Sedatives
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 | Carveout ‐ Bill FFS |
Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|---|
| 00254906858 | CHLORAL HYDRATE | chloral hydrate | SYRUP | 500 mg/5 mL | Y | N | Pharmacy PA | |
| 80491782503 | QUVIVIQ | daridorexant HCl | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 80491785003 | QUVIVIQ | daridorexant HCl | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 70000058401 | SLEEP AID | diphenhydramine HCl | CAPSULE | 25 mg | N | Y | N | Pharmacy PA |
| 46122069572 | NIGHTTIME SLEEP AID | diphenhydramine HCl | CAPSULE | 50 mg | N | Y | N | Pharmacy PA |
| 46122077564 | NIGHTTIME SLEEP AID | diphenhydramine HCl | CAPSULE | 50 mg | N | Y | N | Pharmacy PA |
| 62011041601 | NIGHTTIME SLEEP AID | diphenhydramine HCl | CAPSULE | 50 mg | N | Y | N | Pharmacy PA |
| 70000052701 | SLEEP AID | diphenhydramine HCl | CAPSULE | 50 mg | N | Y | N | Pharmacy PA |
| 70677115101 | SLEEP AID | diphenhydramine HCl | CAPSULE | 50 mg | N | Y | N | Pharmacy PA |
| 83324015132 | SLEEP AID | diphenhydramine HCl | CAPSULE | 50 mg | N | Y | N | Pharmacy PA |
| 70000061601 | SLEEP-AID | diphenhydramine HCl | CAPSULE | 50 mg | N | Y | N | Pharmacy PA |
| 83324001506 | EZZ NITE SLEEP AID | diphenhydramine HCl | LIQUID | 50 mg/30 mL | N | Y | N | Pharmacy PA |
| 46122075429 | SLEEP AID | diphenhydramine HCl | LIQUID | 50 mg/30 mL | N | Y | N | Pharmacy PA |
| 70000017401 | SLEEP AID | diphenhydramine HCl | LIQUID | 50 mg/30 mL | N | Y | N | Pharmacy PA |
| 70000017402 | SLEEP AID | diphenhydramine HCl | LIQUID | 50 mg/30 mL | N | Y | N | Pharmacy PA |
| 00113018640 | SLEEP TIME | diphenhydramine HCl | LIQUID | 50 mg/30 mL | N | Y | N | Pharmacy PA |
| 70677112801 | NIGHTTIME SLEEP AID | diphenhydramine HCl | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 83324011032 | NIGHTTIME SLEEP AID | diphenhydramine HCl | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 83324011301 | REST SIMPLY | diphenhydramine HCl | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00113043162 | SLEEP AID | diphenhydramine HCl | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 46122065162 | SLEEP AID | diphenhydramine HCl | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 46122065178 | SLEEP AID | diphenhydramine HCl | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00904427451 | SLEEP TABS | diphenhydramine HCl | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00228331503 | DOXEPIN HCL | doxepin HCl | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 27241028030 | DOXEPIN HCL | doxepin HCl | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 51672424602 | DOXEPIN HCL | doxepin HCl | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 59651084430 | DOXEPIN HCL | doxepin HCl | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 64380020301 | DOXEPIN HCL | doxepin HCl | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 72205005230 | DOXEPIN HCL | doxepin HCl | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 72578018106 | DOXEPIN HCL | doxepin HCl | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 72603022201 | DOXEPIN HCL | doxepin HCl | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 72819016103 | DOXEPIN HCL | doxepin HCl | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 00228331603 | DOXEPIN HCL | doxepin HCl | TABLET | 6 mg | N | Y | N | Pharmacy PA |
| 27241028130 | DOXEPIN HCL | doxepin HCl | TABLET | 6 mg | N | Y | N | Pharmacy PA |
| 51672424702 | DOXEPIN HCL | doxepin HCl | TABLET | 6 mg | N | Y | N | Pharmacy PA |
| 59651084530 | DOXEPIN HCL | doxepin HCl | TABLET | 6 mg | N | Y | N | Pharmacy PA |
| 64380020401 | DOXEPIN HCL | doxepin HCl | TABLET | 6 mg | N | Y | N | Pharmacy PA |
| 72205005330 | DOXEPIN HCL | doxepin HCl | TABLET | 6 mg | N | Y | N | Pharmacy PA |
| 72578018206 | DOXEPIN HCL | doxepin HCl | TABLET | 6 mg | N | Y | N | Pharmacy PA |
| 72603022301 | DOXEPIN HCL | doxepin HCl | TABLET | 6 mg | N | Y | N | Pharmacy PA |
| 72819016203 | DOXEPIN HCL | doxepin HCl | TABLET | 6 mg | N | Y | N | Pharmacy PA |
| 46122078815 | NIGHTTIME SLEEP AID | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00113040264 | SLEEP AID | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00113044164 | SLEEP AID | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00113044173 | SLEEP AID | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 24385044164 | SLEEP AID | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 46122076351 | SLEEP AID | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 70000056701 | SLEEP AID | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 70677006801 | SLEEP AID | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 70677112901 | SLEEP AID | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00113403262 | SLEEP AID ULTRA | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00113403267 | SLEEP AID ULTRA | doxylamine succinate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00591074401 | ESTAZOLAM | estazolam | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 