Pharmacy

Learn about your pharmacy benefits

Whether it’s pain medication after an injury or medication to manage a health condition, getting the prescription drugs you need is an important part of your health care. We want to make it as easy for you as possible. If you have any questions, please call Member Services at 1-855-772-9076, TTY 711.

If you need medicine, your provider will choose a drug from our list of preferred drugs.

  • Your provider will write you a prescription. Ask your provider to make sure that the medicine is on our list.
  • Take your prescription to a pharmacy that’s in our network.

Sometimes your provider will want to give you a drug that is not on our list or that is a brand name drug. Your provider may feel you need a medicine that is not on our list because you can’t take any other drugs except the one prescribed. Your provider can request approval from us. Your provider knows how to do this.

Take all of your prescriptions to one of our network pharmacies. Show your Aetna Better Health of California member ID card at the pharmacy. We will pay for some drugs that you can get without a prescription when your provider asks us.

Check the list of network pharmacies and look for one in your area.  You can also search for a network pharmacy on the secure web portal and the free mobile app. If you need help, just call Member Services at 1-855-772-9076, TTY 711. They’ll be glad to help you find a network pharmacy near you.

Always remember to fill your prescription at a network pharmacy. Your prescriptions won’t be covered at other pharmacies.

To prevent extra costs, check that your medicines are on the preferred drug list. This is called the formulary. If you have questions, just call Member Services at 1-855-772-9076, TTY 711. Have a list of your prescriptions ready when you call. Ask us to look up your medicines to see if they’re on the list.

You can also view the preferred drug list via our formulary search tool. Searches can be performed by drug name or by drug class. The tool will provide formulary status, generic alternatives and if there are any clinical edits (prior authorization, quantity limits, age limits etc.)

Updates are made regularly to the Aetna Better Health formulary and can be viewed below and through the formulary search tool. Formulary changes to identify include:

  • Addition/removal of a drug from the formulary
  • Addition/removal of quantity limits
  • Addition/removal of prior authorization requirements

If your medicine is not on the preferred drug list, there are some things you can do.

  • Ask your provider for a similar drug that is on the list.
  • Ask your provider to seek “prior authorization” (pre-approval) from Aetna Better Health of California to cover this medicine. Your provider knows how to do this.

Aetna Better Health of California also covers certain over-the-counter drugs, if they are on our list. Some are covered, under certain rules. If the rules for that drug are met, Aetna Better Health of California will cover the drug. Like other drugs, over-the-counter drugs must have a prescription from a provider for them to be covered at no cost to you.

You can look to see if your over-the-counter medicines are on our formulary or use the formulary search tool. You can also check with Member Services at 1-855-772-9076, TTY 711. When you call, have a list of your over-the-counter medicines ready. Ask the representative to look up your medicines to see if they’re on the list.

CVS Specialty Pharmacy is the preferred specialty pharmacy for Aetna Better Health of California members. A specialty pharmacy fills drugs and has other services to help you. The Specialty Drug Program has special services for you:

  • You can talk to a Pharmacist 24 hours a day, 7 days a week
  • Counseling about your drug and disease
  • Coordination of care with you and your doctor
  • Delivery of Specialty drugs to your home or doctor’s office
  • You can drop off your prescription and pick up your drug at any CVS Pharmacy (including those inside Target stores)
  • You can call CVS Specialty Pharmacy at 1-800-237-2767; TTY/TDD: 1-800-863-5488. CVS Specialty Pharmacy will help you with filling your specialty drug.

View the specialty drug list available through CVS Specialty Pharmacy.

If you take medicine for an ongoing health condition, you can have them mailed to your home. Aetna Better Health works with a company called CVS Caremark, to give you this service which is available at no cost to you.

If you choose this option, your medicine comes right to your home. You can set up your refills. You can ask pharmacists questions. Here are some other features of home delivery:

  • Pharmacists check each order for safety.
  • You can order refills by mail, by phone, online, or you can sign up for automatic refills.
  • You can talk with pharmacists by phone.

It’s easy to start using mail service
Choose ONE of the following three ways to use mail service for a medicine that you take on an ongoing basis:

  • Call the CVS toll-free number at 1-855-271-6603, TTY 711 (24 hours a day, 7 days a week). They will let you know which of your medicines can be filled through CVS mail service pharmacy. CVS will then contact your doctor for a prescription and mail the medicine to you. When you call, be sure to have:
    • Your Plan member ID card
    • Your doctor’s first and last name and phone number
    • Your payment information and mailing address
  • Go to our member portal to register or login. Once you enter the member portal, go to Tasks and then Phramacy Services. Click on the CVS link to go to Caremark.com. Click on start "mail service" to print off the mail order form. You can contact CVS at 1-855-271-6603. Be sure to have your member ID card handy when you register for the first time.
  • Fill out and send a mail service order form. If you already have a prescription, you can send it to CVS Caremark with a completed mail service order form. If you don’t have an order form, you can download it. You can also request one by calling Member Services at 1-855-772-9076, TTY 711.

Have the following information with you when you complete the form:

    • Your Plan member ID card
    • Your complete mailing address, including ZIP code
    • Your doctor’s first and last name and phone number
    • A list of your allergies and other health conditions
    • Your original prescription from your doctor

 

Your medicine bottle label says how many refills you can have. If your provider hasn’t ordered refills, and you think you need one, you must call him or her a few days before your medicine runs out. When you call, ask your provider about getting a refill. He or she may want to see you first.

November 2019

Additions:

  • Heplisav Pfs 20 Mcg/0.5ml (Age Limit)
  • Methylergonovine 0.2 Mg Tab
  • Methylergonovine Inj 0.2 Mg/Ml
  • Penicillin G Procaine Im 600000iu/Ml
  • Rhopressa Soln 0.02%
  • Shingrix 50 Mcg/0.5ml (Age Limit)
  • Symlin Pen 60 Inj 1500mcg/1.5ml (Prior Authorization Required)
  • Thiamine Hcl Cap 50 Mg
  • Thiamine Hcl Elixir 2.25 Mg/5ml
  • Thiamine Hcl Tab 10 Mg
  • Thiamine Hcl Tab 100 Mg
  • Thiamine Hcl Tab 25 Mg
  • Thiamine Hcl Tab 250 Mg
  • Thiamine Hcl Tab 5 Mg
  • Thiamine Hcl Tab 50 Mg
  • Thiamine Hcl Tab 500 Mg
  • Thiamine Mononitrate Tab 100 Mg
  • Thiamine Mononitrate Tab 250 Mg
  • Thiamine Pyrophosphate Tab 20 Mg
  • Twinrix Pfs 720-20 Mcg/Ml (Age Limit)

