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DRUG NAME PA_REQUIRED STEP_THERAPY
1 ML SYRINGE MIS 22X1-1/2 N N
1.5 ML SYRNG MIS 22X1-1/2 N N
10-12ML SYRINGE/LUER LOCKTIP N N
10-12ML SYRINGE/LUER SLIPTIP N N
10ML CONTROL SYRINGE LUER-LOK TIP N N
10ML LL SYRN MIS 20GX1.5" N N
10ML LL SYRN MIS 21GX1.5" N N
10ML SYRINGE ECCENTRIC TIP N N
10ML SYRINGE LUER-LOK TIP N N
10ML SYRINGE MIS 18GX1" N N
10ML SYRINGE MIS 18GX1.5" N N
10ML SYRINGE MIS 22GX1.5" N N
10ML SYRINGE MIS 25GX1" N N
10ML SYRINGE MIS 25GX1.5" N N
10ML SYRINGE MIS 27GX1.5" N N
10ML SYRINGE MIS CANNULA N N
12 HOUR ALLERGY-D N N
12 HOUR DECONGESTANT N N
12 HOUR DECONGESTANT NASAL SPRAY N N
12 HOUR NASAL DECONGESTANT N N
12 HOUR NASAL RELIEF SPRAY N N
12 HOUR NASAL SPRAY N N
12ML LL SYRN MIS 20GX1" N N
12ML LL SYRN MIS 22GX1" N N
12ML SYRINGE MIS 18GX1" N N
12ML SYRINGE MIS 20GX1.5" N N
12ML SYRINGE MIS 21GX1" N N
12ML SYRINGE MIS 21GX1.5" N N
12ML SYRINGE MIS 22GX1.5" N N
12ML SYRINGE/20G X 1-1/2"/LUER LOCK TIP N N
140ML SYRING MIS LUER-LOC N N
1ML SYRINGE MIS 23GX1" N N
1ML SYRINGE MIS 25GX1" N N
1ML SYRINGE MIS 25GX1.5" N N
1ML SYRINGE MIS 25GX5/8" N N
1ML SYRINGE MIS 26GX3/8" N N
1ML SYRINGE MIS 30G N N
1ML TB SYRINGE/25G X 5/8"/LUER SLIP TIP N N
1ML TB SYRINGE/26G X 3/8"/LUER SLIP TIP N N
1ML TB SYRINGE/27G X 1/2"/LUER SLIP TIP N N
1ML TB SYRNG MIS 25GX5/8" N N
1ML TB SYRNG MIS 26GX3/8" N N
1ML TB SYRNG MIS 26GX5/8" N N
1ML TB SYRNG MIS 27GX1/2" N N
1ML TB SYRNG MIS 27GX5/8" N N
1ML TB SYRNG MIS 28GX1/2" N N
1ML TB SYRNG MIS LUER SLP N N
1ML TB SYRNG MIS REG LUER N N
DRUG NAME PA_REQUIRED STEP_THERAPY
1ML VANISHPOINT TUBERCULIN SYRINGE 25GX5/8" N N
1ML VANISHPOINT TUBERCULIN SYRINGE 27GX1/2" N N
1ST TIER UNIFINE PENTIPS /MINI/31GX5MM N N
1ST TIER UNIFINE PENTIPS 29GX12MM N N
1ST TIER UNIFINE PENTIPS 31GX6MM N N
1ST TIER UNIFINE PENTIPS 31GX8MM N N
1ST TIER UNIFINE PENTIPS 32GX4MM N N
1ST TIER UNIFINE PENTIPS 32GX6MM N N
1ST TIER UNIFINE PENTIPS 33GX4MM N N
1ST TIER UNIFINE PENTIPS PLUS 31GX8MM N N
1ST TIER UNIFINE PENTIPS PLUS 32GX4MM N N
1ST TIER UNIFINE PENTIPS PLUS 33GX4MM N N
1ST TIER UNIFINE PENTIPS PLUS/MINI/31GX5MM N N
1ST TIER UNIFINE PENTIPS PLUS/ORIGINAL/29GX12MM N N
1ST TIER UNIFINE PENTIPS PLUS/ULTRA SHORT/31GX6MM N N
1ST TIER UNILET COMFORTOUCH LANCETS 28G N N
1ST TIER UNILET COMFORTOUCH LANCETS 30G N N
20-25ML SYRINGE/LUER SLIPTIP/ECCENTRIC TIP N N
20-25ML SYRN MIS LUER LCK N N
2-3ML SYRINGE/LUER SLIP TIP N N
