Drugs That Have Quantitiy Limits (QL)
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- Shona May
- 5 years ago
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1 Drugs That Have Quantitiy Limits (QL) There are Quantity Limits set by your UA Medicare Group Part D Prescription Drug Plan for the drugs listed below. The UA Medicare Group Part D Prescription Drug Plan will only provide coverage up to the limits specified in the chart below. If you require a quantity more than what is specified, then you, your appointed representative, or your prescriber can request review by calling Customer Service toll-free at , 8:00 a.m. to 8:00 p.m., in your local time zone, Monday through Friday. Customer Service is available in English and other languages. TTY/TDD users should call Drug Name Dosage Form Strength Tier Level Value Quantity Limit Amount Quantity Limit Days ABILIFY TABS 10MG ABILIFY TABS 15MG ABILIFY TABS 20MG ABILIFY TABS 2MG ABILIFY TABS 30MG ABILIFY TABS 5MG ABILIFY DISCMELT TBDP 10MG ABILIFY DISCMELT TBDP 15MG ACARBOSE TABS 100MG ACARBOSE TABS 25MG ACARBOSE TABS 50MG ACCOLATE TABS 10MG ACCOLATE TABS 20MG ACEON TABS 2MG ACEON TABS 4MG ACEON TABS 8MG ACTOPLUS MET TABS 500MG; 15MG ACTOPLUS MET TABS 850MG; 15MG ACTOS TABS 15MG ACTOS TABS 30MG ACTOS TABS 45MG ADVAIR DISKUS MISC 100MCG/DOSE; MCG/DOSE ADVAIR DISKUS MISC 250MCG/DOSE; ADVAIR DISKUS MISC 500MCG/DOSE; 50MCG/DOSE ADVAIR HFA AERO 115MCG/ACT; 21MCG/ACT Date of Last Update: 9/1/09
2 ADVAIR HFA AERO 230MCG/ACT; 21MCG/ACT ADVAIR HFA AERO 45MCG/ACT; 21MCG/ACT AFINITOR TABS 10MG AFINITOR TABS 5MG AGGRENOX CP12 25MG; 200MG ALLEGRA-D 12 HOUR TB12 60MG; 120MG ALLEGRA-D 24 HOUR TB24 180MG; 240MG AMERGE TABS 1MG AMERGE TABS 2.5MG AMLODIPINE BESYLATE/BENAZEPRIL CAPS 10MG; 20MG HYDROCHLORIDE AMLODIPINE BESYLATE/BENAZEPRIL CAPS 2.5MG; 10MG HYDROCHLORIDE AMLODIPINE BESYLATE/BENAZEPRIL CAPS 5MG; 10MG HYDROCHLORIDE AMLODIPINE BESYLATE/BENAZEPRIL CAPS 5MG; 20MG HYDROCHLORIDE ANDRODERM PT24 2.5MG/24HR ANDRODERM PT24 5MG/24HR ARANESP ALBUMIN FREE SOLN 100MCG/ML ARANESP ALBUMIN FREE SOLN 100MCG/0.5ML ARANESP ALBUMIN FREE SOLN 150MCG/0.3ML ARANESP ALBUMIN FREE SOLN 200MCG/0.4ML ARANESP ALBUMIN FREE SOLN 200MCG/ML ARANESP ALBUMIN FREE SOLN 25MCG/ML ARANESP ALBUMIN FREE SOLN 