 

October 2019

No Changes

 

September 2019

Additions:

  • Ambrisentan Tab 10mg (Prior Authorization Required, Quantity Limit)
  • Ambrisentan Tab 5mg (Prior Authorization Required, Quantity Limit)
  • Bosentan Tab 125mg (Prior Authorization Required, Quantity Limit)
  • Bosentan Tab 62.5mg (Prior Authorization Required, Quantity Limit)
  • Febuxostat Tab 80mg (Step Therapy Required, Quantity Limit)
  • Febuxostat Tab 80mg (Step Therapy Required, Quantity Limit)

Removals:

  • Letairis Tab 10mg
  • Letairis Tab 5mg
  • Tracleer Tab 125mg
  • Tracleer Tab 62.5mg
  • Uloric Tab 40mg
  • Uloric Tab 80mg

 

August 2019

Additions:

  • Butenafine Hcl Cream 1%
  • Lidocaine Patch 4% (Quantity Limit)
  • Lorcaserin Hcl Tab Er 24hr 20mg (Prior Authorization Required, Quantity Limit)
  • Pegfilgrastim-Cbqv Soln Prefilled Syringe 6mg/0.6ml (Prior Authorization Required)
  • Pegfilgrastim-Jmdb Soln Prefilled Syringe 6mg/0.6ml (Prior Authorization Required)

Removals:

  • Butalbital-Acetaminophen-Caff W/ Cod Cap 50-300-40-30 Mg
  • Butalbital-Acetaminophen-Caffeine Cap 50-300-40 Mg
  • Butalbital-Acetaminophen-Caffeine Cap 50-325-40 Mg
  • Calcium Acetate (Phosphate Binder) Oral Soln 667 Mg/5ml
  • Ciclopirox Gel 0.77%
  • Clotrimazole W/ Betamethasone Lotion 1-0.05%
  • Colestipol Hcl Granule Packets 5 Gm
  • Colestipol Hcl Granules 5 Gm
  • Entecavir Oral Soln 0.05 Mg/Ml
  • Epinastine Hcl Ophth Soln 0.05%
  • Erythromycin Ethylsuccinate For Susp 200 Mg/5ml
  • Erythromycin Ethylsuccinate For Susp 400 Mg/5ml
  • Esterified Estrogens Tab 0.3 Mg
  • Esterified Estrogens Tab 0.625 Mg
  • Esterified Estrogens Tab 1.25 Mg
  • Estradiol Tab 1 Mg(15)/Estrad-Norgestimate Tab 1-0.09mg(15)
  • Etodolac Tab Er 24hr 400 Mg
  • Etodolac Tab Er 24hr 500 Mg
  • Etodolac Tab Er 24hr 600 Mg
  • Lindane Shampoo 1%
  • Moexipril Hcl Tab 15 Mg
  • Moexipril Hcl Tab 7.5 Mg
  • Olopatadine Hcl Ophth Soln 0.2%
  • Quinidine Gluconate Tab Er 324 Mg
  • Thyroid Tab 130 Mg
  • Vagifem Tab 10mcg

Other Updates:

  • Anecream Cre 4% (Added Quantity Level Limit)
  • Armour Thyroid 180mg Tab (Quantity Level Limit)
  • Armour Thyroid 240mg Tab (Quantity Level Limit)
  • Armour Thyroid 300mg Tab (Quantity Level Limit)
  • Azelastine Hcl Ophth Soln 0.05% (Added Quantity Level Limit)
  • Betamethasone Dipropionate Oint 0.05% (Added Quantity Level Limit)
  • Calcipotriene Cream 0.005% (Added Prior Authorization Required, Quantity Limit)
  • Calcipotriene Oint 0.005% (Added Prior Authorization Required, Quantity Limit)
  • Calcipotriene Soln 0.005% (50 Mcg/Ml) (Added Prior Authorization Required, Quantity Limit)
  • Ciclopirox Olamine Cream 0.77% (Added Step Therapy)
  • Ciclopirox Olamine Susp 0.77% (Added Step Therapy)
  • Ciclopirox Shampoo 1% (Added Step Therapy)
  • Clotrimazole Soln 1% (Rx Only) (Added Step Therapy)
  • Estradiol Tab 10mcg (Quantity Level Limit)
  • Fluocinolone Acetonide Cream 0.025% (Added Quantity Level Limit)
  • Fluocinolone Acetonide Oint 0.025% (Added Quantity Level Limit)
  • Ketoconazole Cream 2% (Added Step Therapy, Quantity Limit)
  • Lc-4 Lidocne Cre 4% (Added Quantity Level Limit)
  • Lidocaine Cre 4% (Added Quantity Level Limit)
  • Lidocaine Hcl Gel 2% (Added Quantity Level Limit)
  • Lidocaine-Prilocaine Cream Kit 2.5-2.5%
  • Liothyronine Sodium Tab 5 Mcg (Added Quantity Level Limit)
  • Liothyronine Sodium Tab 50 Mcg (Added Quantity Level Limit)
  • Norethindrone Tab 0.35 Mg (Added Step Therapy)
  • Sertraline conc 20mg/mL (Added Age Limit)
  • Thyroid Tab 120 Mg (2 Grain) (Added Quantity Level Limit)
  • Thyroid Tab 15 Mg (1/4 Grain) (Added Quantity Level Limit)
  • Thyroid Tab 30 Mg (1/2 Grain) (Added Quantity Level Limit)
  • Thyroid Tab 60 Mg (1 Grain) (Added Quantity Level Limit)
  • Thyroid Tab 90 Mg (1 1/2 Grain) (Added Quantity Level Limit)

 

July 2019

Additions:

  • Mesalamine Cap 400mg (Quantity Limit)
  • Cefixime Cap 400mg (Quantity Limit)
  • Erlotinib Tab 25mg, 100mg, 150mg (Quantity Limit)

Removals:

  • Suprax Cap 400mg
  • Tarceva Tab 25mg, 100mg, 150mg

 

June 2019

Additions:

  • Docosanol Crm 10%
  • Insulin Lispro Pen Injector 100u/mL (Age Limit)
  • Insulin Lispro Sol 100u/mL

Removals:

  • Humalog Kwik Pen 100u/mL
  • Humalog Vial 100u/mL
  • Novolog Flex Pen 100u/mL
  • Novolog Sol 100u/mL

