eletriptan hbr (tablet) ELIGARD 22.5 MG SYRINGE KIT ELIGARD 30 MG SYRINGE KIT ELIGARD 45 MG SYRINGE KIT ELIGARD 7.5 MG SYRINGE KIT ELIQUIS 2.5 MG TABLET ELIQUIS 5 MG TABLET EMBEDA (CAP ER PO) EMEND 125 MG CAPSULE EMEND 125 MG POWDER PACKET EMEND 40 MG CAPSULE EMEND 80 MG CAPSULE EMEND TRIPACK EMSAM (PATCH TD24) enoxaparin sodium (30 mg/0.3 ml syr, 40 mg/0.4 ml syr, 60 mg/0.6 ml syr, 80 mg/0.8 ml syr, 100 mg/ml syringe, 120 mg/0.8 ml syr, 150 mg/ml syringe, 300 mg/3 ml vial) ENSTILAR (FOAM) ENTRESTO (TABLET) EPCLUSA (TABLET) esomeprazole dr mg cap esomeprazole dr 49.3 mg cap esomeprazole magnesium (capsule dr) E 6 CARTRIDGES / 30 2 VIALS / DAY 1 VIAL / DAY 12 / 30 1 SYRINGE / 84 1 SYRINGE / SYRINGE / SYRINGE / 28 2 / 30 3 / 30 1 / 30 4 / 30 2 TRIPACKS (6 CAPSULES) / DAY SUPPLY / CANS (420 G) / 30

10 estazolam (tablet) ESTRING (VAG RING) eszopiclone (tablet) EVEKEO (TABLET) EXALGO (TAB ER 24H) EXTAVIA (0.3 MG VIAL, 0.3 MG KIT) E 1 / 90 1 KIT (15 VIALS) / 30 FANAPT (1 MG TABLET, 2 MG TABLET, 4 MG TABLET, 6 MG TABLET, 8 MG TABLET, 10 MG TABLET, 12 MG TABLET) F FANAPT TITRATION PACK 1 PACK (8 TABLETS) / 180 FARYDAK (CAPSULE) FAZACLO (25 MG ODT, 100 MG ODT) FAZACLO 12.5 MG ODT FAZACLO 150 MG ODT FAZACLO 200 MG ODT FEMRING (VAG RING) fentanyl (12, 25, 50) fentanyl (37.5, 62.5) fentanyl (75, 100) fentanyl 87.5 mcg/hr patch fentanyl citrate (cit 1,200 mcg, cit 1,600 mcg, citrate 200 mcg, citrate 400 mcg, citrate 600 mcg, citrate 800 mcg) FENTORA (TABLET EFF) FETZIMA (ER 20 MG CAPSULE, ER 40 MG CAPSULE, ER 80 MG CAPSULE, ER 120 MG CAPSULE) 6 / 30 9 / DAY 1 / / / / / 30 FETZIMA MG TITRATION PAK 1 PACK (28 CAPSULES) / 365 FIRMAGON 2 X 120 MG KIT FIRMAGON 80 MG KIT FLECTOR (PATCH TD12) 2 VIALS / VIAL / 28 FLOVENT 250 MCG DISKUS 4 INHALERS (240 BLISTERS) / 30 FLOVENT DISKUS (50 MCG, 100 MCG) 1 INHALER (60 BLISTERS) / 30

11 FLOVENT HFA (110 MCG, 220 MCG) 2 INHALERS (24 G) / 30 FLOVENT HFA 44 MCG INHALER 2 INHALERS (21.2 G) / 30 flunisolide (spray) 1 BOTTLE (25 ML) / 30 fluoxetine dr (capsule dr) flurazepam hcl (capsule) fluticasone-salmeterol (aer pow ba) fluvoxamine maleate er (cap er 24h) FOCALIN (TABLET) FOCALIN XR (5 MG CAPSULE, 10 MG CAPSULE, 15 MG CAPSULE, 25 MG CAPSULE, 30 MG CAPSULE, 35 MG CAPSULE, 40 MG CAPSULE) FOCALIN XR 20 MG CAPSULE F 4 / 28 1 INHALER / 30 fondaparinux sodium (syringe) 35 DAY SUPPLY / 180 FORADIL (CAP W/DEV) FORFIVO XL (TAB ER 24H) 1 INHALER (60 CAPSULES) / 30 FORTICAL (SPRAY/PUMP) 1 BOTTLE (3.7 ML) / 30 FOSAMAX (TABLET) FOSAMAX PLUS D (TABLET) FRAGMIN (2,500 UNITS/0.2 ML SYR, 5,000 UNITS/0.2 ML SYR, 7,500 UNITS/0.3 ML SYR, 10,000 UNITS/ML SYRING, 12,500 UNITS/0.5 ML, 15,000 UNITS/0.6 ML, 18,000 UNITS/0.72 ML, 25,000 UNITS/ML VIAL, 95,000 UNITS/3.8 ML VL) FROVA (TABLET) frovatriptan succinate (tablet) FULYZAQ (TABLET DR) FUZEON 90 MG VIAL 4 / 28 4 / DAY SUPPLY / / 30 9 / 30 2 VIALS / DAY G GEODON (20 MG CAPSULE, 40 MG CAPSULE, 60 MG CAPSULE, 80 MG CAPSULE) GILENYA (CAPSULE) GILOTRIF (30 MG TABLET, 40 MG TABLET) GILOTRIF 20 MG TABLET