25MCG/0.42ML ARANESP ALBUMIN FREE SOLN 300MCG/ML ARANESP ALBUMIN FREE SOLN 300MCG/0.6ML ARANESP ALBUMIN FREE SOLN 40MCG/ML ARANESP ALBUMIN FREE SOLN 40MCG/0.4ML ARANESP ALBUMIN FREE SOLN 500MCG/ML ARANESP ALBUMIN FREE SOLN 60MCG/ML ARANESP ALBUMIN FREE SOLN 60MCG/0.3ML ARICEPT TABS 10MG ARICEPT TABS 5MG ARICEPT ODT TBDP 10MG ARICEPT ODT TBDP 5MG ASMANEX 120 METERED DOSES AEPB 220MCG/INH Date of Last Update: 9/1/09
3 ASMANEX 14 METERED DOSES AEPB 220MCG/INH ASMANEX 30 METERED DOSES AEPB 220MCG/INH ASMANEX 60 METERED DOSES AEPB 220MCG/INH ATACAND TABS 16MG ATACAND TABS 32MG ATACAND TABS 4MG ATACAND TABS 8MG ATACAND HCT TABS 16MG; 12.5MG ATACAND HCT TABS 32MG; 12.5MG ATACAND HCT TABS 32MG; 25MG ATROVENT HFA AERS 17MCG/ACT AVALIDE TABS 12.5MG; 150MG AVALIDE TABS 12.5MG; 300MG AVALIDE TABS 25MG; 300MG AVANDAMET TABS 1000MG; 2MG AVANDAMET TABS 500MG; 2MG AVANDAMET TABS 1000MG; 4MG AVANDAMET TABS 500MG; 4MG AVANDARYL TABS 1MG; 4MG AVANDARYL TABS 2MG; 4MG AVANDARYL TABS 4MG; 4MG AVANDARYL TABS 2MG; 8MG AVANDARYL TABS 4MG; 8MG AVANDIA TABS 2MG AVANDIA TABS 4MG AVANDIA TABS 8MG AVAPRO TABS 150MG AVAPRO TABS 300MG AVAPRO TABS 75MG AVODART CAPS 0.5MG AVONEX KIT 30MCG/VIAL AVONEX KIT 30MCG/0.5ML AZMACORT AERS 75MCG/ACT BARACLUDE SOLN 0.05MG/ML BARACLUDE TABS 0.5MG BARACLUDE TABS 1MG BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE TABS 10MG; 12.5MG BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE TABS 20MG; 12.5MG Date of Last Update: 9/1/09
4 BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE TABS 20MG; 25MG BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE TABS 5MG; 6.25MG BETASERON SOLR 0.3MG BIDIL TABS 37.5MG; 20MG BROVANA NEBU 15MCG/2ML BUDEPRION SR TB12 100MG BUDEPRION SR TB12 150MG BUDEPRION XL TB24 150MG BUDEPRION XL TB24 300MG BUPROBAN TB12 150MG BUPROPION HCL SR TB12 100MG BUPROPION HCL SR TB12 200MG BUPROPION HCL SR TB12 150MG BUTORPHANOL TARTRATE SOLN 10MG/ML BYETTA SOLN 10MCG/0.04ML CABERGOLINE TABS 0.5MG CADUET TABS 10MG; 10MG CADUET TABS 10MG; 20MG CADUET TABS 10MG; 40MG CADUET TABS 10MG; 80MG CADUET TABS 2.5MG; 10MG CADUET TABS 2.5MG; 20MG CADUET TABS 2.5MG; 40MG CADUET TABS 5MG; 10MG CADUET TABS 5MG; 20MG CADUET TABS 5MG; 40MG CADUET TABS 5MG; 80MG CALCITONIN-SALMON SOLN 200UNIT/ACT CAMPRAL TBEC 333MG CAPTOPRIL /HYDROCHLOROTHIAZIDE TABS 25MG; 15MG CAPTOPRIL /HYDROCHLOROTHIAZIDE TABS 25MG; 25MG CAPTOPRIL /HYDROCHLOROTHIAZIDE TABS 50MG; 15MG CAPTOPRIL /HYDROCHLOROTHIAZIDE TABS 50MG; 25MG CELEBREX CAPS 100MG CELEBREX CAPS 200MG CELEBREX CAPS 400MG CELEBREX CAPS 50MG CENESTIN TABS 0.3MG Date of Last Update: 9/1/09