 

May 2019

Additions:

  • Nivestym Inj 300mcg (Prior Authorization Required)
  • Nivestym Inj 480mcg (Prior Authorization Required)
  • Erythromycin Sup 400/5mL
  • Sirolimus Sol 1mg/mL

Removals:

  • EryPed 400 Sus
  • Rapamune Sol 1mg/mL

 

April 2019

No Changes

 

March 2019

Additions:

  • Albuterol Aer HFA (Quantity Level Limit)        
  • Butalbital-Aspirin-Caffeine Tab 50-325-40mg (Quantity Level Limit)
  • Mesalamine Sup 1000mg        
  • Methylpred Tab 4mg (Quantity Level Limit)    
  • Nicotrol Inh  
  • Nicotrol NS Spr 10mg/ml
  • Tolnaftate Cre 1%
  • Toremifene Tab 60mg  
  • Vigabatrin Tab 500mg

Removals:

  • Canasa Suppository 1000mg
  • Fareston Tablet 60mg
  • Norethin Acet & Estrad-Fe (24)

Other Updates:

  • Butalbital-Acetaminophen-Caffeine Cap 50-325-40mg (Decreased Quantity Level Limit)
  • Butalbital-Acetaminophen-Caffeine Tab 50-325-40mg (Decreased Quantity Level Limit)
  • Butalbital-Aspirin-Caffeine Cap 50-325-40mg (Decreased Quantity Level Limit)
  • Chantix (Removed Prior Authorization

 

February 2019

Additions:

  • Arnuity Elpt 100mcg/Act
  • Arnuity Elpt 200mcg/Act
  • Arnuity Elpt 50mcg/Act
  • Calcipotrien Cre 0.005% (Quantity Level Limit)
  • Immune Globulin (Human) Iv Or Subcutaneous Soln 1 Gm/10ml (Prior Authorization Required)
  • Immune Globulin (Human) Iv Or Subcutaneous Soln 10 Gm/100ml (Prior Authorization Required)
  • Immune Globulin (Human) Iv Or Subcutaneous Soln 2.5 Gm/25ml (Prior Authorization Required)
  • Immune Globulin (Human) Iv Or Subcutaneous Soln 20 Gm/200ml (Prior Authorization Required)
  • Immune Globulin (Human) Iv Or Subcutaneous Soln 30 Gm/300ml (Prior Authorization Required)
  • Immune Globulin (Human) Iv Or Subcutaneous Soln 40 Gm/400ml (Prior Authorization Required)
  • Immune Globulin (Human) Iv Or Subcutaneous Soln 5 Gm/50ml
  • Immune Globulin (Human) Iv Soln 10 Gm/100ml (Prior Authorization Required)
  • Immune Globulin (Human) Iv Soln 20 Gm/200ml (Prior Authorization Required)
  • Immune Globulin (Human) Iv Soln 5 Gm/50ml (Prior Authorization Required)
  • Ozempic Inj (Quantity Level Limit, Step Therapy Required)
  • Ozempic Inj (Quantity Level Limit, Step Therapy Required)
  • Prenatal Mv & Min W/Fe Bisglyc-Fe Prot Succ-Fa-Ca-Omega 3 29-1-200-250mg Pack (Quantity Level Limit)
  • Prenatal Mv & Min W/Fe Fumarate-Fa-Dha 28-0.8-200mg Pack (Quantity Level Limit)
  • Prenatal Vit W/ Ferrous Fumarate-Folic Acid 27-0.8mg Tab (Quantity Level Limit)
  • Prenatal Vit W/ Ferrous Fumarate-Folic Acid 28-0.8mg Tab (Quantity Level Limit)
  • Prenatal Vit W/ Ferrous Fumarate-Folic Acid 29-1mg Tab (Quantity Level Limit)
  • Prenatal Without A Vit W/ Fe Fumarate-Folic Acid 29-1mg Chew Tab (Quantity Level Limit)
  • Prenatal Without A Vit W/ Fe Fum-Iron Polysacch Complex –Fa 130-92.4-1mg Cap (Quantity Level Limit)
  • Prenatal Without A Vit W/ Fe Fum-Iron Polysacch Complex –Fa 20-20-1.25mg Cap (Quantity Level Limit)
  • Segluromet 2.5-1000tab (Quantity Level Limit, Step Therapy Required)
  • Segluromet 2.5-500tab (Quantity Level Limit, Step Therapy Required)
  • Segluromet 7.5-1000 Tab (Quantity Level Limit, Step Therapy Required)
  • Segluromet 7.5-500 Tab (Quantity Level Limit, Step Therapy Required)
  • Steglatro 10mg Tab (Quantity Level Limit, Step Therapy Required)
  • Steglatro 5mg Tab (Quantity Level Limit, Step Therapy Required)
  • Victoza Inj (Quantity Level Limit, Step Therapy Required)
  • Eligard Kit 22.5mg (Prior Authorization Required)
  • Eligard Kit 30 Mg (Prior Authorization Required)
  • Eligard Kit 45 Mg (Prior Authorization Required)
  • Eligard Kit 7.5mg (Prior Authorization Required)
  • Leuprolide Acetate Kit 1mg/0.2ml (Prior Authorization Required)
  • Prenatal Vit W/ Docusate-Fe Fumarate-Folic Acid 29-1mg Tab (Quantity Level Limit)
  • Prenatal Vit W/ Fe Fum-Iron Polysacch Complex -Fa-Omega 3 53.5-38-1mg Cap (Quantity Level Limit)
  • Prenatal Vit W/ Ferrous Fumarate-Folic Acid 28-1mg Tab (Quantity Level Limit)
  • Prenatal Vit W/ Ferrous Fumarate-Folic Acid 29-1mg Chew Tab (Quantity Level Limit)
  • Prenatal Vit W/ Ferrous Fumarate-Folic Acid 60-1mg Tab (Quantity Level Limit)
  • Prenatal Vit W/ Iron Carbonyl-Folic Acid 29-1mg Tab (Quantity Level Limit)
  • Prenatal Without A Vit W/ Fe Fumarate-Folic Acid 106.5-1mg Cap (Quantity Level Limit)
  • Zoladex Imp 10.8mg (Prior Authorization Required)
  • Zoladex Imp 3.6mg (Prior Authorization Required)

Removals:

