Lista de medicamentos preferidos aprobada por Medicaid...New York Health and Recovery Plan (HARP) Lista de medicamentos preferidos aprobada por Medicaid En vigencia desde el 1 de febrero

New York Health and Recovery Plan (HARP)

Lista de medicamentos preferidos aprobada por Medicaid En vigencia desde el 1 de febrero de 2020

Leyenda

En cada categoría, los medicamentos se listan en orden alfabético por marca o nombre genérico.

Medicamento de marca: letra mayúscula en negrita

Medicamento genérico: letra minúscula en texto sin formato

AL: restricción de límite de edad

DO: programa de optimización de dosis

GR: restricción de género

OTC: medicamento de venta libre disponible con receta. (Los recetadores deben incluir la sigla OTC en la

receta).

PA: requiere autorización previa. La autorización previa es el proceso mediante el cual se obtiene la aprobación

de los beneficios antes de que se puedan abastecer ciertas recetas.

QL: límites de cantidad. Ciertos medicamentos recetados tienen límites de cantidad específicos, por receta o por

mes.

SP: farmacia de medicamentos especiales ST: requiere terapia escalonada. Es posible que necesite utilizar un medicamento antes de que los beneficios

para el uso de otro medicamento puedan autorizarse.

Nombre del medicamento Referencia Notas

ADYUVANTES FARMACÉUTICOS

cvs petroleum jelly external gel CareAll Petroleum Jelly OTC

gnp petroleum jelly gelRA Tugaboos Petroleum Jelly

OTC

hm petroleum jelly gelRA Tugaboos Petroleum Jelly

OTC

ORA-PLUS ORAL LIQUID OTC

petroleum jelly external gel CareAll Petroleum Jelly OTC

petroleum jelly external ointment OTC

petroleum jelly gelRA Tugaboos Petroleum Jelly

OTC

ra petroleum jelly gelRA Tugaboos Petroleum Jelly

OTC

RA TUGABOOS PETROLEUM JELLY GEL OTC

RESOURCE THICKENUP ORAL PACKET OTC

RESOURCE THICKENUP ORAL POWDER OTC

SIMPLYTHICK EASY MIX ORAL GEL OTC

SIMPLYTHICK ORAL GEL OTC

sm petroleum jelly gelRA Tugaboos Petroleum Jelly

OTC

sterile water for injection injection solution

sterile water for injection intravenous solution

SUSPENDOL-S LIQUID OTC

SYRSPEND SF ORAL LIQUID OTC

THICK NOW ORAL POWDER OTC

THICK-IT #2 ORAL POWDER OTC

THICK-IT ORAL POWDER OTC

THIK & CLEAR ORAL POWDER OTC

white petrolatum external ointment GRX White Petrolatum OTC

white petroleum jelly external gel CareAll Petroleum Jelly OTC

AGENTES ANORRECTALES

COLOCORT RECTAL ENEMA

cvs hemorrhoidal rectal ointment Major-Prep Hemorrhoidal OTC

eq hemorrhoidal rectal suppository OTC

gnp hemorrhoidal rectal suppository Medicone OTC

hemorrhoidal rectal ointment Major-Prep Hemorrhoidal OTC

hydrocortisone rectal cream Proctosol HC QL

2


hydrocortisone rectal enema Colocort

MEDICONE RECTAL SUPPOSITORY OTC

PROCTOSOL HC RECTAL CREAM QL

PROCTOZONE-HC RECTAL CREAM QL

px hemorrhoidal rectal ointment OTC

px hemorrhoidal rectal suppository OTC

qc hemorrhoidal rectal ointment Major-Prep Hemorrhoidal OTC

qc hemorrhoidal rectal suppository Preparation H OTC

ra hemorrhoid relief rectal suppository OTC

ra hemorrhoidal rectal ointment OTC

rectacaine rectal suppository Medicone OTC

sb hemorrhoid rectal ointment OTC

sm hemorrhoidal rectal suppository Medicone OTC

tgt hemorrhoidal rectal suppository OTC

TRONOLANE RECTAL SUPPOSITORY OTC

AGENTES ANSIOLÍTICOS

ALPRAZOLAM INTENSOL ORAL CONCENTRATE

alprazolam oral tablet Xanax

alprazolam oral tablet dispersible

buspirone hcl oral tablet

chlordiazepoxide hcl oral capsule

clorazepate dipotassium oral tablet