5 CENESTIN TABS 0.45MG CENESTIN TABS 0.625MG CENESTIN TABS 0.9MG CENESTIN TABS 1.25MG CILOSTAZOL TABS 100MG CILOSTAZOL TABS 50MG CITALOPRAM HYDROBROMIDE TABS 10MG CITALOPRAM HYDROBROMIDE TABS 20MG CITALOPRAM HYDROBROMIDE TABS 40MG CLARINEX TABS 5MG CLARINEX REDITABS TBDP 2.5MG CLARINEX REDITABS TBDP 5MG CLARINEX-D 12 HOUR TB12 2.5MG; 120MG CLARINEX-D 24 HOUR TB24 5MG; 240MG COMBIVENT AERO 103MCG/ACT; 18MCG/ACT COPAXONE KIT 20MG/ML COZAAR TABS 100MG COZAAR TABS 25MG COZAAR TABS 50MG CRESTOR TABS 10MG CRESTOR TABS 20MG CRESTOR TABS 40MG CRESTOR TABS 5MG CYMBALTA CPEP 20MG CYMBALTA CPEP 30MG CYMBALTA CPEP 60MG DETROL TABS 1MG DETROL TABS 2MG DETROL LA CP24 2MG DETROL LA CP24 4MG DIOVAN TABS 160MG DIOVAN TABS 320MG DIOVAN TABS 40MG DIOVAN TABS 80MG DIOVAN HCT TABS 12.5MG; 160MG DIOVAN HCT TABS 25MG; 160MG Date of Last Update: 9/1/09
6 DIOVAN HCT TABS 12.5MG; 320MG DIOVAN HCT TABS 25MG; 320MG DIOVAN HCT TABS 12.5MG; 80MG DOXAZOSIN MESYLATE TABS 1MG DOXAZOSIN MESYLATE TABS 2MG DOXAZOSIN MESYLATE TABS 4MG DOXAZOSIN MESYLATE TABS 8MG DUETACT TABS 2MG; 30MG DUETACT TABS 4MG; 30MG EFFEXOR XR CP24 150MG EFFEXOR XR CP MG EFFEXOR XR CP24 75MG EMEND CAPS 125MG EMEND CAPS 40MG EMEND MISC EMEND CAPS 80MG EMSAM PT24 6MG/24HR EMSAM PT24 9MG/24HR EMSAM PT24 12MG/24HR ENABLEX TB24 15MG ENABLEX TB24 7.5MG ENALAPRIL TABS 10MG; 25MG MALEATE/HYDROCHLOROTHIAZIDE ENALAPRIL TABS 5MG; 12.5MG MALEATE/HYDROCHLOROTHIAZIDE ENBREL KIT 25MG ENBREL SOLN 50MG/ML ENBREL SURECLICK SOLN 50MG/ML ENJUVIA TABS 0.3MG ENJUVIA TABS 0.45MG ENJUVIA TABS 0.625MG ENJUVIA TABS 0.9MG ENJUVIA TABS 1.25MG Date of Last Update: 9/1/09