  • Alprazolam ODT
  • Cleocin Vag Ovu 100mg
  • Clorazepate Dipotassium Tab
  • Cortifoam Aer Rectal
  • Dihydroergotamine
  • Dulera Aer
  • Ergot/Caffen
  • Ergotamine
  • Fluticasone Propionate Aer Pow Ba 100 Mcg/Blister
  • Fluticasone Propionate Aer Pow Ba 250 Mcg/Blister
  • Fluticasone Propionate Aer Pow Ba 50 Mcg/Blister
  • Invokamet
  • Invokana Tab
  • Levonor/Ethi Tab Estradio
  • Lidocaine/Hc Kit 20x7gm
  • Lidocaine/Hc Kit 3%-1%
  • Meprobamate Tab
  • Miconazole 3 Sup 200mg
  • Neonatal Pls
  • Nitro-Bid 2% Packets
  • Penicillamine Cap 250 Mg
  • Pimecrolimus Cream 1%
  • Podofilox Gel 0.5%
  • Prenatal Mv & Min W/Fe Polysaccharide Complex-Fa-Dha 29-1mg & 250mg Pack
  • Prenatal Vit W/ Ferrous Fumarate-Folic Acid 65-1mg Tab
  • Prenatal Vit W/ Ferrous Fumarate-L Methylfolate-Folic Acid 27-0.6-0.4mg Tab
  • Prenatal Vit W/ Iron Polysaccharide Complex-Folic Acid 29-1 Chew Tab
  • Prenatal W/O Vit A W/ Fe Carbonyl-Fe Gluconate-Dss-Fa-Dha 27-1mg & 250mg Pack
  • Prenatal W/O Vit A W/ Fe Fumarate-Dss-Fa-Dha 27-1.25-300mg Cap
  • Prenatal Without A W/ Fe Fumarate-L Methylfolate-Fa-Dha 27-0.6-0.4-300mg Cap
  • Pulmicrt Flx
  • Qvar
  • Relenza     Mis Diskhale
  • Synjardy
  • Terconazole Vaginal Suppos 80 Mg
  • Thalomid Cap
  • Triazolam Capsules
  • Tricare Tab Prenatal
  • Trimethobenzamide Hcl Cap 300 Mg
  • Trulicity Inj

 

January 2019

Additions:

  • None

Removals:

  • Ibalizumab-uiyk (Trogarzo) 200mg/1.33mL IV solution

 

December 2018

Additions:

  • Filgrastim-AAFI Soln Prefilled Syringe 300mcg/0.5ml (Prior Authorization Required)
  • Filgrastim-AAFI Soln Prefilled Syringe 480mcg/0.8ml (Prior Authorization Required)

Removals:

  • Tamiflu Caps

 

November 2018

Additions:

