Miscellaneous

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Drug Use Review Documents

PDL Status Values

Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the Non-Preferred Drugs in Select PDL Classes prior authorization criteria. New drugs will be listed as N until reviewed by the P&T Committee and are subject to the New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required but eligible patients will encounter a co-pay at the pharmacy.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.

To request a Prior Authorization, please use this form.

Generic Name Brand Name Form PDL
Status
Current Drug Use Criteria New Drug Evaluation
calc/mag/pot/boron/lys/thr/sil CALCOR TABLET Y    
vit C/E/zinc/lutein/zeaxanthin OCUVITE EYE HEALTH TAB CHEW Y    
eluxadoline VIBERZI TABLET N   Mar 31, 2016
methadone HCl METHADONE HCL POWDER N    
paroxetine mesylate PAROXETINE MESYLATE CAPSULE N    
paroxetine mesylate BRISDELLE CAPSULE N    
pregabalin LYRICA CR TAB ER 24H N PA Document  
sapropterin dihydrochloride KUVAN TABLET SOL N PA Document Jul 25, 2013
5-hydroxytryptophan (5-HTP) 5-HTP CAPSULE    
AA/prot/arginine/C/zinc/copper PROTEINEX WC LIQUID    
AA8/a-carnit/grap/cocoa/hrb126 GABADONE CAPSULE    
AA9/a-carnitin/dex/cocoa/hc127 SENTRA AM CAPSULE    
AA9/a-carnitin/dex/cocoa/hc128 SENTRA PM CAPSULE    
acai berry extract ACAI BERRY CAPSULE    
acemannan/allantoin RADIGEL GEL (GRAM)    
acetic acid ACETIC ACID IRRIG SOLN    
acetic acid DISP DOUCHE EXTRA CLNS V&W SOLUTION    
acetohydroxamic acid LITHOSTAT TABLET    
acetone ACETONE LIQUID    
acetylcysteine ACETYLCYSTEINE VIAL    
agalsidase beta FABRAZYME VIAL    
albumin human FLEXBUMIN IV SOLN    
albumin human BUMINATE IV SOLN    
albumin human ALBUTEIN IV SOLN    
albumin human ALBUMINAR-5 IV SOLN    
albumin human ALBUMIN (HUMAN) IV SOLN    
albumin human ALBUKED-25 VIAL    
albumin human PLASBUMIN-5 VIAL    
albumin human PLASBUMIN-25 VIAL    
albumin human KEDBUMIN VIAL    
albumin human ALBUTEIN VIAL    
albumin human ALBURX VIAL    
albumin human ALBUMINAR-25 VIAL    
albumin human ALBUKED-5 VIAL    
albumin human/sodium chloride ALBUMIN-SALINE VIAL    
alfalfa ALFALFA TABLET    
alglucosidase alfa LUMIZYME VIAL    
aloe vera ALOE VERA CAPSULE    
alosetron HCl LOTRONEX TABLET    
alosetron HCl ALOSETRON HCL TABLET    
alpha lipoic acid ALPHA LIPOIC ACID CAPSULE    
alpha lipoic acid ALPHA LIPOIC ACID TABLET    
alpha-1-proteinase inhibitor ZEMAIRA VIAL    
alpha-1-proteinase inhibitor PROLASTIN C VIAL    
alpha-1-proteinase inhibitor GLASSIA VIAL    
alpha-1-proteinase inhibitor ARALAST NP VIAL    
alprostadil CAVERJECT AMPUL    