7 EPOGEN SOLN 10000UNIT/ML EPOGEN SOLN 2000UNIT/ML EPOGEN SOLN 20000UNIT/ML EPOGEN SOLN 3000UNIT/ML EPOGEN SOLN 4000UNIT/ML EPOGEN SOLN 40000UNIT/ML EVISTA TABS 60MG EXELON CAPS 1.5MG EXELON CAPS 3MG EXELON CAPS 4.5MG EXELON CAPS 6MG EXELON PT24 4.6MG/24HR EXELON PT24 9.5MG/24HR EXFORGE TABS 10MG; 160MG EXFORGE TABS 10MG; 320MG EXFORGE TABS 5MG; 160MG EXFORGE TABS 5MG; 320MG EXFORGE HCT TABS 5MG; 12.5MG; 160MG EXFORGE HCT TABS 5MG; 25MG; 160MG EXFORGE HCT TABS 10MG; 12.5MG; 160MG EXFORGE HCT TABS 10MG; 25MG; 160MG EXFORGE HCT TABS 10MG; 25MG; 320MG FENTANYL CITRATE ORAL TRANSMUCOSAL LPOP 1200MCG FENTANYL CITRATE ORAL TRANSMUCOSAL LPOP 1600MCG FENTANYL CITRATE ORAL TRANSMUCOSAL LPOP 200MCG FENTANYL CITRATE ORAL TRANSMUCOSAL LPOP 400MCG FENTANYL CITRATE ORAL TRANSMUCOSAL LPOP 600MCG Date of Last Update: 9/1/09
8 FENTANYL CITRATE ORAL TRANSMUCOSAL LPOP 800MCG FEXOFENADINE HCL TABS 180MG FEXOFENADINE HCL TABS 30MG FEXOFENADINE HCL TABS 60MG FINASTERIDE TABS 5MG FLOMAX CP24 0.4MG FLOVENT DISKUS AEPB 100MCG/BLIST FLOVENT DISKUS AEPB 250MCG/BLIST FLOVENT DISKUS AEPB 50MCG/BLIST FLOVENT HFA AERO 110MCG/ACT FLOVENT HFA AERO 220MCG/ACT FLOVENT HFA AERO 44MCG/ACT FLUOXETINE HCL CAPS 10MG FLUOXETINE HCL CAPS 20MG FLUOXETINE HCL CAPS 40MG FLUOXETINE HCL TABS 10MG FLUOXETINE HCL TABS 20MG FLUVOXAMINE MALEATE TABS 100MG FLUVOXAMINE MALEATE TABS 25MG FLUVOXAMINE MALEATE TABS 50MG FORADIL AEROLIZER CAPS 12MCG FORTAMET TB MG FORTAMET TB24 500MG FORTEO SOLN 600MCG/2.4ML FORTICAL SOLN 200UNIT/ACT FOSINOPRIL TABS 10MG; 12.5MG SODIUM/HYDROCHLOROTHIAZIDE FOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDE TABS 20MG; 12.5MG Date of Last Update: 9/1/09
9 GALANTAMINE HYDROBROMIDE CP24 16MG GALANTAMINE HYDROBROMIDE CP24 24MG GALANTAMINE HYDROBROMIDE CP24 8MG GALANTAMINE HYDROBROMIDE TABS 12MG GALANTAMINE HYDROBROMIDE TABS 4MG GALANTAMINE HYDROBROMIDE TABS 8MG GEODON CAPS 20MG GEODON CAPS 40MG GEODON CAPS 60MG GEODON CAPS 80MG GLIMEPIRIDE TABS 1MG GLIMEPIRIDE TABS 2MG GLIMEPIRIDE TABS 4MG GLIPIZIDE TABS 10MG GLIPIZIDE TABS 5MG GLIPIZIDE ER TB24 2.5MG GLIPIZIDE XL TB24 10MG GLIPIZIDE XL TB24 5MG GLIPIZIDE/METFORMIN HCL TABS 2.5MG; 250MG GLIPIZIDE/METFORMIN HCL TABS 2.5MG; 500MG GLIPIZIDE/METFORMIN HCL TABS 5MG; 500MG GLYBURIDE MICRONIZED TABS 1.5MG GLYBURIDE MICRONIZED TABS 3MG GLYBURIDE MICRONIZED TABS 6MG GLYBURIDE/METFORMIN HCL TABS 1.25MG; 250MG GLYBURIDE/METFORMIN HCL TABS 2.5MG; 500MG GLYBURIDE/METFORMIN HCL TABS 5MG; 500MG GRANISETRON HCL SOLN 0.1MG/ML GRANISETRON HCL SOLN 1MG/ML GRANISETRON HCL TABS 1MG HEPSERA TABS 10MG Date of Last Update: 9/1/09
