Tetracyclines, Oral
PDL Reference Documents
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.
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.
| NDC | Brand Name | Generic Name | Form | Strength | PDL Status |
Rebate | Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|
| 42806014301 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 150 mg | Y | Quantity Limit | |
| 53746055401 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 150 mg | Y | Quantity Limit | |
| 60687069101 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 150 mg | Y | Quantity Limit | |
| 60687069111 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 150 mg | Y | Quantity Limit | |
| 65162055410 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 150 mg | Y | Quantity Limit | |
| 42806014448 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 300 mg | Y | Quantity Limit | |
| 53746055548 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 300 mg | Y | Quantity Limit | |
| 60687070511 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 300 mg | Y | Quantity Limit | |
| 60687070565 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 300 mg | Y | Quantity Limit | |
| 65162055548 | DEMECLOCYCLINE HCL | demeclocycline HCl | TABLET | 300 mg | Y | Quantity Limit | |
| 00143314250 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 00143980305 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 00143980350 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 00904042804 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 00904042806 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 27808023301 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 27808023302 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 50268027811 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 50268027815 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 51079052201 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 53489011902 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 53489011905 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 60687051311 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 60687051365 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 62135098505 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 62135098550 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 62332036350 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 62332036371 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 69238110002 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 69238110005 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 72578005505 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 72578005518 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 00485004150 | ED DOXY-CAPS | doxycycline hyclate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 00143980250 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 50268027711 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 50268027715 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 53489011802 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 62135098405 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 62135098450 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 62332036250 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 72578005418 | DOXYCYCLINE HYCLATE | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 43538062030 | MORGIDOX | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 00069094050 | VIBRAMYCIN | doxycycline hyclate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 00143211205 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 00143211250 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 00378016702 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 00378016713 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 00591555305 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 00591555350 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 00904043004 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 00904043006 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 00904043095 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 23155037605 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 23155037625 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031001 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031005 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031007 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Quantity Limit | |
| 24658031008 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Quantity Limit | |
| 24658031010 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031020 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031021 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Quantity Limit | |
| 24658031030 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Quantity Limit | |
| 24658031050 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031201 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031205 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031210 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031220 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 24658031250 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 27808023401 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 27808023402 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 42192050105 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 42806031005 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 42806031050 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 42806031205 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 42806031250 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 50268027911 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 50268027915 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 51079055401 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 53489012001 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 53489012002 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 53489012005 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 53489012060 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 62135062601 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 62135062605 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 62135062610 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 62135062650 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 62135062696 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 62584069311 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 62584069321 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 72578000105 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 72578000118 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 85477050105 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 72336059686 | LYMEPAK | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 72336059687 | LYMEPAK | doxycycline hyclate | TABLET | 100 mg | Y | Y | Quantity Limit |
| 27241015402 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 150 mg | N | Y | Quantity Limit |
| 60505438406 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 150 mg | N | Y | Quantity Limit |
| 62135090820 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 150 mg | N | Y | Quantity Limit |
| 62332038860 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 150 mg | N | Y | Quantity Limit |
| 68180065407 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 150 mg | N | Y | Quantity Limit |
| 42806036201 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 20 mg | Y | Y | Quantity Limit |