alprostadil EDEX KIT    
alprostadil CAVERJECT KIT    
alprostadil MUSE SUPP.URETH    
alprostadil CAVERJECT VIAL    
amino acids/protein hydrolys PROTEINEX-18 LIQUID    
amino acids/protein hydrolys PROTEINEX-100 LIQUID    
amino acids/protein hydrolys PROTEINEX LIQUID    
ammonium alum ALUM POWDER    
anagrelide HCl ANAGRELIDE HCL CAPSULE    
anagrelide HCl AGRYLIN CAPSULE    
anise oil ANISE OIL OIL    
antithrombin III (plasma der) THROMBATE III VIAL    
ascorbate calcium/B5/quercetin ANTI-ALLERGY FORMULA TABLET    
asfotase alfa STRENSIQ VIAL    
autologous cult. chondrocytes CARTICEL VIAL    
avanafil STENDRA TABLET    
azathioprine sodium AZATHIOPRINE SODIUM VIAL    
B infantis/B ani/B lon/B bifid PROBIOTIC 4X TABLET DR    
B3/azel ac/zinc/B6/copper/FA VP-ZEL TABLET    
B3/azel/quer/tur/FA/B6/zn/copp NIACIN-AZE AC-TURMER-FA-B6-ZN TABLET    
B3/B6/C/FA/coppr/Mg/Zn/alip ac NICADAN TABLET    
B3/B6/folic/zinc/copper/co-Q10 NICADAN ZX TABLET    
Bacillus coagulans/inulin PROBIOTIC FORMULA CAPSULE    
bacteriostatic sodium chloride SODIUM CHLORIDE VIAL    
barium sulfate BAROSPERSE POWDER    
basiliximab SIMULECT VIAL    
bean pod extract STARCH BLOCKER TABLET    
belatacept NULOJIX VIAL    
beractant SURVANTA VIAL    
betaine CYSTADANE POWDER    
betaine HCl BETAINE HCL TABLET    
black cohosh BLACK COHOSH TABLET    
black cohosh root MENOPAUSE SUPPORT TABLET    
black cohosh root extract BLACK COHOSH CAPSULE    
boric acid BORIC ACID POWDER    
broccoli flower BROCCOLI TABLET    
C/rut/hes/bioflav,cit/Butch br TROMBONEX CAPSULE    
C1 esterase inhibitor BERINERT KIT    
C1 esterase inhibitor HAEGARDA VIAL    
C1 esterase inhibitor CINRYZE VIAL    
C1 esterase inhibitor BERINERT VIAL    
C1 esterase inhibitor, recomb RUCONEST VIAL    
caffeine/choline/AA 11/HC130 HYPERTENSA CAPSULE    
caffeine/choline/AA no.7/hb125 APPTRIM CAPSULE    
carbomer/polysorbates SUSPENDOL-S LIQUID    
carglumic acid CARBAGLU TAB DISPER    
cascara sagrada CASCARA SAGRADA CAPSULE    
castor oil CASTOR OIL OIL    
cerliponase alfa BRINEURA KIT    
cerliponase alfa BRINEURA VIAL    
chlorhexidine gluconate CHLORHEXIDINE GLUCONATE MOUTHWASH    
chlorophyllin/alfalfa CHLOROPHYLL TABLET    
cho/AA21/gaba/ino/grif/glu/cre PERCURA CAPSULE    
chol/AA10/gaba/herb129/prt/lec THERAMINE PLUS POWD PACK    
choline bit/AA 10/gaba/herb129 THERAMINE CAPSULE    
choline bit/amino acid7/hrb125 APPTRIM-D CAPSULE    
choline dihydrogen citrate CHOLINE CITRATE TABLET    
cinacalcet HCl SENSIPAR TABLET    
cinnamon CINNAMON OIL OIL    
cinnamon bark CINNAMON CAPSULE    
citric ac/gluconolact/mag carb RENACIDIN IRRIG SOLN    
citric acid/sodium citrate VIRTRATE-2 SOLUTION    