DIAZEPAM INTENSOL ORAL CONCENTRATE

diazepam oral concentrate Diazepam Intensol

diazepam oral solution

diazepam oral tablet Valium

hydroxyzine hcl oral syrup

hydroxyzine hcl oral tablet

hydroxyzine pamoate oral capsule

lorazepam oral tablet Ativan

oxazepam oral capsule

AGENTES ANTIANGINOSOS

isosorbide dinitrate oral tablet

isosorbide mononitrate er oral tablet extended release 24 hour

isosorbide mononitrate oral tablet

3


NITRO-BID TRANSDERMAL OINTMENT

NITRO-DUR TRANSDERMAL PATCH 24 HOUR

nitroglycerin sublingual tablet sublingual Nitrostat

nitroglycerin transdermal patch 24 hour Nitro-Dur

AGENTES ANTIASMÁTICOS Y AGENTES BRONCODILATADORES

albuterol sulfate er oral tablet extended release 12 hour

albuterol sulfate hfa inhalation aerosol solution

ProAir HFA QL

albuterol sulfate inhalation nebulization solution

QL

albuterol sulfate oral syrup

albuterol sulfate oral tablet

ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED

ARNUITY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED

QL

ATROVENT HFA INHALATION AEROSOL SOLUTION

QL

BREO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-25 MCG/INH

QL

BREO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 200-25 MCG/INH

PA; QL

budesonide inhalation suspension Pulmicort PA; AL; QL

COMBIVENT RESPIMAT INHALATION AEROSOL SOLUTION

cromolyn sodium inhalation nebulization solution

FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED

QL

FLOVENT HFA INHALATION AEROSOL QL

fluticasone-salmeterol inhalation aerosol powder breath activated

Wixela Inhub QL

ipratropium bromide inhalation solution QL

ipratropium-albuterol inhalation solution

4


metaproterenol sulfate oral syrup

montelukast sodium oral packet Singulair QL

montelukast sodium oral tablet Singulair

montelukast sodium oral tablet chewable Singulair

SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED

QL

SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION

QL

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION

QL

terbutaline sulfate oral tablet

THEO-24 ORAL CAPSULE EXTENDED RELEASE 24 HOUR

QL

theophylline er oral tablet extended release 12 hour

theophylline er oral tablet extended release 24 hour

theophylline oral solution

WIXELA INHUB INHALATION AEROSOL POWDER BREATH ACTIVATED

QL

XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PA; SP

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED

PA; SP

zafirlukast oral tablet Accolate QL

AGENTES ANTIINFECCIOSOS VARIOS

clindamycin hcl oral capsule Cleocin

clindamycin palmitate hcl oral solution reconstituted

Cleocin

dapsone oral tablet

linezolid oral suspension reconstituted Zyvox PA; QL

linezolid oral tablet Zyvox PA; QL

metronidazole oral capsule Flagyl

metronidazole oral tablet Flagyl

sulfamethoxazole-trimethoprim oral suspension

Sulfatrim Pediatric

sulfamethoxazole-trimethoprim oral tablet Bactrim

5


SULFATRIM PEDIATRIC ORAL SUSPENSION

tinidazole oral tablet QL

trimethoprim oral tablet

AGENTES ANTIMIASTÉNICOS/COLINÉRGICOS

pyridostigmine bromide er oral tablet extended release

Mestinon

pyridostigmine bromide oral solution Mestinon

pyridostigmine bromide oral tablet Mestinon

AGENTES ANTIMIASTÉNICOS

pyridostigmine bromide er oral tablet extended release

Mestinon

pyridostigmine bromide oral solution Mestinon

pyridostigmine bromide oral tablet Mestinon

AGENTES ANTIMICOBACTERIALES

ethambutol hcl oral tablet Myambutol

isoniazid oral syrup

isoniazid oral tablet