| 53489064701 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 20 mg | Y | Y | Quantity Limit |
| 62135062390 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 20 mg | Y | Y | Quantity Limit |
| 62332035231 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 20 mg | Y | Y | Quantity Limit |
| 68047071401 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 20 mg | Y | Y | Quantity Limit |
| 68047071460 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 20 mg | Y | Y | Quantity Limit |
| 62135062560 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 50 mg | N | Y | Quantity Limit |
| 62332049960 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 50 mg | N | Y | Quantity Limit |
| 27241015302 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 75 mg | N | Y | Quantity Limit |
| 60505438206 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 75 mg | N | Y | Quantity Limit |
| 62135090720 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 75 mg | N | Y | Quantity Limit |
| 62332038760 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 75 mg | N | Y | Quantity Limit |
| 68180065307 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET | 75 mg | N | Y | Quantity Limit |
| 00228289611 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 100 mg | N | Y | Quantity Limit |
| 23155014201 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 100 mg | N | Y | Quantity Limit |
| 62332048231 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 100 mg | N | Y | Quantity Limit |
| 23155014301 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 150 mg | N | Y | Quantity Limit |
| 43547032410 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 150 mg | N | Y | Quantity Limit |
| 62332048331 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 150 mg | N | Y | Quantity Limit |
| 00591457560 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 200 mg | N | Y | Quantity Limit |
| 23155061106 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 200 mg | N | Y | Quantity Limit |
| 43547032506 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 200 mg | N | Y | Quantity Limit |
| 62332048460 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 200 mg | N | Y | Quantity Limit |
| 68308071630 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 200 mg | N | Y | Quantity Limit |
| 00591455022 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 50 mg | N | Y | Quantity Limit |
| 43547046212 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 50 mg | N | Y | Quantity Limit |
| 51862056012 | DORYX MPC | doxycycline hyclate | TABLET DR | 60 mg | N | Y | Quantity Limit |
| 51862056060 | DORYX MPC | doxycycline hyclate | TABLET DR | 60 mg | N | Y | Quantity Limit |
| 00228289506 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 75 mg | N | Y | Quantity Limit |
| 23155014101 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 75 mg | N | Y | Quantity Limit |
| 23155014106 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 75 mg | N | Y | Quantity Limit |
| 62332048131 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 75 mg | N | Y | Quantity Limit |
| 62332048160 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 75 mg | N | Y | Quantity Limit |
| 51862056230 | DORYX | doxycycline hyclate | TABLET DR | 80 mg | N | Y | Quantity Limit |
| 51862057130 | DOXYCYCLINE HYCLATE | doxycycline hyclate | TABLET DR | 80 mg | N | Y | Quantity Limit |
| 43598045730 | DOXYCYCLINE IR-DR | doxycycline monohydrate | CAP IR DR | 40 mg | N | Y | Quantity Limit |
| 60505477503 | DOXYCYCLINE IR-DR | doxycycline monohydrate | CAP IR DR | 40 mg | N | Y | Quantity Limit |
| 62332078530 | DOXYCYCLINE IR-DR | doxycycline monohydrate | CAP IR DR | 40 mg | N | Y | Quantity Limit |
| 68308066830 | DOXYCYCLINE IR-DR | doxycycline monohydrate | CAP IR DR | 40 mg | N | Y | Quantity Limit |
| 70748030806 | DOXYCYCLINE IR-DR | doxycycline monohydrate | CAP IR DR | 40 mg | N | Y | Quantity Limit |
| 00299382230 | ORACEA | doxycycline monohydrate | CAP IR DR | 40 mg | N | Y | Quantity Limit |
| 00713057250 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 00713057293 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 50268028111 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 50268028115 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 60687071611 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 60687071621 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 62135026225 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 62135026250 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 62135026260 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 62332025050 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 63304061650 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 64380018001 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 64380018002 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 68180065208 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 68382070718 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 100 mg | Y | Y | Quantity Limit |
| 49884030502 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 150 mg | N | Y | Quantity Limit |
| 62135026360 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 150 mg | N | Y | Quantity Limit |
| 64380018101 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 150 mg | N | Y | Quantity Limit |
| 00713057001 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 50268028011 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 50268028015 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 62135026001 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 64380017901 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 68180065001 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 68382078201 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 50 mg | Y | Y | Quantity Limit |
| 00713057101 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 75 mg | N | Y | Quantity Limit |
| 62135026101 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 75 mg | N | Y | Quantity Limit |
| 62332024931 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | CAPSULE | 75 mg | N | Y | Quantity Limit |
| 62135041746 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | SUSP RECON | 25 mg/5 mL | Y | Y | Quantity Limit |
| 62135087746 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | SUSP RECON | 25 mg/5 mL | Y | Y | Quantity Limit |
| 68180065701 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | SUSP RECON | 25 mg/5 mL | Y | Y | Quantity Limit |
| 10337080203 | ADOXA PAK | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 10337080206 | ADOXA PAK | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 00527133825 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 00527133850 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 23155013505 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 23155013525 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 60687034425 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 60687034495 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 62135072620 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 63304013204 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 64380020701 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 70710112307 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 100 mg | N | Y | Quantity Limit |
| 10337081403 | ADOXA PAK | doxycycline monohydrate | TABLET | 150 mg | N | Y | Quantity Limit |
| 23155013603 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 150 mg | N | Y | Quantity Limit |