12 glatiramer 20 mg/ml syringe 1 KIT (30 SYRINGES) / 30 glatiramer 40 mg/ml syringe 1 KIT (12 SYRINGES) / 28 glatopa (syringe) 1 KIT (30 SYRINGES) / 30 GRALISE 30-DAY STARTER PACK GRALISE ER 300 MG TABLET GRALISE ER 600 MG TABLET granisetron hcl 1 mg tablet GRASTEK (TAB SUBL) G 1 PACK (78 TABLETS) / RX 4 / 30 HALCION (TABLET) HARVONI (TABLET) HETLIOZ (CAPSULE) HORIZANT (TABLET ER) hydromorphone er (tab er 24h) HYSINGLA ER (TAB ER 24H) H ibandronate 3 mg/3 ml syringe 1 SYRINGE (3 ML) / 90 ibandronate 3 mg/3 ml vial ibandronate sodium 150 mg tab ICLUSIG 15 MG TABLET IDHIFA (TABLET) ILARIS (150 MG/ML VIAL, 180 MG VIAL) ILEVRO (DROPS SUSP) IMBRUVICA (CAPSULE) IMITREX (25 MG TABLET, 50 MG TABLET, 100 MG TABLET) I 1 VIAL / 90 1 / 28 2 VIALS / ML / 30 9 / 30 IMITREX (4 ML, 6 ML) 10 CARTRIDGES (5 ML) / 30 IMITREX (5 MG, 20 MG) 2 PACKS (12 UNITS) / 30 IMITREX 4 MG/0.5 ML PEN INJECT 10 PENS (5 ML) / 30

13 IMITREX 6 MG/0.5 ML PEN INJECT 10 SYRINGES (5 ML) / 30 IMITREX 6 MG/0.5 ML VIAL I 8 VIALS (4 ML) / 30 INCRUSE ELLIPTA (BLST W/DEV) 1 INHALER (30 BLISTERS) / 30 INGREZZA 40 MG CAPSULE INGREZZA 80 MG CAPSULE INTERMEZZO (TAB SUBL) INVEGA (ER 1.5 MG TABLET, ER 3 MG TABLET, ER 9 MG TABLET) INVEGA ER 6 MG TABLET ipratropium br 0.02% soln 125 VIALS (312.5 ML) / 30 ipratropium-albuterol (ampul-neb) 180 VIALS (540 ML) / 30 IRENKA (CAPSULE DR) JAKAFI 10 MG TABLET JUXTAPID (CAPSULE) J KADIAN (ER 10 MG CAPSULE, ER 20 MG CAPSULE, ER 30 MG CAPSULE, ER 40 MG CAPSULE, ER 50 MG CAPSULE, ER 60 MG CAPSULE, ER 80 MG CAPSULE, ER 100 MG CAPSULE, ER 200 MG CAPSULE) ketorolac 10 mg tablet KEVEYIS (TABLET) KHEDEZLA ER 100 MG TABLET KHEDEZLA ER 50 MG TABLET KISQALI 200 MG DAILY DOSE KISQALI 400 MG DAILY DOSE KISQALI 600 MG DAILY DOSE KISQALI FEMARA 200 MG CO-PACK KISQALI FEMARA 400 MG CO-PACK KISQALI FEMARA 600 MG CO-PACK KLONOPIN (0.5 MG TABLET, 1 MG TABLET) KLONOPIN 2 MG TABLET K 20 TABLETS / / / / / / / 28 3 /

14 KORLYM (TABLET) K KYNAMRO (SYRINGE) 4 SYRINGES (4 ML) / 28 LAMISIL 250 MG TABLET 84 DAY SUPPLY / 180 lansoprazole dr 15 mg capsule lansoprazole dr 30 mg capsule latanoprost (drops) LATUDA (20 MG TABLET, 40 MG TABLET, 60 MG TABLET, 120 MG TABLET) LATUDA 80 MG TABLET LAZANDA (SPRAY/PUMP) LETAIRIS (TABLET) L 2.5 ML / 30 levalbuterol 1.25 mg/3 ml sol 90 VIALS (270 ML) / 30 levalbuterol concentrate (vial-neb) 90 VIALS (45 ML) / 30 levalbuterol hcl (0.31 ml, 0.63 ml) 180 VIALS (540 ML) / 30 levalbuterol tartrate hfa (hfa aer ad) 2 INHALERS (30 G) / 30 LEVITRA (TABLET) 6 / 30 linezolid 100 mg/5 ml susp 6 BOTTLES (900 ML) / 28 linezolid 600 mg tablet LINZESS (CAPSULE) LONSURF 15 MG-6.14 MG TABLET LONSURF 20 MG-8.19 MG TABLET lorazepam (0.5 mg tablet, 1 mg tablet) lorazepam 2 mg tablet 28 / / / 84 5 / DAY lorazepam 2 mg/ml oral concent 5 BOTTLES (150 ML) / 30 lorazepam intensol (oral conc) 5 BOTTLES (150 ML) / 30 LOTEMAX 0.5% EYE OINTMENT 4 TUBES (14 G) / 365