24 Hour Nasal Allergy 55 mcg spray aerosol N N 24HR ALLERGY RELIEF (^) N N 3 DAY VAGINAL (^) N N 3 DAY VAGINL CRE 2% (^) N N 30-35ML SYRINGE/CATHETER TIP (^) N N 30-35ML SYRINGE/LUER LOCKTIP N N 30-35ML SYRINGE/LUER SLIPTIP/ECCENTRIC TIP N N 30ML SYRINGES LUER LOCK N N 3ML LL SYRNG MIS 18GX1.5" N N 3ML LL SYRNG MIS 20GX3/4" (^) N N 3ML LL SYRNG MIS 21GX1.25 (^) N N 3ML LL SYRNG MIS 22GX1.25 (^) N N 3ML LL SYRNG MIS 22GX3/4" (^) N N 3ML LL SYRNG MIS 25GX1.5" (^) N N 3ML LUER LOCK SAFETY SYRINGES (^) N N 3ML LUER LOCK SAFETY SYRINGES 3ML/22G X 1 1/2" (^) N N 3ML LUER LOCK SAFETY SYRINGES/3ML/21G X 1 1/2" (^) N N 3ML LUER LOCK SAFETY SYRINGES/3ML/22G X 1" (^) N N 3ML LUER LOCK SAFETY SYRINGES/3ML/23G X 1" N N 3ML LUER LOCK SAFETY SYRINGES/3ML/25G X 1" N N 3ML LUER LOCK SAFETY SYRINGES/3ML/25G X 5/8" N N 3ML LUER-LOK SYRINGE 25G X 5/8" (^) N N 3ML SYRINGE MIS 18GX1" (^) N N 3ML SYRINGE MIS 19GX1" (^) N N 3ML SYRINGE MIS 19GX1.5" (^) N N 3ML SYRINGE MIS 20GX1" (^) N N 3ML SYRINGE MIS 20GX1.5" (^) N N 3ML SYRINGE MIS 21GX1" (^) N N
DRUG NAME PA_REQUIRED STEP_THERAPY
6ML SYRINGE MIS 21GX1.5" N N
6ML SYRINGE MIS 22GX1.5" N N
6ML SYRINGE MIS CANNULA N N
6ML SYRINGE/21G X 1"/LUER LOCK TIP N N
6ML SYRINGE/21G X 1-1/2"/LUER LOCK TIP N N
6ML SYRINGE/22G X 1-1/2"/LUER LOCK TIP N N
7T LIDO GEL N N
A and D (lan, pet) topical ointment N N A and D Diaper Rash Cream 1 %-10 % topical N N A THRU Z ADVANCED (^) N N A THRU Z ADVANCED ADULT FORMULA (^) N N A THRU Z HIGH POTENCY (^) N N A THRU Z SELECT (^) N N A THRU Z SELECT N N A THRU Z SELECT 50+ ADVANCED FORMULA N N A THRU Z SELECT 50+ MENS N N A THRU Z SELECT ADVANCED (^) N N A THRU Z SELECT ULTIMATE WOMENS (^) N N A THRU Z ULTIMATE MENS (^) N N A+D FIRST AID (^) N N A+D PREVENT (^) N N A+D PREVENT OIN (^) N N ABACAVIR (^) N N ABACAVIR (^) N N abacavir 20 mg/mL oral solution N N abacavir 300 mg tablet N N abacavir 300 mg-lamivudine 150 mg-zidovudine 300 mg tablet N N abacavir 600 mg-lamivudine 300 mg tablet N N ABACAVIR SULFATE N N ABACAVIR SULFATE/LAMIVUDINE (^) N N ABATINEX (^) N N ABC COMPLETE SENIOR WOMENS 50+ (^) N N ABC PLUS (^) N N ABC PLUS SENIOR (^) N N ABC PLUS SENIOR ADULTS 50+ (^) N N Abelcet 5 mg/mL intravenous suspension N N abiraterone 250 mg tablet N N ABIRATERONE ACETATE (^) N N ABIRATERONE ACETATE N N ABIRATERONE ACETATE N N ABIRATERONE ACETATE N N ABIRATERONE ACETATE (^) N N ABIRATERONE ACETATE (^) N N ABIRATERONE ACETATE (^) N N ABIRATERONE ACETATE (^) N N ABIRATERONE ACETATE (^) N N ABIRATERONE ACETATE (^) N N ABIRATERONE ACETATE (^) N N
DRUG NAME PA_REQUIRED STEP_THERAPY
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABIRATERONE ACETATE N N
ABOUTTIME PEN NEEDLE 32G X 5/32" N N
ABOUTTIME PEN NEEDLES 30GX 5/16" N N
ABOUTTIME PEN NEEDLES 31G X 3/16" N N
ABOUTTIME PEN NEEDLES 31G X 5/16" N N
Abraxane 100 mg intravenous suspension N N ABREVA (^) N N Abreva 10 % topical cream N N ABSORBASE (^) N N ABSORICA (^) N N ABSORICA (^) N N ABSORICA (^) N N ABSORICA (^) N N Absorica 10 mg capsule N N Absorica 20 mg capsule N N Absorica 25 mg capsule N N Absorica 30 mg capsule N N Absorica 35 mg capsule N N Absorica 40 mg capsule N N acacia (bulk) powder N N acamprosate 333 mg tablet,delayed release N N Acanya 1.2 %-2.5 % topical gel with pump N N ACARBOSE (^) N N ACARBOSE (^) N N ACARBOSE (^) N N acarbose 100 mg tablet N N acarbose 25 mg tablet N N acarbose 50 mg tablet N N ACCOLATE N N ACCOLATE N N ACCU-CHEK KIT AVIVA PL N N ACCU-CHEK KIT COMPACT (^) N N ACCU-CHEK TES AVIVA PL (^) N N ACCU-CHEK TES COMPACT (^) N N ACCU-CHEK TES GUIDE (^) N N ACCU-CHEK TES SMART (^) N N Accu-Chek Aviva Control Soln solution N N Accu-Chek Aviva Plus Meter N N