  • Abelcet Inj 5mg/ml (Prior Authorization required)
  • Acyclovir Na Inj 500mg (Prior Authorization required)
  • Acyclovir Na Inj 50mg/ml (Prior Authorization required)
  • Albendazole Tab 200mg
  • Ambisome Inj 50mg (Prior Authorization required)
  • Aminosyn 7% Inj /Lytes (Prior Authorization required)
  • Aminosyn II Inj 8.5/Lyte (Prior Authorization required)
  • Aminosyn II Inj 7% (Prior Authorization required)
  • Aminosyn II Inj 8.5% (Prior Authorization required)
  • Aminosyn M Inj 3.5% (Prior Authorization required)
  • Aminosyn-Rf Inj 5.2% (Prior Authorization required)
  • Ampicillin Inj 10gm (Prior Authorization required)
  • Ampicillin Inj 1gm (Prior Authorization required)
  • Ampicillin Inj 2gm (Prior Authorization required)
  • Amp-Sulbacta Inj 1.5gm (Prior Authorization required)
  • Amp-Sulbacta Inj 15gm (Prior Authorization required)
  • Amp-Sulbacta Inj 3gm (Prior Authorization required)
  • Ascor Sol 25000mg (Prior Authorization required)
  • Avelox Inj (Prior Authorization required)
  • Avycaz Inj 2-0.5gm (Prior Authorization required)
  • Azactam/Dex Inj 1gm (Prior Authorization required)
  • Azactam/Dex Inj 2gm (Prior Authorization required)
  • Bactocill Inj Dex 1gm (Prior Authorization required)
  • Bactocill Inj Dex 2gm (Prior Authorization required)
  • Baxdela Inj 300mg (Prior Authorization required)
  • Calcium Cl Inj 10% (Prior Authorization required)
  • Cancidas Inj 50mg (Prior Authorization required)
  • Cancidas Inj 70mg (Prior Authorization required)
  • Cefazln/NaCl Sol 3g/100ml (Prior Authorization required)
  • Cefazol/NaCl Inj 1gm/10ml (Prior Authorization required)
  • Cefazol/NaCl Sol 2gm/100 (Prior Authorization required)
  • Cefazol/NaCl Sol 2gm/10ml (Prior Authorization required)
  • Cefazol/NaCl Sol 2gm/50ml (Prior Authorization required)
  • Cefazolin Inj 1gm (Prior Authorization required)
  • Cefazolin Inj 1gm/10ml (Prior Authorization required)
  • Cefazolin Inj 1gm/50ml (Prior Authorization required)
  • Cefazolin Inj 2gm/20ml (Prior Authorization required)
  • Cefazolin Inj 2gm/50ml (Prior Authorization required)
  • Cefazolin Sol (Prior Authorization required)
  • Cefazoln Sod Sol 3gm/20ml (Prior Authorization required)
  • Cefepime Inj 1gm (Prior Authorization required)
  • Cefepime Inj 2gm (Prior Authorization required)
  • Cefoxitin Inj 1gm (Prior Authorization required)
  • Cefoxitin Inj 1gm (Prior Authorization required)
  • Cefoxitin Inj 2gm (Prior Authorization required)
  • Cefoxitin Inj 2gm (Prior Authorization required)
  • Ceftriaxone Inj 10gm (Prior Authorization required)
  • Ceftriaxone Inj 1gm (Prior Authorization required)
  • Ceftriaxone Inj 2gm (Prior Authorization required)
  • Cefuroxime Inj 1.5gm (Prior Authorization required)
  • Chloramphen Inj 1gm (Prior Authorization required)
  • Cidofovir Inj 75mg/ml (Prior Authorization required)
  • Ciprofloxacn Inj 200mg (Prior Authorization required)
  • Ciprofloxacn Inj 200mg (Prior Authorization required)
  • Ciprofloxacn Inj 400mg (Prior Authorization required)
  • Ciprofloxacn Inj 400mg (Prior Authorization required)
  • Claforan Inj 1gm (Prior Authorization required)
  • Claforan Inj 2gm (Prior Authorization required)
  • Cleocin Phos Inj 600/4ml (Prior Authorization required)
  • Cleocin Phos Inj 900/6ml (Prior Authorization required)
  • Cleocin/D5W Inj 300mg (Prior Authorization required)
  • Cleocin/D5W Inj 600mg (Prior Authorization required)
  • Cleocin/D5W Inj 900mg (Prior Authorization required)
  • Clindamycin Inj 300/2ml (Prior Authorization required)
  • Clindmyc/NaC Inj 300/50ml (Prior Authorization required)
  • Clindmyc/NaC Inj 600/50ml (Prior Authorization required)
  • Clindmyc/NaC Inj 900/50ml (Prior Authorization required)
  • Clinimix E Inj 2.75/D10 (Prior Authorization required)
  • Clinimix E Inj 2.75/D5W (Prior Authorization required)
  • Clinimix E Inj 4.25/D10 (Prior Authorization required)
  • Clinimix E Inj 4.25/D25 (Prior Authorization required)
  • Clinimix E Inj 4.25/D5W (Prior Authorization required)
  • Clinimix E Inj 5%/D15W (Prior Authorization required)
  • Clinimix E Inj 5%/D20W (Prior Authorization required)
  • Clinimix E Inj 5%/D25W (Prior Authorization required)
  • Clinimix Inj 2.75/D5W (Prior Authorization required)
  • Clinimix Inj 4.25/D10 (Prior Authorization required)
  • Clinimix Inj 4.25/D20W (Prior Authorization required)
  • Clinimix Inj 4.25/D25 (Prior Authorization required)
  • Clinimix Inj 4.25/D5W (Prior Authorization required)
  • Clinimix Inj 5%/D15W (Prior Authorization required)
  • Clinimix Inj 5%/D20W (Prior Authorization required)
  • Clinimix Inj 5%/D25W (Prior Authorization required)
  • Clinimix Sol 2.75% (Prior Authorization required)
  • Clinimix Sol 4.25% (Prior Authorization required)
  • Clinisol SF Inj 15% (Prior Authorization required)
  • Cresemba Inj 372mg (Prior Authorization required)
  • Cubicin Sol 500mg (Prior Authorization required)
  • Cupric Chlor Inj 0.4mg/ml (Prior Authorization required)
  • Cytogam Inj (Prior Authorization required)
  • Cytovene Inj 500mg (Prior Authorization required)
  • D10w/NaCl Inj 0.2%
  • D10W/NaCl Inj 0.225%
  • D10w/NaCl Inj 0.45%
  • D2.5w/NaCl Inj 0.45%
  • D5W/LR Inj
  • D5W/Lytes Inj #48
  • D5w/NaCl Inj 0.2%
  • D5W/NaCl Inj 0.225%
  • D5W/NaCl Inj 0.3%
  • D5w/NaCl Inj 0.33%
  • D5w/NaCl Inj 0.45%
  • D5w/NaCl Inj 0.9%
  • Dalvance Sol 500mg (Prior Authorization required)
  • Daptomycin Sol 350mg (Prior Authorization required)
  • Darzalex Sol (Prior Authorization required)
  • Dextrose Inj 10%
  • Dextrose Inj 20% (Prior Authorization required)
  • Dextrose Inj 25% (Prior Authorization required)
  • Dextrose Inj 30% (Prior Authorization required)
  • Dextrose Inj 40% (Prior Authorization required)
  • Dextrose Inj 5%
  • Dextrose Inj 50% (Prior Authorization required)
  • Dextrose Inj 70% (Prior Authorization required)
  • Docetaxel Inj (Prior Authorization required)
  • Doribax Inj 250mg (Prior Authorization required)
  • Doribax Inj 500mg (Prior Authorization required)
  • Doxorubicin Inj 2mg/ml (Prior Authorization required)
  • Doxy 100 Inj 100mg (Prior Authorization required)
  • Eraxis Inj 100mg (Prior Authorization required)
  • Eraxis Inj 50mg (Prior Authorization required)
  • Erythrocin Inj 500mg (Prior Authorization required)
  • Fluconazole/ Inj Dex 200 (Prior Authorization required)
  • Fluconazole/ Inj Dex 400 (Prior Authorization required)
  • Fluconazole/ Inj Nacl 100 (Prior Authorization required)
  • Fluconazole/ Inj Nacl 200 (Prior Authorization required)
  • Fluconazole/ Inj Nacl 400 (Prior Authorization required)
  • Fluticasone-Salmeterol Aer Powder Ba 113-14 Mcg/Act (Quantity Level Limit)
  • Fluticasone-Salmeterol Aer Powder Ba 232-14 Mcg/Act (Quantity Level Limit)
  • Fluticasone-Salmeterol Aer Powder Ba 55-14 Mcg/Act (Quantity Level Limit)
  • Fortaz Inj 1gm (Prior Authorization required)
  • Fortaz Inj 2gm (Prior Authorization required)
  • Foscavir Inj 24mg/ml (Prior Authorization required)
  • Freamine Hbc Inj 6.9% (Prior Authorization required)
  • Freamine III Inj 10% (Prior Authorization required)
  • Ganciclovir Inj 500/25 (Prior Authorization required)
  • Ganciclovir Inj 500mg (Prior Authorization required)
  • Gentam/NaCl Inj 0.9mg/ml (Prior Authorization required)