15 LOTEMAX 0.5% OPHTHALMIC GEL 4 BOTTLES (20 G) / 365 LOVENOX (30 MG/0.3 ML SYRINGE, 40 MG/0.4 ML SYRINGE, 60 MG/0.6 ML SYRINGE, 80 MG/0.8 ML SYRINGE, 100 MG/ML SYRINGE, 120 MG/0.8 ML SYRINGE, 150 MG/ML SYRINGE, 300 MG/3 ML VIAL) LUMIGAN (DROPS) LUNESTA (TABLET) LUPANETA PK MG 3MO KIT LUPANETA PK MG 1MO KIT LYRICA (25 MG CAPSULE, 50 MG CAPSULE, 75 MG CAPSULE, 100 MG CAPSULE, 150 MG CAPSULE, 200 MG CAPSULE, 225 MG CAPSULE) LYRICA 20 MG/ML ORAL SOLUTION LYRICA 300 MG CAPSULE L 35 DAY SUPPLY / ML / 30 1 KIT / 90 1 KIT / ML / 30 MARINOL (CAPSULE) MAVYRET (TABLET) MAXALT (TABLET) MAXALT MLT (TAB RAPDIS) METADATE CD (CPBP 30-70) metadate er (tablet er) methamphetamine hcl (tablet) METHYLIN (2.5 MG TAB, 5 MG TABLET) METHYLIN 10 MG CHEWABLE TABLET METHYLIN 10 MG/5 ML SOLUTION METHYLIN 5 MG/5 ML SOLUTION methylphenidate 10 mg chew tab methylphenidate 10 mg/5 ml sol methylphenidate 5 mg/5 ml soln methylphenidate er (er 10 mg tab, er 36 mg tab) methylphenidate er (er 18 mg tab, er 20 mg cap, er 27 mg tab, er 30 mg cap, er 40 mg cap, er 54 mg tab) methylphenidate er 20 mg tab methylphenidate hcl (2.5 mg chew tb, 5 mg tablet, 5 mg chew tab, 10 mg tablet, 20 mg tablet) M 18 / / 30 5 / DAY 900 ML / ML / ML / ML / 30

16 methylphenidate hcl cd (cpbp 30-70) methylphenidate hcl er (cpbp 30-70) methylphenidate la (20 mg cap, 30 mg cap, 40 mg cap) methylphenidate la 60 mg cap M MIACALCIN 200 UNIT NASAL SPRAY 1 BOTTLE (3.7 ML) / 30 MIGRANAL (SPRAY/PUMP) 1 BOX (8 UNITS) / 30 modafinil (tablet) mometasone furoate 50 mcg spry 2 BOTTLES (34 G) / 30 MORPHABOND ER (TAB ER 12H) morphine sulfate er (er 10 mg cap, er 20 mg cap, er 50 mg cap, er 80 mg cap, er 100 mg cap, er 120 mg cap) morphine sulfate er (er 15 mg tablet, er 30 mg tablet, er 60 mg tablet, er 100 mg tablet, er 200 mg tablet) morphine sulfate er (er 30 mg cap, er 45 mg cap, er 60 mg cap, er 75 mg cap, er 90 mg cap) MOVANTIK (TABLET) MOZOBIL (VIAL) 8 VIALS (9.6 ML) / TRANSPLANT MS CONTIN (TABLET ER) MUSE (SUPP.URETH) MYDAYIS (CPTP 24HR) MYTESI (TABLET DR) NAMENDA XR (7 MG CAPSULE, 14 MG CAPSULE, 21 MG CAPSULE, 28 MG CAPSULE, TITRATION PACK) NAMZARIC (7 MG CAPSULE, 14 MG CAPSULE, 21 MG CAPSULE, 28 MG CAPSULE) N 6 / 30 NAMZARIC TITRATION PACK 2 PACKS (56 CAPSULES) / 365 naratriptan (tablet) naratriptan hcl (tablet) 9 / 30 9 / 30 NASONEX (SPRAY/PUMP) 2 BOTTLES (34 G) / 30 NATPARA (CARTRIDGE) 2 CARTRIDGES / 28