PRIFTIN ORAL TABLET

pyrazinamide oral tablet

rifabutin oral capsule Mycobutin

rifampin oral capsule Rifadin

RIFATER ORAL TABLET

AGENTES ANTIPSICÓTICOS/ANTIMANÍACOS

ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE

PA; AL

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER

PA; AL; QL

aripiprazole oral tablet Abilify AL; QL

ARISTADA INTRAMUSCULAR PREFILLED SYRINGE

PA; AL

chlorpromazine hcl oral tablet AL

clozapine oral tablet Clozaril AL; QL

CLOZARIL ORAL TABLET PA; AL; QL

COMPRO RECTAL SUPPOSITORY

fluphenazine decanoate injection solution AL

fluphenazine hcl injection solution AL

6


fluphenazine hcl oral concentrate AL

fluphenazine hcl oral elixir AL

fluphenazine hcl oral tablet AL

haloperidol decanoate intramuscular solution 100 mg/ml

Haldol Decanoate AL; QL

haloperidol decanoate intramuscular solution 50 mg/ml

Haldol Decanoate AL

haloperidol lactate injection solution Haldol AL

haloperidol lactate oral concentrate AL

haloperidol oral tablet AL

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

PA; AL; QL

INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

PA; AL; QL

lithium carbonate er oral tablet extended release

Lithobid

lithium carbonate oral capsule

lithium carbonate oral tablet

lithium oral solution AL

loxapine succinate oral capsule AL

olanzapine intramuscular solution reconstituted

ZyPREXA AL

olanzapine oral tablet ZyPREXA AL; QL

paliperidone er oral tablet extended release 24 hour

Invega AL

perphenazine oral tablet AL

prochlorperazine edisylate injection solution

prochlorperazine maleate oral tablet

prochlorperazine rectal suppository Compro

quetiapine fumarate oral tablet SEROquel AL; QL

RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER

PA; AL; QL

risperidone oral solution RisperDAL AL; QL

risperidone oral tablet RisperDAL AL; QL

thioridazine hcl oral tablet

thiothixene oral capsule AL

trifluoperazine hcl oral tablet AL

ziprasidone hcl oral capsule Geodon AL; QL

7


ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION RECONSTITUTED

PA; AL

AGENTES CARDIOVASCULARES VARIOS

ALYQ ORAL TABLET PA; SP; QL

ambrisentan oral tablet Letairis PA; SP; QL

sildenafil citrate oral tablet Revatio PA; SP; QL

tadalafil (pah) oral tablet Alyq PA; SP; QL

AGENTES DE INMUNIZACIÓN PASIVA

GAMUNEX-C INJECTION SOLUTION PA; SP

OCTAGAM INTRAVENOUS SOLUTION PA; SP

SYNAGIS INTRAMUSCULAR SOLUTION PA; SP

AGENTES DERMATOLÓGICOS

acne foaming wash external liquid PanOxyl Foaming Wash OTC

acne medication 10 external gelClean & Clear Persa-Gel Max St

OTC; QL

acne medication 10 external lotion OTC; QL

acne medication 5 external gel OTC

acne medication 5 external lotion OTC; QL

acne treatment external bar OTC

acne treatment external gelClean & Clear Persa-Gel Max St

OTC; QL

ACTICOAT 7 EXTERNAL PAD

ACTICOAT 7 EXTERNAL SHEET

ACTICOAT ABSORBENT EXTERNAL PAD

ACTICOAT ANTIMICROBIAL EXTERNAL PAD

ACTICOAT EXTERNAL SHEET

ACTICOAT FLEX 3 EXTERNAL SHEET

ACTICOAT FLEX 7 EXTERNAL SHEET

acyclovir external ointment Zovirax PA; QL

advanced acne wash external liquid extended release

OTC

afterburn external gel OTC

AL12 EXTERNAL LOTION OTC

ala-cort external creamCortaid Maximum Strength

PA; QL

alcohol wipes external OTC

8


alevazol external ointment OTC

ALGICELL CALCIUM DRESS 3/4"X12 EXTERNAL

OTC

ALGICELL CALCIUM DRESSING 2"X2 EXTERNAL

OTC


OTC


OTC

ALGISITE M 2"X2" EXTERNAL OTC

ALGISITE M 3/4"X12" EXTERNAL OTC