DRUG NAME PA_REQUIRED STEP_THERAPY
Acetaminophen Congestion-Pain 5 mg-325 mg tablet N N ACETAMINOPHEN EXTRA STRENGTH N N ACETAMINOPHEN INFANTS N N ACETAMINOPHEN/CODEINE N N ACETAMINOPHEN/CODEINE (^) N N ACETAMINOPHEN/CODEINE #3 (^) N N ACETAMINOPHEN/CODEINE PHOSPHATE (^) N N ACETASOL HC (^) N N ACETAZOLAMIDE (^) N N ACETAZOLAMIDE (^) N N acetazolamide 125 mg tablet N N acetazolamide 250 mg tablet N N ACETAZOLAMIDE ER (^) N N acetazolamide ER 500 mg capsule,extended release N N ACETIC ACID N N ACETIC ACID SOL 2% OTIC N N acetic acid 0.25 % irrigation solution N N acetic acid 2 % ear solution N N acetylcysteine 100 mg/mL (10 %) solution N N acetylcysteine 200 mg/mL (20 %) solution N N ACID CONTROL TAB 20MG (^) N N ACID CONTROLLER (^) N N ACID REDUCER (^) N N ACID REDUCER (^) N N ACID REDUCER (^) N N Acid Reducer (ranitidine) 150 mg tablet N N Acid Reducer (ranitidine) 75 mg tablet N N ACID REDUCER ORIGINAL STRENGTH N N ACID REDUCER TAB 150MG N N ACID REDUCER TAB 20MG (^) N N ACID REDUCER TAB 75MG (^) N N ACIDOPHILUS (^) N N ACIDOPHILUS (^) N N ACIDOPHILUS (^) N N ACIDOPHILUS (^) N N ACIDOPHILUS (^) N N ACIDOPHILUS (^) N N ACIDOPHILUS CAP (^) N N ACIDOPHILUS TAB L-SPORO N N ACIDOPHILUS WAF N N ACIDOPHILUS EXTRA STRENGTH N N ACIDOPHILUS HIGH-POTENCY (^) N N ACIDOPHILUS LACTOBACILLI (^) N N ACIDOPHILUS PEARLS (^) N N ACIDOPHILUS PROBIOTIC (^) N N ACIDOPHILUS PROBIOTIC (^) N N ACIDOPHILUS PROBIOTIC (^) N N ACIDOPHILUS PROBIOTIC (^) N N
DRUG NAME PA_REQUIRED STEP_THERAPY
ACIDOPHILUS PROBIOTIC N N
ACIDOPHILUS PROBIOTIC N N
ACIDOPHILUS PROBIOTIC N N
ACIDOPHILUS PROBIOTIC BLEND N N
ACIDOPHILUS PROBIOTIC BLEND N N
ACIDOPHILUS PROBIOTIC COMPLEX N N
Acidophilus Probiotic Complex 250 million cell capsule N N ACIDOPHILUS PROBIOTIC FORMULA (^) N N ACIDOPHILUS SUPER PROBIOTIC (^) N N ACIDOPHILUS WITH BIFIDUS (^) N N ACIDOPHILUS XTRA (^) N N ACIDOPHILUS/ WAF BIFIDUS (^) N N ACIDOPHILUS/BIFIDUS (^) N N ACIDOPHILUS/GOAT MILK N N ACIDOPHILUS/PECTIN N N AcipHex Sprinkle 5 mg capsule,delayed release N N acitretin 10 mg capsule N N acitretin 25 mg capsule N N ACNE FOAMING WASH (^) N N ACNE MEDICATION 10 (^) N N Acne Medication 10 % lotion N N Acne Medication 10 % topical gel N N ACNE MEDICATION 2.5 (^) N N ACNE MEDICATION 5 (^) N N Acne Medication 5 % lotion N N Acne Medication 5 % topical gel N N ACNE TREATMENT GEL N N ACNE-CLEAR N N ActHIB (PF) 10 mcg/0.5 mL intramuscular solution N N Actidose-Aqua 25 gram/120 mL oral suspension