citric acid/sodium citrate SODIUM CITRATE-CITRIC ACID SOLUTION    
citric acid/sodium citrate ORACIT SOLUTION    
coagulation factor X COAGADEX VIAL    
cocaine HCl COCAINE HCL CRYSTALS    
cocoa butter SKIN SOFTENING LOTION    
codeine phosphate CODEINE PHOSPHATE POWDER PA Document  
compound veh.susp sugar-free 1 ORA-BLEND SF ORAL SUSP    
compound vehicle sugar-free 9 ORA-SWEET-SF LIQUID    
compound vehicle susp SF no.20 ORA PLUS ORAL SUSP    
compounding vehicle no.8 ORA SWEET LIQUID    
compounding vehicle susp no.19 ORA-BLEND ORAL SUSP    
cranberry conc/C/Bacill coag CRANBERRY TABLET    
cranberry fruit CRANBERRY TABLET    
cranberry fruit extract CRANBERRY CAPSULE    
cranberry fruit extract CRANBERRY FRUIT CAPSULE    
cranberry fruit extract CRANBERRY TABLET    
cromolyn sodium GASTROCROM ORAL CONC    
cromolyn sodium CROMOLYN SODIUM ORAL CONC    
cupric sulfate COPPER SULFATE SOLUTION    
cyclosporine SANDIMMUNE AMPUL    
cyclosporine CYCLOSPORINE AMPUL    
dextran 40 in 0.9 % NaCl LMD 10% WITH 0.9% SOD CHLORIDE IV SOLN    
dextran 40 in 0.9 % NaCl GENTRAN 40 IN NORMAL SALINE IV SOLN    
dextran 40 in dextrose 5 % LMD 10% WITH 5% DEXTROSE IV SOLN    
dextran 40 in dextrose 5 % GENTRAN 40 IN DEXTROSE 5% IV SOLN    
dextran 75 in 0.9 % NaCl GENTRAN 75 IN NORMAL SALINE IV SOLN    
dextran 75 in 0.9 % NaCl DEXTRAN 75 IN NORMAL SALINE IV SOLN    
dextran 75/inverted sugar 10 % GENTRAN 75 IN TRAVERT 10% IV SOLN    
dextromethorphan Hbr/quinidine NUEDEXTA CAPSULE PA Document  
dichlorphenamide KEVEYIS TABLET PA Document Mar 22, 2018
dietary supplement,misc comb14 LISTER-V CAPSULE    
diluent 1,live virus vac(swfi) DILUENT-MERCK LIVE VIRUS VACC VIAL    
diluent for epoprostenol(glyc) PH 12 DILUENT FOR FLOLAN VIAL    
diluent for epoprostenol(glyc) DILUENT FOR FLOLAN VIAL    
diluent for epoprostenol(glyc) DILUENT FOR EPOPROSTENOL VIAL    
diluent for ixabepilone DILUENT FOR IXEMPRA VIAL    
diluent for rasburicase (pol) DILUENT FOR ELITEK AMPUL    
diluent for treprostinil (gly) DILUENT FOR REMODULIN VIAL    
diluent, insulin aspart no.1 DILUTING MEDIUM FOR NOVOLOG VIAL    
diluent,Hib,tet-conj,0.4% NaCl DILUENT FOR ACTHIB VIAL    
diluent,meninACWY135vac,MD,wtr DILUENT FOR MENOMUNE VIAL    
diluent,meninACWY135vac,SD,wtr DILUENT FOR MENOMUNE VIAL    
diluent,rabies vac,hum (water) DILUENT FOR IMOVAX SYRINGE    
diluent,yellow fev vac,MD,NaCl DILUENT FOR YF-VAX VIAL    
diluent,yellow fev vac,SD,NaCl DILUENT FOR YF-VAX VIAL    
diluent,yellw fev vac,0.4%NaCl DILUENT FOR STAMARIL SYRINGE    
dimethyl sulfoxide CRYOSERV VIAL    
dong quai DONG QUAI CAPSULE    
ecallantide KALBITOR VIAL    