17 NERLYNX (TABLET) N NEVANAC (DROPS SUSP) 2 BOTTLES (6 ML) / 30 NEXIUM (DR 2.5 MG PACKET, DR 5 MG PACKET, DR 10 MG PACKET, DR 20 MG CAPSULE, DR 20 MG PACKET, DR 40 MG PACKET, DR 40 MG CAPSULE) NICOTROL (CARTRIDGE) 1 NICOTROL NS (SPRAY) 12 BOTTLES (120 ML) / 30 NINLARO (CAPSULE) NOVAREL 5,000 UNIT VIAL NUCALA (VIAL) NUCYNTA ER (TAB ER 12H) NUVIGIL (150 MG TABLET, 200 MG TABLET, 250 MG TABLET) NUVIGIL 50 MG TABLET OCALIVA (TABLET) O 3 / 28 1 VIAL / 30 1 VIAL / 30 OCREVUS (VIAL) 4 VIALS (40 ML) / 365 OFEV (CAPSULE) olanzapine (2.5 mg tablet, 5 mg tablet, 7.5 mg tablet, 10 mg tablet, 15 mg tablet, 20 mg tablet) olanzapine odt (tab rapdis) olanzapine-fluoxetine hcl (3-25 mg, 6-25 mg) olanzapine-fluoxetine hcl (6-50 mg, mg, mg) olopatadine 665 mcg nasal spry 1 BOTTLE (30.5 G) / 30 OLYSIO (CAPSULE) omeppi (capsule) omeprazole (capsule dr) omeprazole-sodium bicarbonate (20-1,100 cap, 40-1,100 cap) omeprazole-sodium bicarbonate (20-1,680, 40-1,680) OMNARIS (SPRAY/PUMP) 1 BOTTLE (12.5 G) / 30 ondansetron 4 mg/5 ml solution 120 ML / 30 ondansetron 40 mg/20 ml vial 6 VIALS (120 ML) / 30

18 ondansetron hcl (4 ml amp, 4 ml vial) 60 VIALS (120 ML) / 30 ondansetron hcl (4 ml isecure, hcl 4 ml syr) 60 SYRINGES (120 ML) / 30 ondansetron hcl 24 mg tablet ondansetron odt (tab rapdis) O 2 / / 30 ONZETRA XSAIL (AER POW BA) 1 BOX (16 UNITS) / 30 OPANA ER (TAB ER 12H) OPSUMIT (TABLET) ORALAIR (TAB SUBL) ORKAMBI (TABLET) oseltamivir 6 mg/ml suspension 6 BOTTLES (360 ML) / 365 oseltamivir phos 30 mg capsule oseltamivir phosphate (45 mg capsule, 75 mg capsule) 40 / / 365 OTREXUP (AUTO INJCT) 4 PENS (1.6 ML) / 28 OXANDRIN 10 MG TABLET OXANDRIN 2.5 MG TABLET oxandrolone 10 mg tablet oxandrolone 2.5 mg tablet oxazepam (capsule) oxycodone hcl er (tab er 12h) OXYCONTIN (TAB ER 12H) oxymorphone hcl er (tab er 12h) OXYTROL (PATCH TDSW) OZEMPIC MG DOSE PEN OZEMPIC 1 MG DOSE PEN 8 / DAY 8 / DAY 8 / 28 1 PEN (1.5 ML) / 28 2 PENS (3 ML) / 28 P paliperidone er (er 1.5 mg tablet, er 3 mg tablet, er 9 mg tablet) paliperidone er 6 mg tablet pantoprazole sodium (dr 20 mg tab, dr 40 mg tab) paroxetine mesylate (capsule)

19 PATANASE (SPRAY/PUMP) 1 BOTTLE (30.5 G) / 30 PERFOROMIST (VIAL-NEB) PEXEVA (10 MG TABLET, 20 MG TABLET, 40 MG TABLET) PEXEVA 30 MG TABLET P 2 VIALS (4 ML) / DAY PLEGRIDY (SYRINGE) 2 SYRINGES (1 ML) / 28 PLEGRIDY PEN (PEN INJCTR) 2 PENS (1 ML) / 28 PORTRAZZA (VIAL) 2 VIALS (100 ML) / 21 PRADAXA (CAPSULE) PRALUENT PEN (PEN INJCTR) 2 PENS (2 ML) / 28 PRALUENT SYRINGE (SYRINGE) 2 SYRINGES (2 ML) / 28 PREVACID (15 MG, 30 MG) PREVACID (DR 15 MG CAPSULE, DR 30 MG CAPSULE) PRILOSEC (DR 10 MG CAPSULE, DR 20 MG CAPSULE, DR 40 MG CAPSULE) PRILOSEC (DR 2.5 MG, DR 10 MG) PRISTIQ (ER 25 MG TABLET, ER 50 MG TABLET) PRISTIQ ER 100 MG TABLET PROAIR HFA (HFA AER AD) 2 INHALERS (17 G) / 30 PROAIR RESPICLICK (AER POW BA) procentra (solution) 2 INHALERS / ML / 30 PROLENSA (DROPS) 4 BOTTLES (12 ML) / 180 PROLIA (SYRINGE) 2 SYRINGES (2 ML) / 365 PROTONIX (DR 20 MG TABLET, DR 40 MG TABLET, 40 MG SUSPENSION) PROVENTIL HFA (HFA AER AD) 2 INHALERS (13.4 G) / 30 PROVIGIL (TABLET) PROZAC WEEKLY (CAPSULE DR) 4 / 28 PULMICORT (AMPUL-NEB) 60 AMPULES (120 ML) / 30