alum sulfate-ca acetate external packet Domeboro OTC

amcinonide external lotion

amcinonide external ointment QL

AMLACTIN EXTERNAL LOTION OTC

ammonium lactate external cream Geri-Hydrolac 12 OTC; QL

ammonium lactate external lotion AL12 OTC

AMNESTEEM ORAL CAPSULE PA

antifungal external cream Carrington Antifungal OTC

anti-fungal external powder Odor Eaters Antifungal OTC

anti-itch maximum strength external creamCortaid Maximum Strength

OTC; QL

AQUACEL HYDROFIBER 0.39"X18" EXTERNAL

OTC

AQUACEL-AG EXTRA HYDROFIBER EXTERNAL PAD

OTC

AQUACEL-AG HYDROFIBER EXTERNAL OTC

AQUACEL-AG SURGICAL HYDROFIBER EXTERNAL PAD

OTC

arthritis pain relieving external cream OTC

ASPERCREME LIDOCAINE EXTERNAL LIQUID

OTC

ASPERCREME MAX STRENGTH EXTERNAL AEROSOL

OTC

athletes foot powder spray external aerosol powder

LamISIL AF Defense OTC

ATRAPRO DERMAL SPRAY EXTERNAL LIQUID

9


AVO CREAM EXTERNAL EMULSION

AVOGEL DRESSING 4"X4" EXTERNAL OTC

AVOGEL DRESSING 6"X48" EXTERNAL OTC

AVOGEL SHEET EXTERNAL OTC

bacitracin external ointment Baciguent OTC; QL

bacitracin zinc external ointment CareAll Bacitracin OTC; QL

bedding spray lice treatment aerosol Licide OTC

BENZEPRO EXTERNAL FOAM

benzoyl peroxide cleanser external liquid OTC; QL

benzoyl peroxide external foam BenzePrO OTC

benzoyl peroxide external gel 10 %Clean & Clear Persa-Gel Max St

OTC; QL

benzoyl peroxide external gel 2.5 %, 5 % OTC

benzoyl peroxide wash external liquid 10 % PanOxyl Foaming Wash OTC

benzoyl peroxide wash external liquid 5 % Benzac AC Wash OTC; QL

betamethasone dipropionate aug external cream

Diprolene AF

betamethasone dipropionate external lotion QL

betamethasone valerate external cream QL

betamethasone valerate external ointment QL

BIAFINE EXTERNAL EMULSION

BIOBRANE GLOVES PEDIATRIC EXTERNAL

OTC

BIOBRANE GLOVES SMALL EXTERNAL OTC

bp gel external gel 10 %Clean & Clear Persa-Gel Max St

OTC; QL

bp gel external gel 5 % OTC

bp wash external liquid 10 % PanOxyl Foaming Wash OTC

bp wash external liquid 2.5 % PanOxyl

bp wash external liquid 5 % Benzac AC Wash OTC; QL

bp wash external liquid 7 % BenzePrO Creamy Wash

BREEZEE MIST EXTERNAL AEROSOL POWDER

OTC

calcipotriene external cream Dovonex QL

calcipotriene external ointment Calcitrene

calcipotriene external solution QL

CALCITRENE EXTERNAL OINTMENT

CARRAGINATE EXTERNAL OTC

10


CARRASORB H EXTERNAL OTC

CARRINGTON ANTIFUNGAL EXTERNAL CREAM

OTC

castellani paint modified external liquid OTC

CAVILON EXTERNAL CREAM OTC

CICA-CARE EXTERNAL SHEET OTC

ciclopirox external solution Ciclodan QL

ciclopirox olamine external cream Loprox QL

ciclopirox olamine external suspension Loprox QL

CLARAVIS ORAL CAPSULE PA

CLEAN & CLEAR PERSA-GEL MAX ST EXTERNAL GEL

OTC; QL

CLINDACIN ETZ EXTERNAL SWAB QL

CLINDACIN-P EXTERNAL SWAB QL

clindamycin phos-benzoyl perox external gel Neuac QL

clindamycin phosphate external gel Cleocin-T

clindamycin phosphate external solution QL

clindamycin phosphate external swab Clindacin ETZ QL

clobetasol prop emollient base external cream

QL

clobetasol propionate e external cream QL

clobetasol propionate external cream Temovate QL

clobetasol propionate external gel

clobetasol propionate external ointment Temovate QL

clobetasol propionate external solution QL

clotrimazole anti-fungal external cream Desenex OTC; QL

clotrimazole external cream Desenex QL

clotrimazole-betamethasone external cream Lotrisone QL

clotrimazole-betamethasone external lotion QL