Echinacea ECHINACEA HERB CAPSULE    
Echinacea ECHINACEA CAPSULE    
Echinacea ECHINACEA TABLET    
echinacea purp leaf,e.angus rt ECHINACEA CAPSULE    
Echinacea purpurea extract ECHINACEA TABLET    
Echinacea root/goldenseal root ECHINACEA-GOLDENSEAL TABLET    
eculizumab SOLIRIS VIAL    
edaravone RADICAVA PIGGYBACK    
eliglustat tartrate CERDELGA CAPSULE    
elosulfase alfa VIMIZIM VIAL    
emicizumab-kxwh HEMLIBRA VIAL    
erythromycin base ERYTHROMYCIN POWDER    
etelcalcetide hydrochloride PARSABIV VIAL    
evening primrose oil EVENING PRIMROSE CAPSULE    
factor IX MONONINE VIAL    
factor IX ALPHANINE SD VIAL    
factor IX cplx(pcc)no4,3factor PROFILNINE VIAL    
factor IX cplx(pcc)no4,3factor KONYNE 80 VIAL    
factor IX cplx(pcc)no6,3factor BEBULIN VIAL    
factor IX human rec,pegylated REBINYN VIAL    
factor IX human recomb,Thr 148 IXINITY VIAL    
factor IX human recombinant RIXUBIS VIAL    
factor IX human recombinant BENEFIX VIAL    
factor IX rec, Fc fusion protn ALPROLIX VIAL    
factor IX recom,albumin fusion IDELVION VIAL    
factor XIII CORIFACT VIAL    
factor XIII A-subunit,recomb TRETTEN VIAL    
fat emul/soy/mct/oliv/fish oil SMOFLIPID EMULSION    
fat emulsions TRAVAMULSION EMULSION    
fat emulsions NUTRILIPID EMULSION    
fat emulsions LIPOSYN III EMULSION    
fat emulsions LIPOSYN II EMULSION    
fat emulsions INTRALIPID EMULSION    
FD and C blue no.1 STERIBLU VIAL    
fentanyl citrate FENTANYL CITRATE POWDER    
finasteride PROPECIA TABLET    
finasteride FINASTERIDE TABLET    
fish oil/E/fatty acid5/herb137 SUPER OMEGA-3 CAPSULE    
flavoring agent WATERMELON OIL    
flavoring agent STRAWBERRY OIL    
flavoring agent RASPBERRY OIL    
flavoring agent LEMON OIL    
flavoring agent CLOVE OIL    
flavoring agent CINNAMON OIL    
flavoring agent BUTTER RUM OIL    
flavoring agent APPLE OIL    
flaxseed oil FLAX OIL CAPSULE    
flaxseed oil FLAXSEED OIL CAPSULE    
flaxseed/evening prim/bilberry VP-PRECIP CAPSULE    
flibanserin ADDYI TABLET   Mar 31, 2016
flumazenil FLUMAZENIL VIAL    
fluoride (sodium) SF 5000 PLUS CREAM (G)    
fluoride (sodium) DENTA 5000 PLUS CREAM (G)    
fluoride (sodium) SODIUM FLUORIDE DROPS    
fluoride (sodium) FLUOR-A-DAY DROPS    
fluoride (sodium) SF GEL (GRAM)    
fluoride (sodium) DENTAGEL GEL (GRAM)    
fluoride (sodium) SODIUM FLUORIDE SOLUTION    
fluoride (sodium) LUDENT FLUORIDE TAB CHEW    
fluoride (sodium) FLUORIDE TAB CHEW    
folic acid/inositol PREGNITUDE POWD PACK    
galsulfase NAGLAZYME VIAL    
garlic GARLIC CAPSULE    
garlic GARLIN TABLET    
garlic GARLIC ONE-A-DAY TABLET    
garlic GARLIC TABLET    
gelatin GELFILM EACH    