20 PULMICORT FLEXHALER (AER POW BA) P 2 INHALERS / 30 QNASL (HFA AER AD) 1 INHALER (8.7 G) / 30 QNASL CHILDREN (HFA AER AD) 1 INHALER (4.9 G) / 30 quazepam (tablet) quetiapine er 200 mg tablet quetiapine fumarate (25 mg tab, 50 mg tab, 100 mg tab, 200 mg tab) quetiapine fumarate (300 mg tab, 400 mg tab) quetiapine fumarate er (er 50 mg tablet, er 150 mg tablet, er 300 mg tablet, er 400 mg tablet) QUILLICHEW ER (ER 20 MG TAB, ER 40 MG TAB) QUILLICHEW ER 30 MG CHEW TAB QUILLIVANT XR (SU ER RC24) QUTENZA (KIT) Q 360 ML / 30 4 / 90 QVAR 40 MCG ORAL INHALER 2 INHALERS (17.4 G) / 30 QVAR 80 MCG ORAL INHALER 3 INHALERS (26.1 G) / 30 QVAR REDIHALER (HFA AEROBA) 2 INHALERS (21.2 G) / 30 rabeprazole sodium (tablet dr) RAGWITEK (TAB SUBL) R RASUVO 10 MG/0.2 ML AUTOINJ 4 PENS (0.8 ML) / 28 RASUVO 12.5 MG/0.25 ML AUTOINJ 4 PENS (1 ML) / 28 RASUVO 15 MG/0.3 ML AUTOINJ 4 PENS (1.2 ML) / 28 RASUVO 17.5 MG/0.35 ML AUTOINJ 4 PENS (1.4 ML) / 28 RASUVO 20 MG/0.4 ML AUTOINJ 4 PENS (1.6 ML) / 28 RASUVO 22.5 MG/0.45 ML AUTOINJ 4 PENS (1.8 ML) / 28

21 RASUVO 25 MG/0.5 ML AUTOINJ R 4 PENS (2 ML) / 28 RASUVO 27.5 MG/0.55 ML AUTOINJ 4 PENS (2.2 ML) / 28 RASUVO 30 MG/0.6 ML AUTOINJ 4 PENS (2.4 ML) / 28 RASUVO 7.5 MG/0.15 ML AUTOINJ 4 PENS (0.6 ML) / 28 REBIF (22 ML, 44 ML) REBIF REBIDOSE (22 ML, 44 ML) REBIF REBIDOSE TITRATION PACK REBIF TITRATION PACK 1 KIT (6 ML) / 28 1 KIT (6 ML) / 28 1 KIT (4.2 ML) / KIT (4.2 ML) / 365 RELENZA (BLST W/DEV) 2 INHALERS (40 DISKS) / 365 RELISTOR (8 MG/0.4 ML, 12 MG/0.6 ML) RELISTOR 12 MG/0.6 ML VIAL RELISTOR 150 MG TABLET RELPAX (TABLET) 1 SYRINGE / DAY 1 VIAL / DAY 12 / 30 REPATHA PUSHTRONEX (WEAR INJCT) 1 CARTRIDGE (3.5 ML) / 28 REPATHA SURECLICK (PEN INJCTR) 3 PENS (3 ML) / 28 REPATHA SYRINGE (SYRINGE) 3 SYRINGES (3 ML) / 28 RESCULA (DROPS) 5 ML (1 BOTTLE) / 25 RESTORIL (CAPSULE) REVATIO 10 MG/ML ORAL SUSP 2 BOTTLES (224 ML) / 30 REVATIO 20 MG TABLET REXULTI (TABLET) RHINOCORT AQUA (SPRAY/PUMP) 2 BOTTLES (17.2 G) / 30 RILUTEK (TABLET) riluzole (tablet) risedronate sodium 150 mg tab risedronate sodium 35 mg tab 1 / 28 4 / 28