70954048010 | ESTAZOLAM | estazolam | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 75907002801 | ESTAZOLAM | estazolam | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 00591074501 | ESTAZOLAM | estazolam | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 70954048110 | ESTAZOLAM | estazolam | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 75907002901 | ESTAZOLAM | estazolam | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 00093553756 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 00378527001 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 31722085501 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 31722085530 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 33342029907 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 55111062930 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 65862096701 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 65862096730 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 68462038201 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 69452034713 | ESZOPICLONE | eszopiclone | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 00093553801 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 00378527101 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 31722085601 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 31722085630 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 33342030011 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 55111061901 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 65862096801 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 65862096830 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 68462038301 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 69452034820 | ESZOPICLONE | eszopiclone | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 00093553901 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 00378527201 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 31722085701 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 31722085730 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 33342030111 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 55111061701 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 65862096901 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 65862096930 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 68462038401 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 69452034920 | ESZOPICLONE | eszopiclone | TABLET | 3 mg | N | Y | N | Pharmacy PA |
| 00143336725 | FLURAZEPAM HCL | flurazepam HCl | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 00143336750 | FLURAZEPAM HCL | flurazepam HCl | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 62135073630 | FLURAZEPAM HCL | flurazepam HCl | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 62135073690 | FLURAZEPAM HCL | flurazepam HCl | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 00143337025 | FLURAZEPAM HCL | flurazepam HCl | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 00143337050 | FLURAZEPAM HCL | flurazepam HCl | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 62135073730 | FLURAZEPAM HCL | flurazepam HCl | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 62135073790 | FLURAZEPAM HCL | flurazepam HCl | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 62856041030 | DAYVIGO | lemborexant | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 62856040530 | DAYVIGO | lemborexant | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 00536139708 | MELATONIN | melatonin | TAB RAPDIS | 10 mg | N | Y | N | Pharmacy PA |
| 00904740861 | MELATONIN | melatonin | TAB RAPDIS | 10 mg | N | Y | N | Pharmacy PA |
| 50268055211 | MELATONIN | melatonin | TAB RAPDIS | 5 mg | N | Y | N | Pharmacy PA |
| 50268055215 | MELATONIN | melatonin | TAB RAPDIS | 5 mg | N | Y | N | Pharmacy PA |
| 16571087201 | MELATONIN | melatonin | TABLET | 3 mg | Y | Y | N | Pharmacy PA |
| 16571087290 | MELATONIN | melatonin | TABLET | 3 mg | Y | Y | N | Pharmacy PA |
| 50268052411 | MELATONIN | melatonin | TABLET | 3 mg | Y | Y | N | Pharmacy PA |
| 50268052415 | MELATONIN | melatonin | TABLET | 3 mg | Y | Y | N | Pharmacy PA |
| 68094011059 | MELATONIN | melatonin | TABLET | 3 mg | Y | Y | N | Pharmacy PA |
| 68094011061 | MELATONIN | melatonin | TABLET | 3 mg | Y | Y | N | Pharmacy PA |
| 16571087301 | MELATONIN | melatonin | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 50268053311 | MELATONIN | melatonin | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 50268053315 | MELATONIN | melatonin | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 45861000006 | SINTRALYNE-PM | melatonin/GABA/herbal no.183 | CAPSULE | 5 mg-20 mg-460 mg | Y | N | Pharmacy PA | |
| 67618011460 | SLOWMAG MG CALM-SLEEP | melatonin/magnesium citrate | TABLET DR | 1 mg-71.5 mg | Y | N | Pharmacy PA | |
| 16571073012 | MELATONIN-VITAMIN B6 | melatonin/pyridoxine HCl (B6) | TABLET | 5 mg-10 mg | Y | N | Pharmacy PA | |
| 60687057640 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 10 mg/5 mL (2 mg/mL) | N | Y | N | Pharmacy PA |