  • Gentam/NaCl Inj 1.4mg/ml (Prior Authorization required)
  • Gentam/NaCl Inj 100mg (Prior Authorization required)
  • Gentam/NaCl Inj 100mg (Prior Authorization required)
  • Gentam/NaCl Inj 60mg (Prior Authorization required)
  • Gentam/NaCl Inj 80mg (Prior Authorization required)
  • Gentam/NaCl Inj 80mg (Prior Authorization required)
  • Hepatamine Sol 8% (Prior Authorization required)
  • Herceptin Inj 150mg (Prior Authorization required)
  • Hyperlyte-Cr Inj
  • Infuvite Inj (Prior Authorization required)
  • Infuvite Inj Pediatri (Prior Authorization required)
  • Injectafer Inj 750/15ml (Prior Authorization required)
  • Intralipid Inj 20% (Prior Authorization required)
  • Intralipid Inj 30% (Prior Authorization required)
  • Invanz Inj 1gm (Prior Authorization required)
  • Ionosol-B/ Inj D5W
  • Ionosol-Mb Inj /D5W
  • Isolyte-P Inj /D5W
  • Isolyte-S Inj
  • Isolyte-S Inj Ph 7.4
  • Kabiven EMU (Prior Authorization required)
  • KCl/D5W/Lact Inj 20meq/L
  • KCl/D5W/Lact Inj 40meq/L
  • KCl/D5W/NaCl Inj .075/.45
  • KCl/D5W/NaCl Inj .15-.45%
  • KCl/D5W/NaCl Inj .15/.33%
  • KCl/D5W/NaCl Inj .224/.45
  • KCl/D5W/NaCl Inj 0.15/0.2
  • Kcl/D5W/Nacl Inj 0.15/0.2
  • KCl/D5W/NaCl Inj 0.15/0.9
  • KCl/D5W/NaCl Inj 0.3/0.45
  • KCl/D5W/NaCl Inj 0.3/0.9%
  • KCl/Lido/D5W Sol 20/100ml
  • KCl/Lidocain Inj NaCl
  • KCl/NaCl Inj 10/100ml
  • KCl/NaCl Inj 30/100ml
  • KCl/NaCl Inj 40/250ml
  • Lactated Rin Inj
  • Lartruvo Inj (Prior Authorization required)
  • L-Cysteine Inj 50mg/ml (Prior Authorization required)
  • Levoflox/D5W Inj 250/50ml (Prior Authorization required)
  • Levoflox/D5W Inj 500/100ml (Prior Authorization required)
  • Levoflox/D5W Inj 750/150ml (Prior Authorization required)
  • Levofloxacin Inj 25mg/ml (Prior Authorization required)
  • Linezolid Inj 2mg/ml (Prior Authorization required)
  • Liquilift Kit Trace (Prior Authorization required)
  • Maxipime Inj 1gm (Prior Authorization required)
  • Maxipime Inj 2gm (Prior Authorization required)
  • Merrem Inj 1gm (Prior Authorization required)
  • Merrem Inj 500mg (Prior Authorization required)
  • Metron/Nacl Inj 500mg (Prior Authorization required)
  • Metronidazol Inj 5mg/ml (Prior Authorization required)
  • Metronidazol Inj 5mg/ml (Prior Authorization required)
  • Minocin Inj 100mg (Prior Authorization required)
  • Moxifloxacin Inj (Prior Authorization required)
  • Multitrace-4 Inj (Prior Authorization required)
  • Multitrace-4 Inj Conc (Prior Authorization required)
  • Multitrace-4 Inj Neonatal (Prior Authorization required)
  • Multitrace-4 Inj Ped (Prior Authorization required)
  • Multitrace-5 Inj Conc (Prior Authorization required)
  • Multitrace-5 Inj Regular (Prior Authorization required)
  • Mycamine Inj 100mg (Prior Authorization required)
  • Mycamine Inj 50mg (Prior Authorization required)
  • Nafcillin Inj 10gm (Prior Authorization required)
  • Nafcillin Inj 1gm (Prior Authorization required)
  • Nafcillin Inj 1gm/50ml (Prior Authorization required)
  • Nafcillin Inj 2gm (Prior Authorization required)
  • Nafcillin Inj 2gm/100 (Prior Authorization required)
  • Nephramine   Inj 5.4% (Prior Authorization required)
  • Norml Saline Inj Flush
  • Normosol -M Inj /D5W
  • Normosol -R Inj
  • Normosol -R Inj /D5W
  • Normosol-R Inj Ph 7.4
  • Noxafil Inj 300/16.7 (Prior Authorization required)
  • Nutrilyte Inj
  • Opdivo Inj (Prior Authorization required)
  • Oral Electrolyte Sol
  • Orbactiv Sol 400mg (Prior Authorization required)
  • Penicill Gk/ Inj Dex 1MU (Prior Authorization required)
  • Penicill Gk/ Inj Dex 2MU (Prior Authorization required)
  • Penicill Gk/ Inj Dex 3MU (Prior Authorization required)
  • Perikabiven EMU (Prior Authorization required)
  • Piper/Tazoba Inj 12-1.5gm (Prior Authorization required)
  • Plasma-Lyte Inj -148
  • Plasma-Lyte Inj -A
  • Plasma-Lyte Inj 56/D5W
  • Pot Chl/D5W Inj 20meq/L
  • Pot Chl/D5W Inj 40meq/L
  • Pot Chl/NaCl Inj 20meq/L
  • Pot Chl/NaCl Inj 20meq/L
  • Pot Chl/NaCl Inj 40meq/L
  • Potassium Ch Inj NaCl
  • Potassium Ch Inj NaCl
  • Prevymis Inj 240/12 (Prior Authorization required)
  • Prevymis Inj 480/24 (Prior Authorization required)
  • Primaxin IV Inj 250mg (Prior Authorization required)
  • Primaxin IV Inj 500mg (Prior Authorization required)
  • Procalamine Inj 3% (Prior Authorization required)
  • Proparacaine Sol 0.5% Op
  • Prosol Inj 20% (Prior Authorization required)
  • Rapivab Inj 200mg/20 (Prior Authorization required)
  • Retrovir Inj 10mg/ml (Prior Authorization required)
  • Rifadin Inj 600 mg (Prior Authorization required)
  • Ringers Inj
  • Rituxan Inj 500mg (Prior Authorization required)
  • Selenium Inj 40mcg/ml (Prior Authorization required)
  • Sensipar Tab
  • Sivextro Inj 200mg (Prior Authorization required)
  • Smoflipid EMU (Prior Authorization required)
  • SMZ-TMP Inj 400-80/5 (Prior Authorization required)
  • Sod Acetate Inj 2meq/ml (Prior Authorization required)
  • Sod Acetate Inj 4meq/ml (Prior Authorization required)
  • Sod Chloride Inj 0.45%
  • Sod Chloride Inj 0.9%
  • Sod Chloride Inj 23.4%
  • Sod Chloride Inj 3%
  • Sod Chloride Inj 5%
  • Sod Cit-Gent Inj 4%-320 (Prior Authorization required)
  • Steril Water Inj
  • Sterile Dilu Sol Flolan
  • Synercid Inj 500mg (Prior Authorization required)
  • Tazicef Inj 1gm (Prior Authorization required)
  • Tazicef Inj 1gm/50ml (Prior Authorization required)
  • Tazicef Inj 2gm (Prior Authorization required)
  • Teflaro Inj 400mg (Prior Authorization required)
  • Teflaro Inj 600mg (Prior Authorization required)
  • Trace Elem 4 Inj Ped (Prior Authorization required)
  • Trogarzo Inj 150mg/ml (Prior Authorization required)
  • Trophamine   Inj 6% (Prior Authorization required)
  • Tygacil Inj 50mg (Prior Authorization required)
  • Vabomere Inj 2gm(1-1) (Prior Authorization required)
  • Vancomycin Inj 1000mg (Prior Authorization required)
  • Vancomycin Inj 100gm (Prior Authorization required)
  • Vancomycin Inj 10gm (Prior Authorization required)
  • Vancomycin Inj 1gm (Prior Authorization required)
  • Vancomycin Inj 500mg (Prior Authorization required)
  • Vancomycin Inj 500mg (Prior Authorization required)
  • Vancomycin Inj 5gm (Prior Authorization required)
  • Vancomycin Inj 750mg (Prior Authorization required)
  • Vancomycin Inj 750mg (Prior Authorization required)
  • Venofer Inj 20mg/ml (Prior Authorization required)
  • Vfend IV Inj 200mg (Prior Authorization required)
  • Vibativ Inj 250mg (Prior Authorization required)
  • Vibativ Inj 750mg (Prior Authorization required)
  • Vincristine Inj 1mg/ml (Prior Authorization required)
  • Zemdri Inj 500mg/10 (Prior Authorization required)
  • Zerbaxa Inj 1.5gm (Prior Authorization required)
  • Zinacef Inj 750mg (Prior Authorization required)
  • Zithromax Inj 500mg (Prior Authorization required)
  • Zosyn Inj 2-0.25gm (Prior Authorization required)
  • Zosyn Inj 3-0.375g (Prior Authorization required)
  • Zosyn Inj 36-4.5gm (Prior Authorization required)
  • Zosyn Inj 4-0.5gm (Prior Authorization required)
  • Zosyn Sol 2-0.25gm (Prior Authorization required)
  • Zosyn Sol 3-0.375g (Prior Authorization required)
  • Zosyn Sol 4-0.50gm (Prior Authorization required)
  • Zyvox Sol 2mg/ml (Prior Authorization required)
  • Zyvox Sol 2mg/ml (Prior Authorization required)