ginger root GINGER ROOT CAPSULE    
ginkgo biloba GINKGO BILOBA TABLET    
ginseng GINSENG CAPSULE    
glucose PHYSIOLOGICAL GLUCOSE SCREEN LIQUID    
glutamine ENDARI POWD PACK    
glycerin GLYCERIN LIQUID    
glycerin/propylene glycol/watr PERSONAL LUBRICANT SOLUTION    
glycerin/propylene glycol/watr LUBRICATING SOLUTION    
glycerol phenylbutyrate RAVICTI LIQUID    
goldenseal GOLDENSEAL CAPSULE    
goldenseal root GOLDEN SEAL CAPSULE    
goldenseal root GOLDEN SEAL ROOT CAPSULE    
grape seed extract GRAPE SEED EXTRACT CAPSULE    
green tea leaf xt/green tea lf GREEN TEA COMPLEX TABLET    
hemin PANHEMATIN VIAL    
herbal complex no.174 ECHINACEA-GOLDENSEAL CAPSULE    
hestarch 130/0.4 in 0.9 % NaCl VOLUVEN PLAST. BAG    
hetastarch in 0.9 % NaCl HETASTARCH-0.9% NACL PLAST. BAG    
hetastarch in 0.9 % NaCl HESPAN PLAST. BAG    
hetastarch/e-lyts,lactated HEXTEND LACTATED ELECTROLYTE PLAST. BAG    
hum prothrombin cplx(PCC)4fact KCENTRA VIAL    
hydrocodone bitartrate HYDROCODONE BITARTRATE CRYSTALS    
hydrocortisone HYDROCORTISONE POWDER    
hydrocortisone acetate HYDROCORTISONE ACETATE POWDER    
hydrocortisone acetate ANUCORT-HC SUPP.RECT    
hydrocortisone acetate HYDROCORTISONE ACETATE SUPP.RECT    
hydrocortisone acetate ANUDIL HC SUPP.RECT    
hydromorphone HCl HYDROMORPHONE HCL POWDER    
hydroxyurea DROXIA CAPSULE    
hydroxyurea SIKLOS TABLET    
icatibant acetate FIRAZYR SYRINGE    
idursulfase ELAPRASE VIAL    
imiglucerase CEREZYME VIAL    
isopropyl alcohol ISOPROPYL RUBBING ALCOHOL SOLUTION    
isopropyl alcohol ISOPROPYL ALCOHOL SOLUTION    
isopropyl alcohol DY-O-DERM SOLUTION    
kava KAVA KAVA CAPSULE    
L. acidophilus/Bifid. animalis DIALYVITE CHEWABLE PROBIOTIC TAB CHEW    
L. acidophilus/L.bulgaricus FLORANEX GRAN PACK    
L. acidophilus/L.bulgaricus FLORANEX TABLET    
L. acidophilus/Lactobac spor ACIDOPHILUS TABLET    
L. acidophilus/pectin, citrus ACIDOPHILUS-PECTIN TABLET    
L. acidophilus/pectin, citrus ACIDOPHILUS TABLET    
L. acidophilus/Strept/La p-cas RISAQUAD-2 CAPSULE    
L. acidophilus/Strept/La p-cas RISAQUAD CAPSULE    
L.acidoph,saliva/B.bif/S.therm ACIDOPHILUS CAPSULE    
L.acidoph/L.bulg/B.bif/S.therm RISA-BID TABLET    
Lactobacil 2-S.thermo-Bifido 1 VSL#3 DS PACKET    
Lactobacillus acidophilus ACIDOPHILUS CAPSULE    
Lactobacillus acidophilus MORE-DOPHILUS POWDER    
Lactobacillus acidophilus/pect ACIDOPHILUS-PECTIN CAPSULE    
Lactobacillus acidophilus/pect KALA TABLET    
Lactobacillus casei/folic acid RESTORA RX CAPSULE    
lactobacillus combo no.5 PROVELLA TABLET DR    
Lactobacillus reuteri PEDIA-LAX PROBIOTIC YUMS TAB CHEW    
laronidase ALDURAZYME VIAL    