| 60687057646 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 10 mg/5 mL (2 mg/mL) | N | Y | N | Pharmacy PA |
| 60687057686 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 10 mg/5 mL (2 mg/mL) | N | Y | N | Pharmacy PA |
| 68094076459 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 10 mg/5 mL (2 mg/mL) | N | Y | N | Pharmacy PA |
| 68094076462 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 10 mg/5 mL (2 mg/mL) | N | Y | N | Pharmacy PA |
| 00054356699 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 2 mg/mL | N | Y | N | Pharmacy PA |
| 00574015004 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 2 mg/mL | N | Y | N | Pharmacy PA |
| 60687057603 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 5 mg/2.5 mL | N | Y | N | Pharmacy PA |
| 60687057604 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 5 mg/2.5 mL | N | Y | N | Pharmacy PA |
| 60687057610 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 5 mg/2.5 mL | N | Y | N | Pharmacy PA |
| 68094076259 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 5 mg/2.5 mL | N | Y | N | Pharmacy PA |
| 68094076262 | MIDAZOLAM HCL | midazolam HCl | SYRUP | 5 mg/2.5 mL | N | Y | N | Pharmacy PA |
| 61825016510 | DORAL | quazepam | TABLET | 15 mg | N | Y | N | Pharmacy PA |
| 61825016530 | DORAL | quazepam | TABLET | 15 mg | N | Y | N | Pharmacy PA |
| 71993026510 | QUAZEPAM | quazepam | TABLET | 15 mg | N | Y | N | Pharmacy PA |
| 71993026530 | QUAZEPAM | quazepam | TABLET | 15 mg | N | Y | N | Pharmacy PA |
| 00591219101 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 00591219130 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 00832125011 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 00832125030 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 00904749406 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 42571037501 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 42571037530 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 43598074101 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 43598074130 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 50268070811 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 50268070815 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 52817023510 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 52817023530 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 59651050501 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 59651050530 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 60687069211 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 60687069265 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 69367035601 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 69367035630 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 70010002803 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 70700027205 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 70700027210 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 70700027230 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 70710134401 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 70710134403 | RAMELTEON | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 64764080510 | ROZEREM | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 64764080530 | ROZEREM | ramelteon | TABLET | 8 mg | Y | Y | N | Pharmacy PA |
| 00006003310 | BELSOMRA | suvorexant | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 00006003313 | BELSOMRA | suvorexant | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 00006003330 | BELSOMRA | suvorexant | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 00006032510 | BELSOMRA | suvorexant | TABLET | 15 mg | N | Y | N | Pharmacy PA |
| 00006032513 | BELSOMRA | suvorexant | TABLET | 15 mg | N | Y | N | Pharmacy PA |
| 00006032530 | BELSOMRA | suvorexant | TABLET | 15 mg | N | Y | N | Pharmacy PA |
| 00006033510 | BELSOMRA | suvorexant | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 00006033513 | BELSOMRA | suvorexant | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 00006033530 | BELSOMRA | suvorexant | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 00006000510 | BELSOMRA | suvorexant | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 00006000513 | BELSOMRA | suvorexant | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 00006000530 | BELSOMRA | suvorexant | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 43068022001 | HETLIOZ | tasimelteon | CAPSULE | 20 mg | N | Y | N | Pharmacy PA |
| 00480449056 | TASIMELTEON | tasimelteon | CAPSULE | 20 mg | N | Y | N | Pharmacy PA |
| 60505466503 | TASIMELTEON | tasimelteon | CAPSULE | 20 mg | N | Y | N | Pharmacy PA |
| 69238254803 | TASIMELTEON | tasimelteon | CAPSULE | 20 mg | N | Y | N | Pharmacy PA |
| 43068030402 | HETLIOZ LQ | tasimelteon | ORAL SUSP | 4 mg/mL | N | Y | N | Pharmacy PA |
| 43068030406 | HETLIOZ LQ | tasimelteon | ORAL SUSP | 4 mg/mL | N | Y | N | Pharmacy PA |