Removals:

  • Albenza Tab 200mg

 

October 2018

Additions:

  • Loratadine Chw 5mg Tab (Quantity Level Limit)
  • Prasugrel Tab 10mg (Quantity Level Limit)
  • Prasugrel Tab 5mg (Quantity Level Limit)
  • Tadalafil 20mg (PAH) (Quantity Level Limit)
  • Tazarotene Cre 0.1% (Quantity Level Limit)
  • Tizanidine HCl Tab 2mg (Quantity Level Limit)
  • Tizanidine HCl Tab 4mg (Quantity Level Limit)
  • Tymlos Pen 3120mcg (Prior Authorization Required, Quantity Level Limit)
  • Valganciclov Tab 450mg (Quantity Level Limit)

Removals:

  • Adcirca Tab 20mg

Other Updates:

  • Ondansetron HCl Tab 4mg (Increased Quantity Level Limit)
  • Ondansetron HCl Tab 8mg (Increased Quantity Level Limit)

 

September 2018

Additions:

  • Humira Pen Kit CD/UC/HS Starter Kit 80mg/0.8ml (Prior Authorization Required, Quantity Level Limit)
  • Humira Pen 80mg/ml and 40mg/0.4ml Kit PS/UV Starter Kit (Prior Authorization Required, Quantity Level Limit)

 

August 2018

Additions:

  • Epoetin Alfa-Epbx Inj (Prior Authorization Required)
  • Hydroxyprogesterone Inj 250mg/ml
  • Ibuprofen Tab 100mg Jr
  • Omega-3-Acid Cap 1gm (Quantity Level Limit, Step Therapy Required)
  • Sevelamer Tab 800mg (Step Therapy Required)
  • Telmisartan Tab (Quantity Level Limit)
  • Tolterodine Cap ER (Quantity Level Limit, Step Therapy Required)
  • Verzenio Tab (Prior Authorization Required, Quantity Level Limit)

Removals:

  • Amlodipine-Valsartan-Hydrochlorothiazide
  • Benzonatate Cap 150mg
  • Betaxolol
  • Captopril Tab
  • Captopril-Hydrochlorothiazide
  • Chlorpropamide
  • Climara Pro Patch Weekly
  • Desipramine
  • Diltiazem CD Cap 360/24hr
  • Femring
  • Fenofibrate Tab 145mg
  • Fenofibrate Tab 48mg
  • Fenofibric Cap DR
  • Fenoprofen Tab 600mg
  • Lidocaine Cre 3%
  • Makena Oil 250mg/ml
  • Meclofenamate Sod Cap
  • Methyltestos Cap 10mg
  • Nadolol
  • Nisoldipine Tab ER
  • Ondansetron Sol 4mg/5ml
  • Oxaprozin Tab 600mg
  • Oxytrol Patch
  • Pindolol
  • Pioglitazone-Glimepiride
  • Pioglitazone-Metformin
  • Potassium/Sodium Citrates & Citric Acid
  • Premarin Tabs
  • Premarin Vag Cre 0.625mg
  • Prempro And Premphase Tabs
  • Protriptyline
  • Tolazamide
  • Tolbutamide 500mg Tab
  • Verapamil Extended Release 24 Hour Cap 200mg
  • Verapamil Extended Release 24 Hour Cap 300mg

Other Updates:

  • Amlodipine Besylate Tab 2.5mg, 5mg (Increased Quantity Level Limit)
  • Baraclude Sol .05mg/ml (Added Quantity Level Limit)
  • Benazepril Tab 5mg, 10mg, 20mg (Quantity Level Limit Increased)
  • Benzonatate Cap 100mg, 200mg (Added Age Limit, Added Quantity Level Limit)
  • Bupropion SR (Removed Prior Authorization)
  • Clonidine-TTS Dis (Added Step Therapy)
  • Diclofenac Gel 1% (Removed Prior Authorization, Added Quantity Level Limit)
  • Diltiazem CD Capsule Extended Release 24 Hour 180mg (Increased Quantity Level Limit)
  • Diltiazem HCl ER Capsule Extended Release 24hr 180mg Oral (Increased Quantity Level Limit)
  • Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 180mg (Increased Quantity Level Limit)
  • Elmiron Cap 100mg (Added Prior Authorization)
  • Enalapril Tab 2.5mg, 5mg, 10mg (Increased Quantity Level Limit)
  • Estradiol Vag Cre 0.01% (Added Prior Authorization)
  • Flunisolide Nasal Soln 25mcg/Act (0.025%) (Added Quantity Level Limit)
  • Fosinopril Tab 10mg, 20mg (Increased Quantity Level Limit)
  • Griseofulvin Sus 125/5ml (Added Step Therapy)
  • Griseofulvin Tab Micr 500mg (Added Step Therapy)
  • Griseofulvin Tab Ultr (Added Step Therapy)
  • Hydrocodone W/ Homatropine Syrup, Tablet (Added Age Limit, Added Quantity Level Limit)
  • Lidocaine 5% Ointment (Added Prior Authorization)
  • Lisinopril Tab 2.5mg, 5mg, 10mg, 20mg, 30mg (Increased Quantity Level Limit)
  • Losartan Potassium Tab 25mg, 50mg (Increased Quantity Level Limit)
  • Mometasone Furoate Nasal Susp 50mcg/ACT (Added Quantity Level Limit)
  • Oxybutynin ER 15mg Tablet (Increased Quantity Level Limit)
  • Oxybutynin IR 5mg Tablet (Increased Quantity Level Limit)
  • Oxybutynin Syrup (Added Quantity Level Limit)
  • Propranolol Cap 80mg ER (Decreased Quantity Level Limit)
  • Quinapril Tab 5mg, 10mg, 20mg (Increased Quantity Level Limit)
  • Ramipril Cap 1.25mg, 2.5mg, 5mg (Increased Quantity Level Limit)
  • Tolterodine Tab (Added Step Therapy)
  • Verapamil HCl ER Tablet Extended Release 120mg (Increased Quantity Level Limit)

 

July 2018

Additions:

  • Baclofen Tab 5 Mg (Quantity Level Limit)
  • Diphenhydramine Liq 6.25mg
  • Pediatric Multiple Vitamins W/ Iron Drops 11 Mg/Ml
  • Phytonadione Tab 5mg
  • Zenpep Cap 15000 Unit
  • Zenpep Cap 3000 Unit    

Removals:

  • Mephyton Tab 5mg

 

June 2018

Additions:

  • Humira Pedia Inj Crohns Prefilled Syringe Kit 80mg/0.8ml & 40mg/0.4ml (Prior Authorization Required, Quantity Level Limit)
  • Humira Pedia Inj Crohns Prefilled Syringe Kit 80mg/0.8ml (Prior Authorization Required, Quantity Level Limit)
  • Humira Pen-injector kit 40mg/0.4ml (Prior Authorization Required, Quantity Level Limit)
  • Humira Prefilled Syringe Kit 10mg/0.1ml, 20mg/0.2ml, 40mg/0.4ml (Prior Authorization Required, Quantity Level Limit)
  • Polyethylene Glycol 3350 Powder (Quantity Level Limit)
  • Praziqueantel Tab 600mg
  • Tasigna 50mg (Prior Authorization Required, Quantity Level Limit)
  • Zenpep 10000 Unit

Removals:

  • Biltricide Tab 600mg

 

May 2018

Additions:

  • Colchicine Cap 0.6mg (Quantity Level Limit)
  • Firvanq Sol 25mg/Ml; 50mg/Ml
  • Flovent Hfa 44mcg , 110mcg, 220mcg (Quantity Level Limit)
  • Imbruvica Cap 70mg (Quantity Level Limit)
  • Jardiance Tablet (Quantity Level Limit, Step Therapy Required)
  • Synjardy Tablet & Synjardy Xr 5mg/1000mg; 12.5mg/1000mg; 10mg/1000mg; 25mg/1000mg (Quantity Level Limit, Step Therapy Required)

Other Updates:

  • Rosuvastatin Tablets (Remove Prior Authorization, Added Step Therapy)

 

April 2018

Additions:

  • Zenpep Cap 5000-17000-24000 UNIT; 25000-79000-105000 UNIT

 

March 2018

  • No Formulary Updates

 

February 2018

Additions:

  • Armodafanil 50, 150, 200, 250 mg tablets (Prior Authorization Required, Quantity Level Limit)
  • Estradiol   Cre 0.01%    
  • Janumet 50-1000 MG, 50-500 MG (Quantity Level Limit, Step Therapy Required)
  • Janumet XR ER 24HR 50-1000 MG, 50-500 MG, 00-1000 MG (Quantity Level Limit, Step Therapy Required)
  • Januvia 100 MG, 25 MG, 50 MG (Quantity Level Limit, Step Therapy Required)
  • Qvar Rediha Aer 40MCG, 80MCG (Quantity Level Limit)
  • Sprycel tablets, all strengths (Prior Authorization Required, Quantity Level Limit)
  • Tamiflu 30 mg, 45mg, 75mg (Quantity Level Limit)

Removals:

  • Betoptic-S susp 0.25%
  • Brimonidine 0.15% ophth soln
  • Cefaclor ER tablets 500 mg; Use Cefaclor IR
  • Cefixime Suspension, all strengths
  • Cephalexin tablets, all strengths; Use capsules
  • Ciloxan ointment 0.3%
  • Ciprofloxacin ER tablets, all strengths; Use ciprofloxacin IR
  • Estrace Cream 0.01%
  • FML Forte 0.25%
  • Fondaparinux, all strengths
  • Fragmin, all strengths
  • Gatifloxacin solution 0.5%
  • Jentadueto 2.5/1000 mg, 2.5/850 mg, 2.5/500 mg tablets
  • Jentadueto XR 2.5-1000 MG, 5-1000 MG
  • Modafinil tablets 100 MG, 200 MG
  • Morphine ER Capsule (generic Kadian), all strengths
  • Moxifloxacin Solution 0.5%
  • Neomycin/polymixin/HC Susp
  • Ofloxacin tablets, all strengths
  • Oxycodone 5mg CAPSULE, Use tablets
  • Oxycodone concentrated solution (20mg/mL)
  • Oxycontin, all strengths
  • Oxymorphone IR tablets, all strengths
  • Pen needles; Use BD brand
  • Pred Mild 0.12%
  • Suprax chew tablets, all strengths
  • Tobradex Ointment 0.3-0.1%
  • Tobradex ST Suspension 0.3-0.05%
  • Tobramycin/dexamethasone Suspension 0.3-0.1%
  • Tobrex Ointment 0.3%
  • Tradjenta 5mg