levocarnitine CARNITOR SF SOLUTION    
levocarnitine LEVOCARNITINE TABLET    
levocarnitine CARNITOR TABLET    
levocarnitine LEVOCARNITINE VIAL    
levocarnitine CARNITOR VIAL    
levocarnitine (with sugar) LEVOCARNITINE SOLUTION    
levocarnitine (with sugar) CARNITOR SOLUTION    
licorice root LICORICE ROOT CAPSULE    
lutein LUTEIN CAPSULE    
lutein LUTEIN TABLET    
lutein/zeaxanthin OCUVITE LUTEIN 25 CAPSULE    
lutein/zeaxanthin LUTEIN-ZEAXANTHIN CAPSULE    
lutetium Lu 177 dotatate LUTATHERA VIAL    
lycopene LYCOPENE CAPSULE    
m-vit/folic acid/D3/K2/herb222 STAGES MEN'S MULTI-VITAMIN TABLET    
magnesium sulfate EPSOM SALT CRYSTALS    
mannitol/sorbitol solution SORBITOL-MANNITOL IRRIG SOLN    
megestrol acetate MEGESTROL ACETATE ORAL SUSP    
megestrol acetate MEGACE ES ORAL SUSP    
megestrol acetate MEGACE ORAL SUSP    
methylphenidate HCl METHYLPHENIDATE HCL POWDER    
mifepristone MIFEPREX TABLET    
miglustat ZAVESCA CAPSULE    
miglustat MIGLUSTAT CAPSULE    
milnacipran HCl SAVELLA TAB DS PK PA Document  
milnacipran HCl SAVELLA TABLET PA Document  
mineral oil MINERAL OIL OIL    
mineral oil MURI-LUBE MINERAL OIL VIAL    
morphine sulfate MORPHINE SULFATE POWDER    
mucositis and stomatitis comb1 MUCOTROL WAFER    
mucositis and stomatitis comb2 EPISIL SOL-GEL    
multivit-min/iron/folic/hrb186 HAIR, SKIN AND NAILS TABLET    
mupirocin/chlorhexidine/dimeth DERMACINRX SURGICAL PHARMAPAK KIT    
mupirocin/chlorhexidine/dimeth DERMACINRX CLORHEXACIN KIT    
mv-min/vit C/glut/lysine/hb124 GERM DEFENSE TABLET EFF    
mv-min/vit C/glut/lysine/hb124 EFFERVESCENT HEALTH FORMULA TABLET EFF    
mv-mins no.22/lut/om3/dha/epa TOZAL CAPSULE    
mv-mins/folic acid/guarana/caf ONE DAILY TABLET    
mvit,calc,min/folic ac/hrb176 ESTRO SUPPORT ES TABLET    
mycophenolate mofetil HCl MYCOPHENOLATE MOFETIL VIAL    
mycophenolate mofetil HCl CELLCEPT VIAL    
naloxone HCl NALOXONE HCL POWDER    
neomycin sulf/polymyxin B sulf NEOMYCIN-POLYMYXIN B AMPUL    
neomycin sulf/polymyxin B sulf NEOSPORIN G.U. IRRIGANT VIAL    
neomycin sulf/polymyxin B sulf NEOMYCIN-POLYMYXIN B VIAL    
neomycin sulfate NEOMYCIN SULFATE POWDER    
niacin1/folic/B12/iron/zinc/Cr DERMANIC TAB IR DR    
nitisinone ORFADIN CAPSULE    
nitisinone ORFADIN ORAL SUSP    
nitisinone NITYR TABLET    
nitroglycerin RECTIV OINT. (G)   Jun 28, 2012
omega-3 fatty acids/dha/epa OCEAN BLUE PRENATAL DHA CAPSULE    
omega-3/dha/epa/lut/zeaxanthin ADVANCED EYE HEALTH CAPSULE    
omega-3/dha/epa/vit E SYSTANE VITAMIN CAPSULE    
omega-3s/dha/epa/fish oil OMEGA-3 IQ CHILDREN'S CAP CHEW    
ospemifene OSPHENA TABLET PA Document  
oxycodone HCl OXYCODONE HYDROCHLORIDE POWDER    