22 risedronate sodium dr (tablet dr) RISPERDAL (0.25 MG TABLET, 0.5 MG TABLET, 1 MG TABLET, 2 MG TABLET, 3 MG TABLET, 4 MG TABLET) R 4 / 28 RISPERDAL 1 MG/ML SOLUTION 8 BOTTLES (240 ML) / 30 RISPERDAL M-TAB (TAB RAPDIS) risperidone (0.25 mg tablet, 0.5 mg tablet, 1 mg tablet, 2 mg tablet, 3 mg tablet, 4 mg tablet) risperidone 0.25 mg odt risperidone 1 mg/ml solution 8 BOTTLES (240 ML) / 30 risperidone odt (0.5 mg odt, 1 mg odt, 2 mg odt, 3 mg odt, 4 mg odt) RITALIN (TABLET) RITALIN LA (CPBP 50-50) rizatriptan (5 mg tablet, 5 mg odt, 10 mg tablet, 10 mg odt) ROZEREM (TABLET) RUBRACA (TABLET) RYDAPT (CAPSULE) SAMSCA (TABLET) SANCUSO (PATCH TDWK) SAPHRIS (TAB SUBL) SAVAYSA (TABLET) SAVELLA (12.5 MG TABLET, 25 MG TABLET, 50 MG TABLET, 100 MG TABLET) S 18 / 30 8 / DAY 30 DAY SUPPLY / 60 2 / 30 SAVELLA TITRATION PACK 1 PACK (55 TABLETS) / 365 SEEBRI NEOHALER (CAP W/DEV) 1 INHALER (60 CAPSULES) / 30 SEREVENT DISKUS (BLST W/DEV) 1 INHALER (60 BLISTERS) / 30 SEROQUEL (25 MG TABLET, 50 MG TABLET, 100 MG TABLET, 200 MG TABLET) SEROQUEL (300 MG TABLET, 400 MG TABLET) SEROQUEL XR (50 MG TABLET, 150 MG TABLET, 300 MG TABLET, 400 MG TABLET) SEROQUEL XR 200 MG TABLET SIGNIFOR (AMPUL) 2 AMPULES / DAY

23 SIGNIFOR LAR (VIAL) sildenafil (tablet) sildenafil citrate (25 mg tablet, 50 mg tablet, 100 mg tablet) SILENOR (TABLET) SITAVIG (MA BUC TAB) SIVEXTRO 200 MG TABLET SIVEXTRO 200 MG VIAL SOLARAZE (GEL (GRAM)) SOLIQUA (INSULN PEN) SONATA 10 MG CAPSULE SONATA 5 MG CAPSULE SOVALDI (TABLET) SPIRIVA (CAP W/DEV) S 1 VIAL / 28 6 / 30 2 / 30 6 / 30 6 VIALS / 30 3 TUBES (300G) / 30 6 PENS (18 ML) / 30 1 CAPSULE / DAY SPIRIVA RESPIMAT (MIST INHAL) 1 INHALER (4 G) / 30 SPRIX (SPRAY) STAXYN (TAB RAPDIS) STENDRA (TABLET) 5 DAY SUPPLY / 30 6 / 30 6 / 30 STIOLTO RESPIMAT (MIST INHAL) 1 INHALER (4 G) / 30 STRATTERA (10 MG CAPSULE, 18 MG CAPSULE, 25 MG CAPSULE, 40 MG CAPSULE) STRATTERA (60 MG CAPSULE, 80 MG CAPSULE, 100 MG CAPSULE) STRIVERDI RESPIMAT (MIST INHAL) 1 INHALER (4 G) / 30 SUBOXONE 12 MG-3 MG SL FILM SUBOXONE 2 MG-0.5 MG SL FILM SUBOXONE 4 MG-1 MG SL FILM SUBOXONE 8 MG-2 MG SL FILM SUBSYS (SPRAY) 1 1 sumatriptan (spray) 2 PACKS (12 UNITS) / 30 sumatriptan 4 mg/0.5 ml inject sumatriptan 6 mg/0.5 ml vial 10 PENS (5 ML) / 30 8 VIALS (4 ML) / 30

24 sumatriptan succinate (25 mg tablet, 50 mg tablet, 100 mg tablet) S 9 / 30 sumatriptan succinate (4 ml cart, 6 ml refill) 10 CARTRIDGES (5 ML) / 30 sumatriptan succinate (6 ml syrng, 6 ml inject) 10 SYRINGES (5 ML) / 30 SUMAVEL DOSEPRO (NDL FR INJ) SUPPRELIN LA (KIT) 12 PENS (6 ML) / 30 1 KIT / 365 SUSTOL (LIQ ER SYR) 3 SYRINGES (1.2 ML) / 30 SYMBICORT (HFA AER AD) 1 INHALER (10.2 G) / 30 SYMBYAX (3-25 MG CAPSULE, 6-25 MG CAPSULE) SYMBYAX (6-50 MG CAPSULE, MG CAPSULE, MG CAPSULE) SYMPROIC (TABLET) SYNDROS (SOLUTION) 4 BOTTLES (120 ML) / 30 TACLONEX 0.005%-0.064% SUSPENS TACLONEX OINTMENT TAGRISSO (TABLET) TAMIFLU (45 MG CAPSULE, 75 MG CAPSULE) TAMIFLU 30 MG CAPSULE T 120 G / G / / / 365 TAMIFLU 6 MG/ML SUSPENSION 6 BOTTLES (360 ML) / 365 TANZEUM (PEN INJCTR) TARCEVA (100 MG TABLET, 150 MG TABLET) TARCEVA 25 MG TABLET TECFIDERA (DR 120 MG CAPSULE, DR 240 MG CAPSULE) 4 PENS / 28 TECFIDERA STARTER PACK 1 PACK (60 CAPSULES) / 365 TECHNIVIE (TABLET) temazepam (capsule) 168 / 84 terbinafine hcl (tablet) 84 DAY SUPPLY / 180 TOBI PODHALER (CAP W/DEV, CAPSULE) 1 KIT (224 CAPSULES) / 56