| 00406991601 | RESTORIL | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 00228207610 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 00228207650 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 00406996101 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 43547061210 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 43547061250 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 50268077911 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 50268077915 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 62332038031 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 62332038071 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 62584086033 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 67877014601 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 67877014605 | TEMAZEPAM | temazepam | CAPSULE | 15 mg | N | Y | N | Pharmacy PA |
| 00406991403 | RESTORIL | temazepam | CAPSULE | 22.5 mg | N | Y | N | Pharmacy PA |
| 00406995903 | TEMAZEPAM | temazepam | CAPSULE | 22.5 mg | N | Y | N | Pharmacy PA |
| 43547061303 | TEMAZEPAM | temazepam | CAPSULE | 22.5 mg | N | Y | N | Pharmacy PA |
| 62332038130 | TEMAZEPAM | temazepam | CAPSULE | 22.5 mg | N | Y | N | Pharmacy PA |
| 67877014930 | TEMAZEPAM | temazepam | CAPSULE | 22.5 mg | N | Y | N | Pharmacy PA |
| 00406991701 | RESTORIL | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 00228207710 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 00228207750 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 00406996201 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 43547061410 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 43547061450 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 50268078011 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 50268078013 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 62332038231 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 62332038271 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 67877014701 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 67877014705 | TEMAZEPAM | temazepam | CAPSULE | 30 mg | N | Y | N | Pharmacy PA |
| 00406991501 | RESTORIL | temazepam | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 00406991503 | RESTORIL | temazepam | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 00406996001 | TEMAZEPAM | temazepam | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 00904643604 | TEMAZEPAM | temazepam | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 43547061110 | TEMAZEPAM | temazepam | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 62332037931 | TEMAZEPAM | temazepam | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 67877014801 | TEMAZEPAM | temazepam | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 68084054911 | TEMAZEPAM | temazepam | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 68084054921 | TEMAZEPAM | temazepam | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 00054485825 | TRIAZOLAM | triazolam | TABLET | 0.125 mg | N | Y | N | Pharmacy PA |
| 50742064501 | TRIAZOLAM | triazolam | TABLET | 0.125 mg | N | Y | N | Pharmacy PA |
| 59762371701 | TRIAZOLAM | triazolam | TABLET | 0.125 mg | N | Y | N | Pharmacy PA |
| 59762371703 | TRIAZOLAM | triazolam | TABLET | 0.125 mg | N | Y | N | Pharmacy PA |
| 59762371709 | TRIAZOLAM | triazolam | TABLET | 0.125 mg | N | Y | N | Pharmacy PA |
| 70710152101 | TRIAZOLAM | triazolam | TABLET | 0.125 mg | N | Y | N | Pharmacy PA |
| 00009001755 | HALCION | triazolam | TABLET | 0.25 mg | N | Y | N | Pharmacy PA |
| 00009001758 | HALCION | triazolam | TABLET | 0.25 mg | N | Y | N | Pharmacy PA |
| 00054485925 | TRIAZOLAM | triazolam | TABLET | 0.25 mg | N | Y | N | Pharmacy PA |
| 00054485929 | TRIAZOLAM | triazolam | TABLET | 0.25 mg | N | Y | N | Pharmacy PA |
| 50742064601 | TRIAZOLAM | triazolam | TABLET | 0.25 mg | N | Y | N | Pharmacy PA |
| 59762371803 | TRIAZOLAM | triazolam | TABLET | 0.25 mg | N | Y | N | Pharmacy PA |
| 59762371809 | TRIAZOLAM | triazolam | TABLET | 0.25 mg | N | Y | N | Pharmacy PA |
| 70710128901 | TRIAZOLAM | triazolam | TABLET | 0.25 mg | N | Y | N | Pharmacy PA |
| 70710128905 | TRIAZOLAM | triazolam | TABLET | 0.25 mg | N | Y | N | Pharmacy PA |
| 00054008525 | ZALEPLON | zaleplon | CAPSULE | 10 mg | N | Y | N | Pharmacy PA |
| 29300013201 | ZALEPLON | zaleplon | CAPSULE | 10 mg | N | Y | N | Pharmacy PA |
| 57237024001 | ZALEPLON | zaleplon | CAPSULE | 10 mg | N | Y | N | Pharmacy PA |
| 65862021501 | ZALEPLON | zaleplon | CAPSULE | 10 mg | N | Y | N | Pharmacy PA |
| 69452036520 | ZALEPLON | zaleplon | CAPSULE | 10 mg | N | Y | N | Pharmacy PA |
| 00054008425 | ZALEPLON | zaleplon | CAPSULE | 5 mg | N | Y | N | Pharmacy PA |
| 29300013101 | ZALEPLON | zaleplon | CAPSULE | 5 mg | N | Y | N | Pharmacy PA |
| 57237023901 | ZALEPLON | zaleplon | CAPSULE | 5 mg | N | Y | N | Pharmacy PA |
| 65862021401 | ZALEPLON | zaleplon | CAPSULE | 5 mg | N | Y | N | Pharmacy PA |
| 69452036420 | ZALEPLON | zaleplon | CAPSULE | 5 mg | N | Y | N | Pharmacy PA |
| 52427077530 | ZOLPIDEM TARTRATE | zolpidem tartrate | CAPSULE | 7.5 mg | N | Y | N | Pharmacy PA |