Panax ginseng root KOREAN GINSENG CAPSULE    
Panax ginseng root PANAX GINSENG TABLET    
Panax ginseng root extract GINSENG EXTRACT CAPSULE    
papain PAPAYA TABLET    
papaya PAPAYA TABLET    
pegademase bovine ADAGEN VIAL    
pegvisomant SOMAVERT VIAL    
pentastarch/0.9 % sod chloride PENTASPAN INFUS. BTL    
peppermint oil PEPPERMINT SPIRIT    
phenol ULCEREASE LIQUID    
plasma protein fraction PLASMANATE VIAL    
plla/carboxymethylcel/mannitol SCULPTRA VIAL    
poractant alfa CUROSURF VIAL    
pot sor/he-cellulos/pov/hyalur GELCLAIR GEL PACKET    
potassium citrate UROCIT-K TABLET ER    
potassium citrate POTASSIUM CITRATE ER TABLET ER    
potassium citrate/citric acid POTASSIUM CITRATE-CITRIC ACID PACKET    
potassium citrate/citric acid VIRTRATE-K SOLUTION    
potassium citrate/citric acid POTASSIUM CITRATE-CITRIC ACID SOLUTION    
prasterone (DHEA) DHEA CAPSULE    
prasterone (DHEA) DHEA TABLET    
procyanidolic oligomers PYCNOGENOL TABLET    
progesterone PROGESTERONE POWDER    
propylene glycol PROPYLENE GLYCOL LIQUID    
protein C, human CEPROTIN VIAL    
radium-223 dichloride XOFIGO VIAL    
red yeast rice RED YEAST RICE CAPSULE    
resver/wine/bfl/grpsd/pc/C/pom RED WINE CAPSULE    
resveratrol RESVERATROL CAPSULE    
rilonacept ARCALYST VIAL    
riluzole RILUZOLE TABLET    
riluzole RILUTEK TABLET    
Ringer's solution TIS-U-SOL IRRIG SOLN    
Ringer's solution RINGERS IRRIGATION IRRIG SOLN    
Ringer's solution,lactated LACTATED RINGERS IRRIG SOLN    
saccharin DILUENT ORAL SUSP    
saliva substitute combo no.3 AQUORAL SPRAY/PUMP    
saliva substitute combo no.7 DRY MOUTH MOUTHWASH    
samarium Sm 153 lexidronam QUADRAMET VIAL    
sapropterin dihydrochloride KUVAN POWD PACK PA Document  
saw palmetto SAW PALMETTO CAPSULE    
sebelipase alfa KANUMA VIAL    
shark cartilage SHARK FIN CARTILAGE CAPSULE    
shark cartilage SHARK CARTILAGE CAPSULE    
Siberian ginseng root SIBERIAN GINSENG CAPSULE    
simethicone SIMETHICONE CAPSULE    
simethicone PHAZYME CAPSULE    
simethicone GAS-X ULTRA STRENGTH CAPSULE    
simethicone GAS-X CAPSULE    
simethicone GAS RELIEF CAPSULE    
simethicone ANTI-GAS CAPSULE    
simethicone GAS RELIEF DROPS SUSP    
simethicone SIMETHICONE DROPS SUSP    
simethicone INFANTS' GAS RELIEF DROPS SUSP    
simethicone INFANT GAS RELIEF DROPS SUSP    
simethicone COLIC DROPS SUSP    
simethicone SIMETHICONE TAB CHEW    
simethicone MYTAB GAS MAXIMUM STRENGTH TAB CHEW    
simethicone MYTAB GAS TAB CHEW    
simethicone MI-ACID TAB CHEW    
simethicone GAS-X TAB CHEW    
simethicone GAS RELIEF TAB CHEW    
simethicone GAS RELIEF 80 TAB CHEW    