10 HUMIRA KIT 40MG/0.8ML HYZAAR TABS 12.5MG; 100MG HYZAAR TABS 25MG; 100MG HYZAAR TABS 12.5MG; 50MG IMITREX SOLN 6MG/0.5ML INTAL INHALER AERS 800MCG/ACT ITRACONAZOLE CAPS 100MG JANUMET TABS 1000MG; 50MG JANUMET TABS 500MG; 50MG JANUVIA TABS 100MG JANUVIA TABS 25MG JANUVIA TABS 50MG KAPIDEX CPDR 30MG KAPIDEX CPDR 60MG KETEK TABS 300MG KETEK TABS 400MG LEFLUNOMIDE TABS 10MG LEFLUNOMIDE TABS 20MG LEXAPRO TABS 10MG LEXAPRO TABS 20MG LEXAPRO TABS 5MG LIPITOR TABS 10MG LIPITOR TABS 20MG LIPITOR TABS 40MG LIPITOR TABS 80MG LISINOPRIL /HYDROCHLOROTHIAZIDE TABS 12.5MG; 10MG LISINOPRIL /HYDROCHLOROTHIAZIDE TABS 12.5MG; 20MG LISINOPRIL /HYDROCHLOROTHIAZIDE TABS 25MG; 20MG LOTREL CAPS 10MG; 40MG LOTREL CAPS 5MG; 40MG LOTRONEX TABS 0.5MG LOTRONEX TABS 1MG LOVASTATIN TABS 10MG LOVASTATIN TABS 20MG LOVASTATIN TABS 40MG LYRICA CAPS 100MG LYRICA CAPS 150MG LYRICA CAPS 200MG Date of Last Update: 9/1/09
11 LYRICA CAPS 225MG LYRICA CAPS 25MG LYRICA CAPS 300MG LYRICA CAPS 50MG LYRICA CAPS 75MG MAXALT TABS 10MG MAXALT TABS 5MG MAXALT-MLT TBDP 10MG MAXALT-MLT TBDP 5MG METFORMIN HCL TABS 1000MG METFORMIN HCL TABS 500MG METFORMIN HCL TABS 850MG METFORMIN HCL ER TB24 500MG METFORMIN HCL ER TB24 750MG MICARDIS TABS 20MG MICARDIS TABS 40MG MICARDIS TABS 80MG MICARDIS HCT TABS 12.5MG; 40MG MICARDIS HCT TABS 12.5MG; 80MG MICARDIS HCT TABS 25MG; 80MG MIGRANAL SOLN 4MG/ML MIRTAZAPINE TABS 15MG MIRTAZAPINE TBDP 15MG MIRTAZAPINE TABS 30MG MIRTAZAPINE TABS 45MG MIRTAZAPINE TABS 7.5MG MIRTAZAPINE ODT TBDP 30MG MIRTAZAPINE ODT TBDP 45MG MOEXIPRIL /HYDROCHLOROTHIAZIDE TABS 12.5MG; 15MG MOEXIPRIL /HYDROCHLOROTHIAZIDE TABS 25MG; 15MG MOEXIPRIL /HYDROCHLOROTHIAZIDE TABS 12.5MG; 7.5MG NAMENDA TABS 10MG NAMENDA TABS 5MG NEFAZODONE HCL TABS 100MG NEFAZODONE HCL TABS 150MG NEFAZODONE HCL TABS 200MG NEFAZODONE HCL TABS 250MG NEFAZODONE HCL TABS 50MG Date of Last Update: 9/1/09
12 NEULASTA SOLN 6MG/0.6ML NEUMEGA SOLR 5MG NEUPOGEN SOLN 300MCG/0.5ML NEUPOGEN SOLN 480MCG/0.8ML NEUPOGEN SOLN 480MCG/1.6ML NEXAVAR TABS 200MG NEXIUM CPDR 20MG NEXIUM CPDR 40MG NEXIUM PACK 10MG NEXIUM PACK 20MG NEXIUM PACK 40MG NICOTROL INHALER INHA 10MG OMEPRAZOLE CPDR 10MG OMEPRAZOLE CPDR 20MG OMEPRAZOLE CPDR 40MG ONDANSETRON HCL TABS 24MG ONDANSETRON HCL TABS 4MG ONDANSETRON HCL TABS 8MG ONDANSETRON