COLEMAN BOTANICALS INSECT REP EXTERNAL LIQUID

OTC

COLEMAN INSECT REPEL HIGH&DRY EXTERNAL AEROSOL

OTC

COLEMAN INSECT REPEL SPORTSMEN EXTERNAL AEROSOL

OTC

COLEMAN SKINSMART INSECT REPEL EXTERNAL AEROSOL

OTC

COLEMAN SKINSMART INSECT REPEL EXTERNAL LIQUID

OTC

11


CONFORMANT 2 WOUND VEIL EXTERNAL

OTC

COOLMAGIC EXTERNAL SHEET OTC

COOLMAGIC TUBE SITE DRESSING EXTERNAL SHEET

OTC

CORTAID MAXIMUM STRENGTH EXTERNAL CREAM

OTC; QL

CUTTER BACKWOODS DRY EXTERNAL AEROSOL

OTC

CUTTER BACKWOODS EXTERNAL AEROSOL

OTC

CUTTER BACKWOODS EXTERNAL LIQUID

OTC

CUTTER LEMON EUCALYPTUS EXTERNAL LIQUID

OTC

CUTTER SKINSATIONS EXTERNAL LIQUID

OTC

cvs acne cleansing external bar OTC

cvs acne control cleanser external cream Clean & Clear Continuous OTC

cvs acne external cream Clean & Clear Continuous OTC

cvs acne foaming face wash external liquid PanOxyl Foaming Wash OTC

cvs acne treatment external gelClean & Clear Persa-Gel Max St

OTC; QL

cvs bedding spray lice treat aerosol Licide OTC

cvs creamy acne face wash external liquid PanOxyl Creamy Wash OTC

cvs foaming acne face wash external liquid PanOxyl Foaming Wash OTC

cvs hydrating skin treatment external lotion AL12 OTC

cvs insect repellent external aerosolColeman Insect Repel High

OTC

cvs isopropyl alcohol wipes external OTC

cvs skin treatment external lotion AL12 OTC

cvs total home insect repel external aerosolColeman Insect Repel High

OTC

DERMAGAUZE HYDROGEL DRESSING EXTERNAL

OTC

DERMAGINATE DRESSING 12" EXTERNAL

OTC

DERMAGINATE DRESSING 4"X4" EXTERNAL PAD

OTC

DESENEX EXTERNAL CREAM OTC; QL

12


diclofenac sodium transdermal gel Voltaren PA; QL

diclofenac sodium transdermal solution PA; QL

DIFFERIN EXTERNAL GEL OTC; QL

diflorasone diacetate external cream QL

docosanol external cream Abreva OTC; QL

DOLOGESIC PAIN RELIEF ROLL-ON EXTERNAL LIQUID

OTC

DRS CHOICE DIABETIC BANDAGES EXTERNAL KIT

OTC

DRS CHOICE SKIN CLOSURE EXTERNAL KIT

OTC

DRS CHOICE SLOW HEAL BANDAGES EXTERNAL KIT

OTC

DRS CHOICE ULTRA-FLEX EXTERNAL OTC

DUODERM CGF BORDER EXTERNAL OTC

DUODERM CGF DRESSING EXTERNAL OTC

DUODERM CGF EXTRA THIN EXTERNAL OTC

DUODERM CGF SPOTS EXTRA THIN EXTERNAL

OTC

DUODERM HYDROACTIVE EXTERNAL OTC

DUODERM HYDROACTIVE EXTERNAL PASTE

OTC

DUODERM SIGNAL DRESSING EXTERNAL

OTC

DY-O-DERM VITILIGO STAIN EXTERNAL SOLUTION

OTC

eq hydrocortisone external creamCortaid Maximum Strength

OTC; QL

eq lidocaine pain relieving external patch Lido King OTC

eq pain relieving external creamGold Bond Multi-Symptom

OTC

ery external pad QL

erythromycin external solution QL

EXU-DRY BOOT/FOOT CHILD EXTERNAL OTC

EXU-DRY BURN JACKET 36"X40" EXTERNAL

OTC

EXU-DRY BURN VEST 26"X38" EXTERNAL

OTC

EXU-DRY BURN VEST CHILD 15X20" EXTERNAL

OTC

13


EXU-DRY LEG 34"X37" EXTERNAL OTC

EXU-DRY NON-PERMEABLE 36"X72" EXTERNAL SHEET

OTC

EXU-DRY QUILTED 36"X72" EXTERNAL SHEET

OTC

fluocinonide emulsified base external cream

fluorouracil external cream Efudex QL

fluorouracil external solution QL

fluticasone propionate external cream QL

fluticasone propionate external ointment QL

foraxa external emulsion AVO Cream

fungi-guard external cream CareAll Tolnaftate OTC

gentamicin sulfate external cream

gentamicin sulfate external ointment

GERI-HYDROLAC 12 EXTERNAL CREAM OTC; QL

GERI-HYDROLAC 12 EXTERNAL LOTION OTC

gnp aloe vera/lidocaine external gel OTC

gnp athletes foot external cream Desenex OTC; QL

gnp bacitracin zinc external ointment CareAll Bacitracin OTC; QL