N N ACTIFLOVIT EAR HEALTH (^) N N ACTI-LANCE LANCETS 28G (^) N N ACTI-LANCE LITE SAFETY LANCETS 28G (^) N N ACTI-LANCE SPECIAL SAFETY LANCETS 17G (^) N N ACTI-LANCE SPECIAL SAFETYLANCETS 17G (^) N N ACTI-LANCE UNIVERSAL SAFETY LANCETS 23G (^) N N ACTIMMUNE (^) Y N Actimmune 100 mcg (2 million unit)/0.5 mL subcutaneous solution Y N ACTIPHLORA N N Activase 50 mg intravenous solution N N ACTIVITE N N Actonel 35 mg tablet N N Actonel 5 mg tablet N N ACTOPLUS MET (^) N N Actoplus MET 15 mg-850 mg tablet N N Actoplus Met XR 30 mg-1,000 mg tablet,extended release N N ACTOS (^) N N ACTOS (^) N N
DRUG NAME PA_REQUIRED STEP_THERAPY
Admelog SoloStar U-100 Insulin lispro 100 unit/mL subcutaneous pen N N Admelog U-100 Insulin lispro 100 unit/mL subcutaneous solution N N ADRENALIN N N ADRENALIN N N Adrucil 2.5 gram/50 mL intravenous solution N N Adrucil 5 gram/100 mL intravenous solution N N Adrucil 500 mg/10 mL intravenous solution N N ADULT ASPIRIN REGIMEN (^) N N ADULT GUMMY (^) N N Adult Multivitamin Extra Vitamin D3 200 mcg chewable tablet N N ADULT ONE DAILY GUMMIES (^) N N Adult One Daily Multivitamin 0.4 mg tablet N N Adult Robitussin Peak Cold DM 10 mg-100 mg/5 mL oral liquid N N Adult Tussin DM 10 mg-100 mg/5 mL oral syrup N N Adults' Daily Formula 18 mg iron-25 mcg tablet N N Adults Multivitamin 18 mg iron-400 mcg-25 mcg tablet N N Advanced Antacid-Antigas 400 mg-400 mg-40 mg/5 mL oral suspension N N ADVANCED DIABETIC MULTIVITAMIN FORMULA (^) N N Advanced Healing (Petrolatum) 41 % topical ointment N N ADVANCED MOBILE LANCET 30G (^) N N ADVANCED MULTI EA (^) N N ADVANCED PROBIOTIC (^) N N ADVANCED PROBIOTIC 10 (^) N N ADVANCED PROBIOTIC-14 (^) N N ADVANCED STRESS FORMULA/ZINC (^) N N Advate 1,000 (+/-) unit intravenous solution N N Advate 1,500 (+/-) unit intravenous solution N N Advate 2,000 (+/-) unit intravenous solution N N Advate 250 (+/-) unit intravenous solution N N Advate 3,000 (+/-) unit intravenous solution N N Advate 4,000 (+/-) unit intravenous solution N N Advate 500 (+/-) unit intravenous solution N N ADVIL (^) N N ADVIL (^) N N Advil 100 mg tablet N N Advil 200 mg tablet N N Advil Allergy Sinus 2 mg-30 mg-200 mg tablet N N Advil Cold and Sinus 30 mg-200 mg tablet N N ADVIL JUNIOR STRENGTH N N ADVIL LIQUI-GELS MINIS N N ADVIL MIGRAINE N N Advil Migraine 200 mg capsule N N Advil PM 200 mg-38 mg tablet N N ADVOCATE ALCOHOL PREP PADS (^) N N ADVOCATE INSULIN PEN NEEDLES (^) N N ADVOCATE INSULIN PEN NEEDLES 29GX12.7MM (^) N N ADVOCATE INSULIN PEN NEEDLES 31GX5MM (^) N N ADVOCATE INSULIN PEN NEEDLES 31GX8MM (^) N N
DRUG NAME PA_REQUIRED STEP_THERAPY
ADVOCATE INSULIN SYRINGE/U-100/0.3ML/29GX1/2" N N
ADVOCATE INSULIN SYRINGE/U-100/0.3ML/30GX5/16" N N
ADVOCATE INSULIN SYRINGE/U-100/0.3ML/31GX5/16" N N
ADVOCATE INSULIN SYRINGE/U-100/0.5ML/29GX1/2" N N
ADVOCATE INSULIN SYRINGE/U-100/0.5ML/30GX5/16" N N