ODT TBDP 4MG ONDANSETRON ODT TBDP 8MG OXYBUTYNIN CHLORIDE ER TB24 10MG OXYBUTYNIN CHLORIDE ER TB24 15MG OXYBUTYNIN CHLORIDE ER TB24 5MG OXYTROL PTTW 3.9MG/24HR PANTOPRAZOLE SODIUM TBEC 20MG PANTOPRAZOLE SODIUM TBEC 40MG PAROXETINE HCL TABS 10MG PAROXETINE HCL TABS 20MG PAROXETINE HCL TABS 30MG PAROXETINE HCL TABS 40MG PAROXETINE HCL ER TB MG PAROXETINE HCL ER TB24 25MG PEGASYS KIT 180MCG/0.5ML PEG-INTRON KIT 50MCG/0.5ML PEG-INTRON REDIPEN KIT 120MCG/0.5ML PEG-INTRON REDIPEN KIT 150MCG/0.5ML PEG-INTRON REDIPEN KIT 50MCG/0.5ML PEG-INTRON REDIPEN KIT 80MCG/0.5ML Date of Last Update: 9/1/09
13 PEG-INTRON REDIPEN PAK 4 KIT 120MCG/0.5ML PEG-INTRON REDIPEN PAK 4 KIT 150MCG/0.5ML PEG-INTRON REDIPEN PAK 4 KIT 80MCG/0.5ML PRANDIN TABS 0.5MG PRANDIN TABS 1MG PRANDIN TABS 2MG PRAVASTATIN SODIUM TABS 10MG PRAVASTATIN SODIUM TABS 20MG PRAVASTATIN SODIUM TABS 40MG PRAVASTATIN SODIUM TABS 80MG PRAZOSIN HCL CAPS 1MG PRAZOSIN HCL CAPS 2MG PRAZOSIN HCL CAPS 5MG PREVACID CPDR 15MG PREVACID CPDR 30MG PREVACID SOLUTAB TBDP 15MG PREVACID SOLUTAB TBDP 30MG PRISTIQ TB24 100MG PRISTIQ TB24 50MG PROAIR HFA AERS 108MCG/ACT PROCRIT SOLN 10000UNIT/ML PROCRIT SOLN 2000UNIT/ML PROCRIT SOLN 20000UNIT/ML PROCRIT SOLN 3000UNIT/ML PROCRIT SOLN 4000UNIT/ML PROCRIT SOLN 40000UNIT/ML PROMACTA TABS 25MG PROMACTA TABS 50MG PROVENTIL HFA AERS 108MCG/ACT PROVIGIL TABS 100MG PROVIGIL TABS 200MG PULMICORT FLEXHALER AEPB 180MCG/ACT PULMICORT FLEXHALER AEPB 90MCG/ACT QUINAPRIL /HYDROCHLOROTHIAZIDE TABS 12.5MG; 10MG QUINAPRIL /HYDROCHLOROTHIAZIDE TABS 12.5MG; 20MG QUINAPRIL /HYDROCHLOROTHIAZIDE TABS 25MG; 20MG QUINARETIC TABS 12.5MG; 10MG QUINARETIC TABS 12.5MG; 20MG Date of Last Update: 9/1/09
14 QUINARETIC TABS 25MG; 20MG QVAR AERS 40MCG/ACT QVAR AERS 80MCG/ACT REBIF SOLN 22MCG/0.5ML REBIF SOLN 44MCG/0.5ML RELENZA DISKHALER AEPB 5MG/BLISTER RELPAX TABS 20MG RELPAX TABS 40MG REVATIO TABS 20MG RISPERDAL M-TAB TBDP 1MG RISPERIDONE TABS 0.25MG RISPERIDONE TABS 0.5MG RISPERIDONE TABS 1MG RISPERIDONE TABS 2MG RISPERIDONE TABS 3MG RISPERIDONE TABS 4MG RISPERIDONE ODT TBDP 0.25MG RISPERIDONE ODT TBDP 0.5MG RISPERIDONE ODT TBDP 2MG RISPERIDONE ODT TBDP 3MG RISPERIDONE ODT TBDP 4MG SANCTURA TABS 20MG SANCTURA XR CP24 60MG SELFEMRA CAPS 10MG SELFEMRA CAPS 20MG SEREVENT DISKUS AEPB 50MCG/DOSE SEROQUEL TABS 100MG SEROQUEL TABS 200MG SEROQUEL TABS 25MG SEROQUEL TABS 300MG SEROQUEL TABS 400MG SEROQUEL TABS 50MG SEROQUEL XR TB24 150MG SEROQUEL XR TB24 200MG SEROQUEL XR TB24 300MG Date of Last Update: 9/1/09