gnp capsaicin external liquid Capzasin OTC

gnp hydrocortisone max st external ointment Cortizone-10 OTC; QL

gnp hydrocortisone/aloe external creamCortizone-10 Intensive Healing

OTC; QL

gnp lice bedding aerosol Licide OTC

gnp lice treatment external liquid Nix Creme Rinse OTC; QL

gnp lice treatment external shampoo Licide OTC

gnp lidocaine pain relief external patch Lido King OTC

gnp terbinafine hydrochloride external cream LamISIL AT OTC

gnp triple antibiotic external ointment CareAll Triple AntiBiotic OTC; QL

gnp vitamin a & d external ointment CareAll Vitamin A & D OTC; QL

GOLD BOND MULTI-SYMPTOM EXTERNAL CREAM

OTC

halobetasol propionate external cream QL

halobetasol propionate external ointment QL

hm bacitracin zinc external ointment CareAll Bacitracin OTC; QL

hm hydrocortisone plus external creamCortizone-10 Intensive Healing

OTC; QL

14


hm hydrocortisone-aloe max st external cream

Cortizone-10 Intensive Healing

OTC; QL

hm lice treatment external liquid Nix Creme Rinse OTC; QL

horizontal drain/tube att dev OTC

hydrocortisone external creamCortaid Maximum Strength

QL

hydrocortisone external ointment QL

hydrocortisone max st external creamCortaid Maximum Strength

OTC; QL

hydrocortisone max st/12 moist external cream

Cortaid Maximum Strength

OTC; QL

hydrocortisone plus external creamCortaid Maximum Strength

OTC; QL

hydrocortisone-aloe external creamCortizone-10 Intensive Healing

OTC; QL

HYPERCARE EXTERNAL SOLUTION OTC

imiquimod external cream Aldara PA; QL

isotretinoin oral capsule Amnesteem PA

KALTOSTAT ROPE EXTERNAL OTC

KENDALL CA ALGINATE 12" ROPE EXTERNAL

OTC

KENDALL CA ALGINATE 12"X24" EXTERNAL

OTC


OTC


OTC


OTC


OTC

KENDALL CA ALGINATE 4"X5-1/2" EXTERNAL

OTC


OTC


OTC

KENDALL CA ALGINATE PLUS 4"X4" EXTERNAL

OTC

KERICORT 10 EXTERNAL CREAM OTC; QL

ketoconazole external cream QL

15


ketoconazole external shampoo Nizoral QL

kp benzoyl peroxide external gelClean & Clear Persa-Gel Max St

OTC; QL

kp benzoyl peroxide wash external liquid Benzac AC Wash OTC; QL

LAMISIL AF DEFENSE EXTERNAL AEROSOL POWDER

OTC

lice killing external shampoo Licide OTC

lice killing maximum strength external shampoo

Licide OTC

lice treatment external lotion OTC; QL

LIDO KING EXTERNAL PATCH OTC

lidocaine external cream AneCream OTC

lidocaine external patch Lidoderm PA; QL

lidocaine hcl external solution PA; QL

lidocaine hcl urethral/mucosal external gel

lidocaine pain relief external patch Lido King OTC

lidocaine-prilocaine external cream QL

LOTRIMIN AF JOCK ITCH EXTERNAL CREAM

OTC; QL

MASTISOL ADHESIVE EXTERNAL LIQUID

OTC

MAXORB EXTRA ROPE EXTERNAL OTC

MEDFIX EZ EXTERNAL OTC

meijer hydrocortisone external creamCortaid Maximum Strength

OTC; QL

meijer zinc oxide external ointment CareAll Zinc Oxide OTC; QL

metronidazole external cream Rosadan QL

metronidazole external gel 0.75 % Rosadan

metronidazole external gel 1 % Metrogel QL

metronidazole external lotion MetroLotion

micaderm external cream Carrington Antifungal OTC

miconazole nitrate external cream Carrington Antifungal OTC

MIRODERM BIOLOGIC WOUND MATRIX EXTERNAL SHEET

mometasone furoate external cream Elocon QL

mometasone furoate external ointment QL

mometasone furoate external solution QL

mupirocin external ointment Centany QL

MYORISAN ORAL CAPSULE PA

16


NATRAPEL 12-HOUR TICK/INSECT EXTERNAL AEROSOL

OTC

NEUROMED7 EXTERNAL CREAM OTC

NYAMYC EXTERNAL POWDER QL

nystatin external cream QL