ADVOCATE INSULIN SYRINGE/U-100/0.5ML/31GX5/16" N N
ADVOCATE INSULIN SYRINGE/U-100/1ML/29GX1/2" N N
ADVOCATE INSULIN SYRINGE/U-100/1ML/30GX5/16" N N
ADVOCATE INSULIN SYRINGE/U-100/1ML/31GX5/16" N N
ADVOCATE LANCETS N N
ADVOCATE LANCETS 30G N N
ADVOCATE LANCING DEVICE N N
ADVOCATE RAPID-SAFE LANCING DEVICE N N
ADVOCATE SAFETY LANCETS N N
ADVOCATE SAFETY LANCETS 26G N N
ADYPHREN AMP II KIT N N
ADYPHREN AMP KIT N N
ADYPHREN II N N
ADYPHREN KIT N N
AERCHMBR PLS MIS FLOW-VU N N
AERCHMBR PLS MIS LRG MASK N N
AERCHMBR PLS MIS MED MASK N N
AERCHMBR PLS MIS SM MASK N N
AERCHMBR Z- MIS STAT PLS N N
AEROCHAMBER MIS PLUS N N
AEROCHAMBER MIS FLOSIGNA N N
AEROCHAMBER MIS MV N N
AEROCHAMBER MIS PLUS N N
AEROSOL MASK MIS ADULT N N
AFEDITAB CR N N
AFEDITAB CR N N
Afeditab CR 30 mg tablet,extended release N N Afeditab CR 60 mg tablet,extended release N N Afinitor 10 mg tablet N N Afinitor 5 mg tablet N N Afinitor 7.5 mg tablet N N Afinitor Disperz 2 mg tablet for oral suspension N N Afinitor Disperz 5 mg tablet for oral suspension N N AFIRMELLE N N Afirmelle 0.1 mg-20 mcg tablet N N Afrezza (regular insulin) 8 unit (90)/12 unit (90) cartridge,inhaler N N AFRIN 12 HOUR (^) N N AFRIN ALL NIGHT NODRIP (^) N N AFRIN NASAL SPRAY (^) N N Afrin No Drip (oxymetazoline) 0.05 % nasal mist N N AFRIN NODRIP EXTRA MOISTURIZING (^) N N AFRIN NODRIP ORIGINAL (^) N N AFRIN NODRIP SEVERE CONGESTION (^) N N
DRUG NAME PA_REQUIRED STEP_THERAPY
ALBUTEROL NEB 0.5% N N
ALBUTEROL SULFATE N N
ALBUTEROL SULFATE N N
ALBUTEROL SULFATE N N
ALBUTEROL SULFATE N N
ALBUTEROL SULFATE N N
ALBUTEROL SULFATE N N
ALBUTEROL SULFATE N N
ALBUTEROL SULFATE N N
albuterol sulfate 0.63 mg/3 mL solution for nebulization N N albuterol sulfate 1.25 mg/3 mL solution for nebulization N N albuterol sulfate 2 mg tablet N N albuterol sulfate 2 mg/5 mL oral syrup N N albuterol sulfate 2.5 mg/3 mL (0.083 %) solution for nebulization N N albuterol sulfate 4 mg tablet N N albuterol sulfate concentrate 5 mg/mL(0.5 %) solution for nebulization N N albuterol sulfate ER 4 mg tablet,extended release,12 hr N N albuterol sulfate ER 8 mg tablet,extended release,12 hr N N ALBUTEROL SULFATE HFA (^) N N albuterol sulfate HFA 90 mcg/actuation aerosol inhaler N N alclometasone 0.05 % topical cream N N alclometasone 0.05 % topical ointment N N ALCLOMETASONE DIPROPIONATE (^) N N ALCLOMETASONE DIPROPIONATE (^) N N ALCOH-GLOVE CONTOURED WIPE (^) N N ALCOHOL PADS N N ALCOHOL PREP PADS N N ALCOHOL PREP PADS N N ALCOHOL PREPS N N ALCOHOL SWAB PAD 70% (^) N N ALCOHOL SWABS (^) N N ALCOHOL SWABS (^) N N ALCOHOL WIPES (^) N N ALCOH-WIPE MIS 12"X12" (^) N N Aldactazide 25 mg-25 mg tablet N N Aldactazide 50 mg-50 mg tablet N N ALDACTONE (^) N N ALDACTONE (^) N N Aldactone 25 mg tablet N N Aldara 5 % topical cream packet N N Aldurazyme 2.9 mg/5 mL intravenous solution N N Alecensa 150 mg capsule Y N ALENDRONATE TAB 35MG (^) N N ALENDRONATE TAB 5MG (^) N N ALENDRONATE TAB 70MG (^) N N alendronate 10 mg tablet N N alendronate 35 mg tablet N N alendronate 40 mg tablet N N