| 00024552131 | AMBIEN CR | zolpidem tartrate | TAB MPHASE | 12.5 mg | N | Y | N | Pharmacy PA |
| 00713552101 | AMBIEN CR | zolpidem tartrate | TAB MPHASE | 12.5 mg | N | Y | N | Pharmacy PA |
| 00955170310 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 12.5 mg | N | Y | N | Pharmacy PA |
| 10370011610 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 12.5 mg | N | Y | N | Pharmacy PA |
| 47335030888 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 12.5 mg | N | Y | N | Pharmacy PA |
| 51991098201 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 12.5 mg | N | Y | N | Pharmacy PA |
| 68180078001 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 12.5 mg | N | Y | N | Pharmacy PA |
| 68180078004 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 12.5 mg | N | Y | N | Pharmacy PA |
| 00024550131 | AMBIEN CR | zolpidem tartrate | TAB MPHASE | 6.25 mg | N | Y | N | Pharmacy PA |
| 00713550101 | AMBIEN CR | zolpidem tartrate | TAB MPHASE | 6.25 mg | N | Y | N | Pharmacy PA |
| 00955170210 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 6.25 mg | N | Y | N | Pharmacy PA |
| 10370011710 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 6.25 mg | N | Y | N | Pharmacy PA |
| 47335030788 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 6.25 mg | N | Y | N | Pharmacy PA |
| 51991098101 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 6.25 mg | N | Y | N | Pharmacy PA |
| 68180077901 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 6.25 mg | N | Y | N | Pharmacy PA |
| 68180077904 | ZOLPIDEM TARTRATE ER | zolpidem tartrate | TAB MPHASE | 6.25 mg | N | Y | N | Pharmacy PA |
| 49884089811 | ZOLPIDEM TARTRATE | zolpidem tartrate | TAB SUBL | 1.75 mg | N | Y | N | Pharmacy PA |
| 49884089852 | ZOLPIDEM TARTRATE | zolpidem tartrate | TAB SUBL | 1.75 mg | N | Y | N | Pharmacy PA |
| 00037601035 | EDLUAR | zolpidem tartrate | TAB SUBL | 10 mg | N | Y | N | Pharmacy PA |
| 00037601093 | EDLUAR | zolpidem tartrate | TAB SUBL | 10 mg | N | Y | N | Pharmacy PA |
| 49884089911 | ZOLPIDEM TARTRATE | zolpidem tartrate | TAB SUBL | 3.5 mg | N | Y | N | Pharmacy PA |
| 49884089952 | ZOLPIDEM TARTRATE | zolpidem tartrate | TAB SUBL | 3.5 mg | N | Y | N | Pharmacy PA |
| 00037605035 | EDLUAR | zolpidem tartrate | TAB SUBL | 5 mg | N | Y | N | Pharmacy PA |
| 00037605093 | EDLUAR | zolpidem tartrate | TAB SUBL | 5 mg | N | Y | N | Pharmacy PA |
| 00024542131 | AMBIEN | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 00713542101 | AMBIEN | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 00093007401 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 00781531801 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 00781531810 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 13668000801 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 13668000805 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 13668000810 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 13668000815 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 16714062201 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 16714062202 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 55111047901 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 55111047905 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 62135077990 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 65862016001 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 65862016099 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 71093015604 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 71093015606 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 10 mg | Y | Y | N | Pharmacy PA |
| 00024540131 | AMBIEN | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 00713540101 | AMBIEN | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 00093007301 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 00781531701 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 00781531710 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 00904608261 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 13668000701 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 13668000705 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 13668000710 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 13668000715 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 16714062101 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 16714062102 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 55111047801 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 55111047805 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 60687083801 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 60687083811 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 62135077890 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 65862015901 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 65862015999 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 71093015504 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |
| 71093015506 | ZOLPIDEM TARTRATE | zolpidem tartrate | TABLET | 5 mg | Y | Y | N | Pharmacy PA |