nystatin external ointment QL

nystatin external powder Nyamyc QL

NYSTOP EXTERNAL POWDER QL

OASIS ULTRA TRI-LAYER MATRIX EXTERNAL SHEET

OASIS WOUND MATRIX FENESTRATED EXTERNAL SHEET

ODOR EATERS ANTIFUNGAL EXTERNAL POWDER

OTC

ODOR EATERS FOOT/SNEAKER SPRAY EXTERNAL AEROSOL POWDER

OTC

OFF ACTIVE EXTERNAL AEROSOL OTC

OFF DEEP WOODS EXTERNAL AEROSOL

OTC

OFF DEEP WOODS EXTERNAL LIQUID OTC

OFF DEEP WOODS SPORTSMEN EXTERNAL LIQUID

OTC

OFF SMOOTH & DRY EXTERNAL AEROSOL

OTC

pain relief roll-on external liquid Aspercreme Lidocaine OTC

pain relieving external cream Aspercreme/Aloe OTC

pain relieving lidocaine external patch Lido King OTC

pain relieving ultra st external patch Bengay Ultra Strength OTC

PANOXYL CREAMY WASH EXTERNAL LIQUID

OTC

PANOXYL FOAMING WASH EXTERNAL LIQUID

OTC

PEDI-PRE TAPE SPRAY EXTERNAL LIQUID

OTC

permethrin external cream Elimite QL

pimecrolimus external cream Elidel PA; AL; QL

podactin external cream Carrington Antifungal OTC

podofilox external solution PA

prednicarbate external ointment QL

pro-ex antifungal external cream Desenex OTC; QL

17


PRUTECT EXTERNAL EMULSION

qc athletes foot external cream LamISIL AT OTC

qc clotrimazole external cream Desenex OTC; QL

qc lidocaine pain relief external patch Lido King OTC

qc tolnaftate external cream CareAll Tolnaftate OTC

ra acne treatment external cream Clean & Clear Continuous OTC

ra antifungal external cream Carrington Antifungal OTC

ra athletes foot (tolnaftate) external cream CareAll Tolnaftate OTC

ra hydrocortisone max st external creamCortaid Maximum Strength

OTC; QL

ra isopropyl alcohol wipes external OTC

ra lice bedding aerosol Licide OTC

ra lice treatment external lotion OTC; QL

ra lidocaine pain relieving external patch Lido King OTC

RA RENEWAL ACNE TREATMENT EXTERNAL GEL

OTC; QL

RADIADRES GEL SHEET EXTERNAL SHEET

OTC

REGENECARE EXTERNAL GEL

REGRANEX EXTERNAL GEL

RE-LIEVED MAXIMUM STRENGTH EXTERNAL PATCH

OTC

REPEL 100 EXTERNAL LIQUID OTC

REPEL HUNTERS FORMULA EXTERNAL AEROSOL

OTC

REPEL LEMON EUCALYPTUS EXTERNAL AEROSOL

OTC

REPEL SPORTSMEN DRY EXTERNAL AEROSOL

OTC

REPEL SPORTSMEN EXTERNAL AEROSOL

OTC

REPEL SPORTSMEN MAX EXTERNAL AEROSOL

OTC

REPEL SPORTSMEN MAX EXTERNAL LIQUID

OTC

REPEL SPORTSMEN MAX EXTERNAL LOTION

OTC

RESTORE CALCICARE DRESSING EXTERNAL

OTC

18


RESTORE SILVER DRESSING EXTERNAL

OTC

RESTORE SILVER DRESSING EXTERNAL PAD

RIAX EXTERNAL FOAM

ROSADAN EXTERNAL CREAM QL

ROSADAN EXTERNAL GEL

sb anti-fungal external cream CareAll Tolnaftate OTC

sb bacitracin external ointment Baciguent OTC; QL

sb clotrimazole foot external cream Desenex OTC; QL

sb lice treatment external liquid Nix Creme Rinse OTC; QL

selenium sulfide external lotion QL

SHOPKO ATHLETES FOOT EXTERNAL CREAM

OTC; QL

SILVASORB EXTERNAL GEL

silver sulfadiazine external cream SSD

sm antibiotic external ointment CareAll Bacitracin OTC; QL

sm antifungal clotrimazole external cream Desenex OTC; QL

sm antifungal tolnaftate external cream CareAll Tolnaftate OTC

sm athletes foot external cream LamISIL AT OTC

sm bedding lice treatment aerosol Licide OTC

sm hydrocortisone external creamCortaid Maximum Strength

OTC; QL

sm hydrocortisone max st external ointment Cortizone-10 OTC; QL

sm lice killing max strength external shampoo

Licide OTC

sm muscle rub external cream Arthritis Hot OTC

SONAFINE EXTERNAL EMULSION

SOOTHE & COOL INZO ANTIFUNGAL EXTERNAL CREAM

OTC

spinosad external suspension Natroba