DRUG NAME PA_REQUIRED STEP_THERAPY
alendronate 5 mg tablet N N alendronate 70 mg tablet N N alendronate 70 mg/75 mL oral solution N N ALENDRONATE SODIUM N N ALENDRONATE SODIUM (^) N N ALENDRONATE SODIUM (^) N N ALENDRONATE SODIUM (^) N N ALENDRONATE SODIUM (^) N N ALER-CAP (^) N N ALERTAB (^) N N Alertness Aid 200 mg tablet N N ALEVE (^) N N Aleve 220 mg tablet N N ALEVE ARTHRITIS N N Aleve-D Sinus and Cold 220 mg-120 mg tablet,extended release N N alfentanil 500 mcg/mL injection solution N N ALFUZOSIN TAB 10MG ER (^) N N alfuzosin ER 10 mg tablet,extended release 24 hr N N ALGAE BASED CALCIUM (^) N N ALIGN (^) N N ALIGN (^) N N ALIGN EXTRA STRENGTH (^) N N ALIGN JR FOR KIDS (^) N N Alimta 500 mg intravenous solution N N Alinia 100 mg/5 mL oral suspension N N Alinia 500 mg tablet N N aliskiren 150 mg tablet N N aliskiren 300 mg tablet N N ALIVE ENERGY 50+ N N ALIVE GUMMIES FOR CHILDREN (^) N N ALIVE MENS ENERGY (^) N N ALIVE MULTI-VITAMIN (^) N N ALIVE MULTI-VITAMIN (^) N N ALIVE MULTI-VITAMIN CHILDRENS CHEWABLE (^) N N ALIVE ONCE DAILY WOMENS 50+ ULTRA POTENCY (^) N N ALIVE ONCE DAILY WOMENS ULTRA POTENCY (^) N N ALIVE WOMENS 50+ (^) N N ALIVE WOMENS 50+ (^) N N ALIVE WOMENS ENERGY N N ALIVE WOMENS GUMMY VITAMINS N N Alka-Seltzer Gold 344 mg-1,050 mg-1,000 mg effervescent tablet N N ALKA-SELTZER PLUS ALLERGY FAST RELIEF FORMULA (^) N N Alkeran 2 mg tablet N N ALL DAY ALLERGY (^) N N All Day Allergy (cetirizine) 1 mg/mL oral solution N N ALL DAY ALLERGY CHILDRENS (^) N N ALL DAY ALLERGY D (^) N N ALL DAY ALLERGY D-12 (^) N N
DRUG NAME PA_REQUIRED STEP_THERAPY
ALLERGY RELIEF 24HR N N
ALLERGY RELIEF 24HR/INDOOR/OUTDOOR N N
ALLERGY RELIEF CHILD N N
ALLERGY RELIEF CHILDRENS N N
ALLERGY RELIEF CHILDRENS N N
ALLERGY RELIEF CHILDRENS N N
ALLERGY RELIEF CHILDRENS N N
ALLERGY RELIEF D N N
ALLERGY RELIEF D N N
ALLERGY RELIEF D-12 N N
ALLERGY RELIEF D-24 N N
Allergy Relief D-24hr 10 mg-240 mg tablet,extended release N N ALLERGY RELIEF NASAL DECONGESTANT (^) N N ALLERGY RELIEF/INDOOR/OUTDOOR N N ALLERGY RELIEF/NASAL DECONGESTANT N N ALLERGY RELIEF-D N N ALLERGY RELIEF-D (^) N N ALLERGY RLF SUS 30/5ML (^) N N ALLERGY SYRG MIS 1ML/27G (^) N N ALLERGY SYRINGE/1ML/27G X 1/2" (^) N N ALLERGY TABLETS (^) N N ALLERGY/CONG TAB 5-120MG (^) N N ALLERGY-D TAB 5-120MG (^) N N ALLERGY-RELIEF-D (^) N N ALLER-TEC TAB 10MG (^) N N ALLEVACAINE N N Alli 60 mg capsule N N allopurinol 100 mg tablet N N allopurinol 300 mg tablet N N ALLZITAL (^) N N ALLZITAL TAB 25-325MG (^) N N Almacone-2 400 mg-400 mg-40 mg/5 mL oral suspension N N Alocril 2 % eye drops N N ALOE 10000 & PROBIOTICS (^) N N ALOE VESTA 2-N-1 PROTECTIVE (^) N N ALOE VESTA