sod,pot chlor/mag/sod,pot phos TIS-U-SOL PENTALYTE IRRIG SOLN    
sod/pot/K cit/sod cit/cit acid POTASS CIT-SOD CIT-CITRIC ACID SOLUTION    
sod/pot/K cit/sod cit/cit acid VIRTRATE-3 SOLUTION    
sod/pot/K cit/sod cit/cit acid TRICITRATES SOLUTION    
sodium benzoate/sod phenylacet SODIUM PHENYLACET-SOD BENZOATE VIAL    
sodium benzoate/sod phenylacet AMMONUL VIAL    
sodium fluoride/vitamin D3 FLORIVA DROPS    
sodium fluoride/xylitol FLUOR-A-DAY TAB CHEW    
sodium phenylbutyrate SODIUM PHENYLBUTYRATE POWDER    
sodium phenylbutyrate BUPHENYL POWDER    
sodium phenylbutyrate SODIUM PHENYLBUTYRATE TABLET    
sodium phenylbutyrate BUPHENYL TABLET    
sorbitol solution SORBITOL IRRIG SOLN    
sorbitol solution SORBITOL SOLUTION    
sufentanil citrate SUFENTANIL CITRATE POWDER    
sugammadex sodium BRIDION VIAL    
tacrolimus PROGRAF AMPUL    
taliglucerase alfa ELELYSO VIAL    
teduglutide GATTEX KIT    
tiopronin THIOLA TABLET    
triamcinolone acetonide TRIAMCINOLONE ACETONIDE PASTE (G)    
triamcinolone acetonide ORALONE PASTE (G)    
triamcinolone acetonide TRIAMCINOLONE ACETONIDE POWDER    
ubidecarenone COENZYME Q10 CAPSULE    
ubidecarenone CO Q-10 CAPSULE    
ubidecarenone CO Q10 CAPSULE    
ubidecarenone COENZYME Q10 TABLET    
ubidecarenone/omega-3/vit E COQ-10 & FISH OIL CAPSULE    
ubidecarenone/vit E acet CO Q-10 CAPSULE    
valerian root VALERIAN ROOT CAPSULE    
vardenafil HCl STAXYN TAB RAPDIS    
vardenafil HCl LEVITRA TABLET    
velaglucerase alfa VPRIV VIAL    
venom-wasp VENOMIL MAINTENANCE VIAL    
venom-wasp ALBAY VIAL    
venom-wasp protein VENOMIL INDIVIDUAL DIAGNOSTIC VIAL    
vestronidase alfa-vjbk MEPSEVII VIAL    
vit A,C,E/dietary supp no.12 AIRSHIELD TABLET EFF    
vit B comp/vit E/folic/herb156 ESTRO VITAL NUTRIENTS TABLET    
vit C/dios/rut/bioflav/butc br TROMBONEX-D CAPSULE    
vit C/E/Zn/coppr/lutein/zeaxan PRESERVISION AREDS 2 CAPSULE    
vit C/E/Zn/coppr/lutein/zeaxan OCUVITE LUTEIN & ZEAXANTHIN CAPSULE    
vit C/vit E ac/selenium/ginkgo MEMORY COMPLEX TABLET    
vit C/vit E/lutein/minerals 1 PROSIGHT WITH LUTEIN CAPSULE    
vit C/zinc/Kginseng/rose/hrb62 IMMUNE SUPPORT COMPLEX TABLET    
vits A,C,E/mins/herbal no.147 GERM DEFENSE PM TABLET EFF    
von Willebrand factor VONVENDI VIAL    
water ENFAMIL LIQUID    
water for inj.,bacteriostatic WATER VIAL    
water for injection,sterile WATER AMPUL    
water for injection,sterile WATER IV SOLN    
water for injection,sterile WATER VIAL    
water for injection,sterile STERILE WATER FOR KCENTRA VIAL    
water/me-paraben/propylparaben WATER VIAL    
yohimbe bark YOHIMBE TABLET    
Zinc Mth/Copper/Saw Palm/Gnsg PROSTATE HEALTH FORMULA CAPSULE