25 TRACLEER (62.5 MG TABLET, 125 MG TABLET) TRACLEER 32 MG TABLET FOR SUSP tramadol hcl er (er 100 mg capsule, er 200 mg capsule, er 300 mg capsule) tramadol hcl er (er 100 mg tablet, er 200 mg tablet, er 300 mg tablet) tramadol hcl er (er 100 mg tablet, er 200 mg tablet, er 300 mg tablet) tramadol hcl er 150 mg capsule TRANXENE T-TAB 3.75 MG TRANXENE T-TAB 7.5 MG TRAVATAN Z (DROPS) travoprost (drops) T 4 TABLETS / DAY ML / ML / 25 TRELEGY ELLIPTA (BLST W/DEV) 60 BLISTERS (1 PACK) / 30 TRELSTAR MG SYRINGE TRELSTAR MG VIAL TRELSTAR 22.5 MG SYRINGE TRELSTAR 22.5 MG VIAL TRELSTAR 3.75 MG SYRINGE TRELSTAR 3.75 MG VIAL TREXIMET (TABLET) triazolam mg tablet triazolam 0.25 mg tablet TRINTELLIX (TABLET) TRIPTODUR (VIAL) TRULANCE (TABLET) TRULICITY (PEN INJCTR) TUDORZA PRESSAIR (AER POW BA) TYSABRI (VIAL) TYVASO (AMPUL-NEB) TYVASO INSTITUTIONAL START KIT (AMPUL-NEB) TYVASO REFILL KIT (AMPUL-NEB) TYVASO STARTER KIT (AMPUL-NEB) ULTRAM ER (TAB ER 24H) U 1 SYRINGE / 84 1 VIAL / 84 1 SYRINGE / VIAL / SYRINGE / 28 1 VIAL / 28 9 / 30 1 KIT / PENS (2 ML) / 28 1 INHALER / 30 1 VIAL (15 ML) / 28 1 AMPULE / DAY 1 KIT / 28 1 KIT / 28 1 KIT / 28

26 UPTRAVI (200 MCG TABLET, 400 MCG TABLET, 600 MCG TABLET, 800 MCG TABLET, 1,000 MCG TABLET, 1,200 MCG TABLET, 1,400 MCG TABLET, 1,600 MCG TABLET) U UPTRAVI TITRATION PACK 2 PACKS (400 TABLETS) / 365 UTIBRON NEOHALER (CAP W/DEV) valacyclovir (tablet) VALTREX (TABLET) VANTAS (KIT) VARUBI 90 MG TABLET VENTAVIS (AMPUL-NEB) V 1 INHALER (60 CAPSULES) / 30 1 KIT / / 30 9 AMPULES / DAY VENTOLIN HFA (HFA AER AD) 6 INHALERS (48 G) / 30 VERAMYST (SPRAY SUSP) 1 BOTTLE (10 G) / 30 VERSACLOZ (ORAL SUSP) VERZENIO (TABLET) VIAGRA (TABLET) VIBERZI (TABLET) VICTOZA 2-PAK (PEN INJCTR) VICTOZA 3-PAK (PEN INJCTR) VIEKIRA PAK (TAB DS PK) VIEKIRA XR (TAB BP 24H) VIIBRYD (10 MG TABLET, 20 MG TABLET, 40 MG TABLET) 540 ML / 30 2 TABLETS / DAY 6 / 30 3 PENS (9 ML) / 30 3 PENS (9 ML) / 30 VIIBRYD (10-20 MG PACK, MG PK) 1 PACK (30 TABLETS) / 30 VIMOVO (TAB IR DR) VOLTAREN (GEL (GRAM)) VOSEVI (TABLET) VRAYLAR (1.5 MG CAPSULE, 1.5 MG-3 MG PACK, 3 MG CAPSULE, 4.5 MG CAPSULE, 6 MG CAPSULE) 10 / 30