BODY WAS H/SHAMPOO (^) N N ALOE VESTA BODY WASH/SHAMPOO (^) N N ALOE VESTA PROTECTIVE (^) N N ALOGLIPTIN N N alogliptin 12.5 mg tablet N N alogliptin 12.5 mg-metformin 1,000 mg tablet N N alogliptin 12.5 mg-metformin 500 mg tablet N N alogliptin 12.5 mg-pioglitazone 15 mg tablet N N alogliptin 12.5 mg-pioglitazone 30 mg tablet N N alogliptin 12.5 mg-pioglitazone 45 mg tablet N N alogliptin 25 mg tablet N N alogliptin 25 mg-pioglitazone 15 mg tablet N N alogliptin 25 mg-pioglitazone 30 mg tablet N N
DRUG NAME PA_REQUIRED STEP_THERAPY
alogliptin 25 mg-pioglitazone 45 mg tablet N N alogliptin 6.25 mg tablet N N Alomide 0.1 % eye drops N N ALOPHEN N N Aloprim 500 mg intravenous solution N N ALORA (^) N N ALORA (^) N N ALORA (^) N N ALORA (^) N N ALORA DIS 0.05MG (^) N N ALORA DIS 0.075MG (^) N N ALORA DIS 0.1MG (^) N N Alora 0.025 mg/24 hr transdermal patch N N Alora 0.05 mg/24 hr transdermal patch N N Aloxi 0.25 mg/5 mL intravenous solution N N ALPHA BETIC N N ALPHA LIPOIC ACID (^) N N ALPHA LIPOIC ACID (^) N N ALPHA LIPOIC ACID (^) N N ALPHA LIPOIC ACID (^) N N ALPHA LIPOIC ACID (^) N N ALPHA LIPOIC ACID (^) N N ALPHA LIPOIC ACID (^) N N alpha lipoic acid (bulk) 100 % powder N N ALPHA LIPOIC CAP 100MG (^) N N ALPHA LIPOIC CAP 200MG N N ALPHA LIPOIC CAP 300MG N N ALPHA LIPOIC CAP 600MG N N ALPHA LIPOIC TAB 50MG N N ALPHA LIPOIC TAB ACID (^) N N Alphagan P 0.1 % eye drops N N Alphagan P 0.15 % eye drops N N ALPHA-LIPOIC ACID (^) N N ALPHA-LIPOIC ACID (^) N N ALPHA-LIPOIC CAP 50MG (^) N N ALPHA-LIPOIC TAB 100MG (^) N N ALPHA-LIPOIC TAB 300MG (^) N N ALPHA-LIPOIC TAB 600MG (^) N N Alphanate 1,500 (600 vWF) unit/10 mL intravenous solution N N Alprolix 1,000 unit intravenous solution N N Alprolix 2,000 unit intravenous solution N N Alprolix 3,000 unit intravenous solution N N Alprolix 500 unit intravenous solution N N alprostadil 500 mcg/mL injection solution N N Alrex 0.2 % eye drops,suspension N N Altabax 1 % topical ointment N N ALTACE (^) N N ALTACE (^) N N
DRUG NAME PA_REQUIRED STEP_THERAPY
AMERICERIN N N
AMERIDERM PERISHIELD N N
AMERIPHOR N N
AmeriPhor topical ointment N N AMETHIA (^) N N Amethia 0.15 mg-30 mcg (84)/10 mcg(7) tablets,3 month dose pack N N Amethia Lo 0.10 mg-20 mcg (84)/10 mcg(7) tablets,3 month dose pack N N AMETHYST (^) N N Amethyst (28) 90 mcg-20 mcg tablet N N AMICAR (^) N N Amicar 250 mg/mL (25 %) oral solution N N Amicar 500 mg tablet N N Amidate 2 mg/mL intravenous solution N N amifostine crystalline 500 mg intravenous solution N N amikacin 1,000 mg/4 mL injection solution N N amikacin 500 mg/2 mL injection solution N N amiloride 5 mg tablet N N amiloride 5 mg-hydrochlorothiazide 50 mg tablet N N AMILORIDE HCL (^) N N AMILORIDE HYDROCHLORIDE (^) N N AMILORIDE/HYDROCHLOROTHIAZIDE (^) N N AMINOCAPROIC ACID (^) N N AMINOCAPROIC ACID (^) N N AMINOCAPROIC ACID (^) N N AMINOCAPROIC