15 SEROQUEL XR TB24 400MG SEROQUEL XR TB24 50MG SERTRALINE HCL TABS 100MG SERTRALINE HCL TABS 25MG SERTRALINE HCL TABS 50MG SIMVASTATIN TABS 10MG SIMVASTATIN TABS 20MG SIMVASTATIN TABS 40MG SIMVASTATIN TABS 5MG SIMVASTATIN TABS 80MG SINGULAIR CHEW 4MG SINGULAIR CHEW 5MG SINGULAIR PACK 4MG SINGULAIR TABS 10MG SKELID TABS 240MG SOMAVERT SOLR 10MG SOMAVERT SOLR 15MG SOMAVERT SOLR 20MG SPIRIVA HANDIHALER CAPS 18MCG SPRYCEL TABS 100MG SPRYCEL TABS 20MG SPRYCEL TABS 50MG SPRYCEL TABS 70MG STARLIX TABS 120MG STARLIX TABS 60MG SUMATRIPTAN SUCCINATE SOLN 6MG/0.5ML SUMATRIPTAN SUCCINATE TABS 25MG SUMATRIPTAN SUCCINATE TABS 50MG SUMATRIPTAN SUCCINATE TABS 100MG SUTENT CAPS 12.5MG SUTENT CAPS 25MG SUTENT CAPS 50MG SYMBICORT AERO 160MCG/ACT; 4.5MCG/ACT SYMBICORT AERO 80MCG/ACT; 4.5MCG/ACT SYMBYAX CAPS 25MG; 12MG SYMBYAX CAPS 50MG; 12MG Date of Last Update: 9/1/09
16 SYMBYAX CAPS 25MG; 3MG SYMBYAX CAPS 25MG; 6MG SYMBYAX CAPS 50MG; 6MG SYMLIN SOLN 600MCG/ML SYMLINPEN 60 SOLN 1000MCG/ML TAMIFLU CAPS 30MG TAMIFLU CAPS 45MG TAMIFLU CAPS 75MG TARCEVA TABS 100MG TARCEVA TABS 150MG TARCEVA TABS 25MG TEKTURNA TABS 150MG TEKTURNA TABS 300MG TEKTURNA HCT TABS 150MG; 12.5MG TEKTURNA HCT TABS 150MG; 25MG TEKTURNA HCT TABS 300MG; 12.5MG TEKTURNA HCT TABS 300MG; 25MG TERAZOSIN HCL CAPS 10MG TERAZOSIN HCL CAPS 1MG TERAZOSIN HCL CAPS 2MG TERAZOSIN HCL CAPS 5MG TERBINAFINE HCL TABS 250MG TICLOPIDINE HCL TABS 250MG TYKERB TABS 250MG TYZEKA TABS 600MG UROXATRAL TB24 10MG VALTREX TABS 1GM VALTREX TABS 500MG VENLAFAXINE HCL TABS 100MG VENLAFAXINE HCL TABS 25MG VENLAFAXINE HCL TABS 37.5MG VENLAFAXINE HCL TABS 50MG VENLAFAXINE HCL TABS 75MG VENTOLIN HFA AERS 108MCG/ACT VESICARE TABS 10MG VESICARE TABS 5MG VFEND SUSR 40MG/ML VFEND TABS 200MG Date of Last Update: 9/1/09