27 VYVANSE (10 MG CHEWABLE TABLET, 10 MG CAPSULE, 20 MG CHEWABLE TABLET, 20 MG CAPSULE, 30 MG CHEWABLE TABLET, 30 MG CAPSULE, 40 MG CAPSULE, 40 MG CHEWABLE TABLET, 50 MG CAPSULE, 50 MG CHEWABLE TABLET, 60 MG CHEWABLE TABLET, 60 MG CAPSULE, 70 MG CAPSULE) V VYZULTA (DROPS) 1 BOTTLE (5ML) / 25 WELLBUTRIN SR (TAB ER 12H) WELLBUTRIN XL 150 MG TABLET WELLBUTRIN XL 300 MG TABLET W XADAGO (TABLET) XALATAN (DROPS) XANAX (0.25 MG TABLET, 0.5 MG TABLET, 1 MG TABLET) XANAX 2 MG TABLET XANAX XR (0.5 MG TABLET, 1 MG TABLET) XANAX XR 2 MG TABLET XANAX XR 3 MG TABLET XARELTO (10 MG TABLET, 20 MG TABLET) XARELTO 15 MG TABLET X 2.5 ML / 30 5 / DAY 5 / DAY XARELTO STARTER PACK 1 PACK (51 TABLETS) / 30 XERMELO (TABLET) XOPENEX (0.31 ML, 0.63 ML) 180 VIALS (540 ML) / 30 XOPENEX 1.25 MG/3 ML SOLUTION 90 VIALS (270 ML) / 30 XOPENEX CONCENTRATE (VIAL-NEB) 90 VIALS (45 ML) / 30 XOPENEX HFA (HFA AER AD) 2 INHALERS (30 G) / 30 XTAMPZA ER (CAP SPR 12) XULTOPHY (INSULN PEN) XURIDEN (GRAN PACK) 5 PENS (15 ML) / 30 XYREM (SOLUTION) 3 BOTTLES (540 ML) / 30

28 YOSPRALA (TAB IR DR) zaleplon 10 mg capsule zaleplon 5 mg capsule ZECUITY (PATCH IOPH) ZEGERID (20 MG CAPSULE, 20 MG PACKET, 40 MG CAPSULE, 40 MG PACKET) ZEJULA (CAPSULE) ZEMBRACE SYMTOUCH (PEN INJCTR) ZENZEDI (2.5 MG TABLET, 5 MG TABLET, 7.5 MG TABLET, 15 MG TABLET, 20 MG TABLET) zenzedi 10 mg tablet ZENZEDI 30 MG TABLET ZEPATIER (TABLET) Y Z 4 / PENS (8 ML) / 30 ZETONNA (HFA AER AD) 1 INHALER (6.1 G) / 30 ZIOPTAN (DROPERETTE) ziprasidone hcl (capsule) 30 / 30 ZOFRAN 2 MG/ML VIAL 6 VIALS (120 ML) / 30 ZOFRAN 4 MG/5 ML ORAL SOLN ZOFRAN ODT (TAB RAPDIS) ZOHYDRO ER (ER 10 MG CAPSULE, ER 15 MG CAPSULE, ER 20 MG CAPSULE, ER 30 MG CAPSULE, ER 40 MG CAPSULE) ZOHYDRO ER 50 MG CAPSULE ZOLADEX 10.8 MG IMPLANT SYRN ZOLADEX 3.6 MG IMPLANT SYRN zolmitriptan 2.5 mg odt zolmitriptan 2.5 mg tablet zolmitriptan 5 mg odt zolmitriptan 5 mg tablet zolpidem tartrate (1.75 mg tab, 3.5 mg tablet) zolpidem tartrate (5 mg tablet, 10 mg tablet) zolpidem tartrate er (tab mphase) 120 ML / / 30 1 IMPLANT / 84 1 IMPLANT / / / 30 9 / 30 9 / 30

29 ZOLPIMIST (SPRAY/PUMP) 1 BOTTLE (7.7 ML) / 30 ZOMIG (2.5 MG, 5 MG) 2 BOXES (12 UNITS) / 30 ZOMIG 2.5 MG TABLET ZOMIG 5 MG TABLET ZOMIG ZMT 2.5 MG TABLET ZOMIG ZMT 5 MG TABLET ZUBSOLV ( MG TABLET, MG TABLET) ZUBSOLV MG TABLET SL ZUBSOLV MG TABLET SL ZUBSOLV MG TABLET SL ZUBSOLV MG TABLET SL ZUPLENZ (FILM) ZYBAN (TAB ER 12H) ZYKADIA (CAPSULE) ZYPREXA (2.5 MG TABLET, 5 MG TABLET, 7.5 MG TABLET, 10 MG TABLET, 15 MG TABLET, 20 MG TABLET) ZYPREXA ZYDIS (TAB RAPDIS) Z 12 / 30 9 / / 30 9 / / 30 5 / DAY ZYVOX 100 MG/5 ML SUSPENSION 6 BOTTLES (900 ML) / 28 ZYVOX 600 MG TABLET 28 / 30