| 64380020801 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 150 mg | N | Y | Quantity Limit |
| 70710112403 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 150 mg | N | Y | Quantity Limit |
| 10337080001 | ADOXA | doxycycline monohydrate | TABLET | 50 mg | N | Y | Quantity Limit |
| 00527133501 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 50 mg | N | Y | Quantity Limit |
| 23155013301 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 50 mg | N | Y | Quantity Limit |
| 62135072520 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 50 mg | N | Y | Quantity Limit |
| 64380020501 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 50 mg | N | Y | Quantity Limit |
| 70710112101 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 50 mg | N | Y | Quantity Limit |
| 10337080101 | ADOXA | doxycycline monohydrate | TABLET | 75 mg | N | Y | Quantity Limit |
| 10337080103 | ADOXA PAK | doxycycline monohydrate | TABLET | 75 mg | N | Y | Quantity Limit |
| 23155013401 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 75 mg | N | Y | Quantity Limit |
| 70710112201 | DOXYCYCLINE MONOHYDRATE | doxycycline monohydrate | TABLET | 75 mg | N | Y | Quantity Limit |
| 00591569550 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 00904688806 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 13668048405 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 13668048450 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 57664085385 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 60687033611 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 60687033665 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 65862021105 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 65862021150 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 68382031818 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 100 mg | N | Y | Quantity Limit |
| 00591569401 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 50 mg | N | Y | Quantity Limit |
| 00591569460 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 50 mg | N | Y | Quantity Limit |
| 13668048201 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 50 mg | N | Y | Quantity Limit |
| 57664085188 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 50 mg | N | Y | Quantity Limit |
| 65862020901 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 50 mg | N | Y | Quantity Limit |
| 68382031601 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 50 mg | N | Y | Quantity Limit |
| 99207049905 | DYNACIN | minocycline HCl | CAPSULE | 75 mg | N | Y | Quantity Limit |
| 00591315301 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 75 mg | N | Y | Quantity Limit |
| 13668048301 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 75 mg | N | Y | Quantity Limit |
| 57664085288 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 75 mg | N | Y | Quantity Limit |
| 65862021001 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 75 mg | N | Y | Quantity Limit |
| 68382031701 | MINOCYCLINE HCL | minocycline HCl | CAPSULE | 75 mg | N | Y | Quantity Limit |
| 67877043830 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 105 mg | N | Y | Quantity Limit |
| 67877064430 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 115 mg | N | Y | Quantity Limit |
| 16714010901 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 135 mg | N | Y | Quantity Limit |
| 67877057730 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 135 mg | N | Y | Quantity Limit |
| 16714010201 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 45 mg | N | Y | Quantity Limit |
| 67877057830 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 45 mg | N | Y | Quantity Limit |
| 67877043630 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 55 mg | N | Y | Quantity Limit |
| 67877064330 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 65 mg | N | Y | Quantity Limit |
| 67877043730 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 80 mg | N | Y | Quantity Limit |
| 99207046630 | SOLODYN | minocycline HCl | TAB ER 24H | 80 mg | N | Y | Quantity Limit |
| 16714010601 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 90 mg | N | Y | Quantity Limit |
| 67877057630 | MINOCYCLINE HCL ER | minocycline HCl | TAB ER 24H | 90 mg | N | Y | Quantity Limit |
| 13668048750 | MINOCYCLINE HCL | minocycline HCl | TABLET | 100 mg | N | Y | Quantity Limit |
| 57664085685 | MINOCYCLINE HCL | minocycline HCl | TABLET | 100 mg | N | Y | Quantity Limit |
| 59651033950 | MINOCYCLINE HCL | minocycline HCl | TABLET | 100 mg | N | Y | Quantity Limit |
| 62135088960 | MINOCYCLINE HCL | minocycline HCl | TABLET | 100 mg | N | Y | Quantity Limit |
| 64380015601 | MINOCYCLINE HCL | minocycline HCl | TABLET | 100 mg | N | Y | Quantity Limit |
| 13668048501 | MINOCYCLINE HCL | minocycline HCl | TABLET | 50 mg | N | Y | Quantity Limit |
| 59651033701 | MINOCYCLINE HCL | minocycline HCl | TABLET | 50 mg | N | Y | Quantity Limit |
| 62135088790 | MINOCYCLINE HCL | minocycline HCl | TABLET | 50 mg | N | Y | Quantity Limit |
| 64380015401 | MINOCYCLINE HCL | minocycline HCl | TABLET | 50 mg | N | Y | Quantity Limit |
| 13668048601 | MINOCYCLINE HCL | minocycline HCl | TABLET | 75 mg | N | Y | Quantity Limit |
| 49884051210 | MINOCYCLINE HCL | minocycline HCl | TABLET | 75 mg | N | Y | Quantity Limit |
| 59651033801 | MINOCYCLINE HCL | minocycline HCl | TABLET | 75 mg | N | Y | Quantity Limit |
| 62135088860 | MINOCYCLINE HCL | minocycline HCl | TABLET | 75 mg | N | Y | Quantity Limit |
| 64380015501 | MINOCYCLINE HCL | minocycline HCl | TABLET | 75 mg | N | Y | Quantity Limit |
| 71715000221 | NUZYRA | omadacycline tosylate | TABLET | 150 mg | N | Y | Quantity Limit |
| 71715000227 | NUZYRA | omadacycline tosylate | TABLET | 150 mg | N | Y | Quantity Limit |
| 71715000228 | NUZYRA | omadacycline tosylate | TABLET | 150 mg | N | Y | Quantity Limit |
| 00115140001 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 00115140003 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 00115140501 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 00115140503 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 00591247401 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 23155076601 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 51991090601 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 60219152201 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 62135022501 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 62135022560 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 64380089006 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 69238152201 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 250 mg | Y | Y | Quantity Limit |
| 00115140201 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 00115140203 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 00591247501 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 23155076701 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 51991090701 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 60219152301 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 62135026601 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 62135026660 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 64380089106 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 69238152301 | TETRACYCLINE HCL | tetracycline HCl | CAPSULE | 500 mg | Y | Y | Quantity Limit |
| 82644008760 | TETRACYCLINE HCL | tetracycline HCl | TABLET | 250 mg | Y | Quantity Limit | |
| 82644087060 | TETRACYCLINE HCL | tetracycline HCl | TABLET | 500 mg | Y | Quantity Limit |