17 VFEND TABS 50MG VIDAZA SUSR 100MG VYTORIN TABS 10MG; 10MG VYTORIN TABS 10MG; 20MG VYTORIN TABS 10MG; 40MG VYTORIN TABS 10MG; 80MG XIFAXAN TABS 200MG ZETIA TABS 10MG ZOMIG SOLN 5MG ZOMIG TABS 2.5MG ZOMIG TABS 5MG ZOMIG ZMT TBDP 2.5MG ZOMIG ZMT TBDP 5MG ZYFLO CR TB12 600MG ZYPREXA TABS 10MG ZYPREXA TABS 15MG ZYPREXA TABS 2.5MG ZYPREXA TABS 20MG ZYPREXA TABS 5MG ZYPREXA TABS 7.5MG ZYPREXA ZYDIS TBDP 10MG ZYPREXA ZYDIS TBDP 15MG ZYPREXA ZYDIS TBDP 20MG ZYPREXA ZYDIS TBDP 5MG ZYVOX SUSR 100MG/5ML ZYVOX TABS 600MG Date of Last Update: 9/1/09
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Medication and Dose 10/04/ /05/2016 Total % Change Since 10/2012 ABILIFY 10 MG TABLET $18.76 $ %
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Abilify Abilify Discmelt Abilify oral solution Aciphex Actiq Page 1 of 9 750 ml 120 units Actonel 5 mg, 30 mg Actonel 35 mg 4 tabs Actonel 75 mg 2 tabs Actonel 150 mg 1 tab Actonel with Calcium Adcirca
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1 of 5 ALLERGY / ASTHMA THERAPIES ANTIHISTAMINES, MINIMALLY SEDATING cetirizine fexofenadine loratadine ANTIHISTAMINE/DECONGESTANT COMBINATIONS cetirizine/pseudoephedrine fexofenadine/pseudoephedrine loratadine/pseudoephedrine
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Allergy Chlorpheniramine Tablet* Diphenhydramine Tablet* Diphenhydramine Liquid* Loratadine Tablet* Cetirizine Tablet* Loratadine 10mg ODT* Less than $10 Loratadine Liquid* $10-$15 Cetirizine liquid 1mg/mL*
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Abstral (fentanyl) sl tab all strength Acetaminophen Actonel Actonel 35mg Adderall XR 5mg, 10mg, 15mg Advair Diskus Advair HFA Aero Chambers and Spacers Aerobid Aerobid M Albuterol HFA 90mcg Akynzeo Aldara
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PDF created with pdffactory trial version
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Antiviral Acyclovir 400mg Zovirax Asthma Advair Diskus Diskus 250/50 Fluticasone/Salmeterol Asthma Albuterol Sulfate 2.5 mg/3 ml Proventil Arthritis and Pain Allendronate Sodium 70 mg Fosamax Arthritis
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Amitriptyline Hydrochloride Heart Health & BP Amlodipine Besylate 5mg Norvasc Antibiotics Amoxicillin 500 mg Amoxil
School Corp Formulary Antiviral Acyclovir 400mg Zovirax Asthma Advair Diskus Diskus 250/50 Fluticasone/Salmeterol Asthma Albuterol Sulfate 2.5 mg/3 ml Proventil Arthritis and Pain Allendronate Sodium 70
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