ACID (^) N N Aminosyn II 10 % intravenous solution N N Aminosyn II 15 % intravenous solution N N amiodarone 100 mg tablet N N amiodarone 200 mg tablet N N amiodarone 400 mg tablet N N amiodarone 50 mg/mL intravenous solution N N AMIODARONE HCL (^) N N AMIODARONE HCL (^) N N AMIODARONE HYDROCHLORIDE (^) N N AMIODARONE HYDROCHLORIDE (^) N N AMIODARONE HYDROCHLORIDE (^) N N AMITIZA (^) Y N Amitiza 8 mcg capsule Y N amitriptyline (bulk) powder N N amitriptyline 10 mg tablet N N amitriptyline 100 mg tablet N N amitriptyline 150 mg tablet N N amitriptyline 25 mg tablet N N amitriptyline 50 mg tablet N N amitriptyline 75 mg tablet N N amitriptyline-chlordiazepoxide 12.5 mg-5 mg tablet N N amitriptyline-chlordiazepoxide 25 mg-10 mg tablet N N AMLACTIN (^) N N
DRUG NAME PA_REQUIRED STEP_THERAPY
AMLACTIN LOT 12% N N
AMLACTIN DAILY N N
AMLOD/BENAZP CAP 10-20MG N N
AMLOD/BENAZP CAP 5-10MG N N
AMLOD/BENAZP CAP 5-20MG N N
AMLOD/VALSAR TAB /HCTZ N N
amlodipine 10 mg tablet N N amlodipine 10 mg-atorvastatin 10 mg tablet N N amlodipine 10 mg-atorvastatin 20 mg tablet N N amlodipine 10 mg-atorvastatin 40 mg tablet N N amlodipine 10 mg-atorvastatin 80 mg tablet N N amlodipine 10 mg-benazepril 20 mg capsule N N amlodipine 10 mg-benazepril 40 mg capsule N N amlodipine 10 mg-valsartan 160 mg tablet N N amlodipine 10 mg-valsartan 160 mg-hydrochlorothiazide 12.5 mg tablet N N amlodipine 10 mg-valsartan 160 mg-hydrochlorothiazide 25 mg tablet N N amlodipine 10 mg-valsartan 320 mg tablet N N amlodipine 10 mg-valsartan 320 mg-hydrochlorothiazide 25 mg tablet N N amlodipine 2.5 mg tablet N N amlodipine 2.5 mg-atorvastatin 10 mg tablet N N amlodipine 2.5 mg-atorvastatin 20 mg tablet N N amlodipine 2.5 mg-atorvastatin 40 mg tablet N N amlodipine 2.5 mg-benazepril 10 mg capsule N N amlodipine 5 mg tablet N N amlodipine 5 mg-atorvastatin 10 mg tablet N N amlodipine 5 mg-atorvastatin 20 mg tablet N N amlodipine 5 mg-atorvastatin 40 mg tablet N N amlodipine 5 mg-atorvastatin 80 mg tablet N N amlodipine 5 mg-benazepril 10 mg capsule N N amlodipine 5 mg-benazepril 20 mg capsule N N amlodipine 5 mg-benazepril 40 mg capsule N N amlodipine 5 mg-valsartan 160 mg tablet N N amlodipine 5 mg-valsartan 160 mg-hydrochlorothiazide 12.5 mg tablet N N amlodipine 5 mg-valsartan 160 mg-hydrochlorothiazide 25 mg tablet N N amlodipine 5 mg-valsartan 320 mg tablet N N AMLODIPINE BESYLATE (^) N N AMLODIPINE BESYLATE (^) N N AMLODIPINE BESYLATE (^) N N amlodipine besylate (bulk) 100 % powder N N AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM N N AMLODIPINE BESYLATE/BENAZEPRIL HCL N N AMLODIPINE BESYLATE/BENAZEPRIL HYDROCHLORIDE (^) N N AMLODIPINE BESYLATE/VALSARTAN (^) N N AMLODIPINE/VALSARTAN/HYDROCHLOROTHIAZIDE (^) N N ammonium bromide (bulk) granules N N AMMONIUM LAC CRE 12% (^) N N AMMONIUM LACTATE (^) N N AMMONIUM LACTATE (^) N N