SSD EXTERNAL CREAM

STIK-IT EXTERNAL LIQUID OTC

suction tube attachment device OTC

tacrolimus external ointment Protopic PA; AL; QL

TEGADERM AG MESH EXTERNAL PAD

TEGADERM HIGH GELLING ALGINATE EXTERNAL

OTC

19


TEGADERM HIGH INTEG ALGINATE EXTERNAL

OTC

TEGADERM HYDROCOLLOID EXTERNAL OTC

TEGADERM HYDROCOLLOID THIN EXTERNAL

OTC

terbinafine hcl external cream LamISIL AT OTC

TEXACORT EXTERNAL SOLUTION

tgt anti-itch plus oatmeal external creamCortaid Maximum Strength

OTC; QL

theracare pain relief external patch Lido King OTC

TINACTIN DEODORANT EXTERNAL AEROSOL POWDER

OTC

TINACTIN JOCK ITCH EXTERNAL AEROSOL POWDER

OTC

TINEACIDE EXTERNAL CREAM OTC

tolnaftate external cream CareAll Tolnaftate OTC

tolnaftate external powder Odor Eaters Antifungal OTC

tretinoin (emollient) external cream Refissa PA; AL

tretinoin external cream Retin-A PA

tretinoin external gel Retin-A PA; QL

tretinoin microsphere external gel Retin-A Micro PA; AL; QL

triamcinolone acetonide external cream Triderm QL

triamcinolone acetonide external ointment QL

TRIANEX EXTERNAL OINTMENT QL

TRIDERM EXTERNAL CREAM 0.1 % QL

TRIDERM EXTERNAL CREAM 0.5 % PA; QL

triple antibiotic external ointment CareAll Triple AntiBiotic OTC; QL

triple antibiotic first aid external ointment CareAll Triple AntiBiotic OTC; QL

triple helix collagen 12" rope externalAquacel Hydrofiber 0.39"x18"

OTC

ULTRATHON INSECT REPELLENT 8 EXTERNAL AEROSOL

OTC

universal catheter access port OTC

UNNA-FLEX ELASTIC UNNA BOOT EXTERNAL

OTC

UNNA-FLEX PLUS VENOUS ULCER EXTERNAL KIT

OTC

urea external cream QL

urea nail external gel Uramaxin

20


VANALICE EXTERNAL GEL OTC

vertical drain/tube att device OTC

wound drainage collector OTC

XEROFORM OIL EMULSION 2"X2" EXTERNAL PAD

XEROFORM OIL EMULSION GAUZE EXTERNAL PAD

XEROFORM OIL EMULSION STRIP EXTERNAL

XEROFORM OIL ROLL 4"X9' EXTERNAL

XEROFORM PETROLAT GAUZE 1"X8" EXTERNAL

XEROFORM PETROLAT GAUZE 5"X9" EXTERNAL

XEROFORM PETROLAT PATCH 2"X2" EXTERNAL PAD

XEROFORM PETROLAT PATCH 4"X4" EXTERNAL PAD

XEROFORM PETROLATUM ROLL 4"X9' EXTERNAL

ZENATANE ORAL CAPSULE PA

zinc oxide external ointment CareAll Zinc Oxide OTC; QL

AGENTES DIARRÉICOS/PROBIÓTICOS

bismatrol oral suspension Kaopectate OTC; QL

bismatrol oral tablet chewable Soothe OTC

bismuth oral tablet chewable Soothe OTC

bismuth subsalicylate oral tablet chewable Soothe OTC

cvs anti-diarrheal oral suspension Kaopectate OTC; QL

cvs bismuth oral tablet chewable Soothe OTC

cvs stomach relief oral suspension Kaopectate OTC; QL

cvs stomach relief oral tablet chewable Soothe OTC

diarrhea oral suspension Kaopectate OTC; QL

eq pink-bismuth oral tablet chewable Soothe OTC

eq stomach relief oral suspension Kaopectate OTC; QL

eq stomach relief oral tablet chewable Soothe OTC

eql stomach relief oral suspension Kaopectate OTC; QL

eql stomach relief oral tablet chewable Soothe OTC

geri-pectate oral suspension Kaopectate OTC; QL

21


gnp k-pec oral suspension Kaopectate OTC; QL

gnp pink bismuth oral tablet chewable Soothe OTC

gnp stomach relief oral suspension Kaopectate OTC; QL

goodsense stomach relief oral suspension Kaopectate OTC; QL

goodsense stomach relief oral tablet chewable

Soothe OTC

hm stomach relief oral suspension Kaopectate OTC; QL

hm stomach relief oral tablet chewable Soothe OTC

KAOPECTATE ORAL SUSPENSION OTC; QL

medi-bismuth oral tablet chewable Soothe OTC

peptic relief oral tablet chewable Soothe OTC

pink bismuth oral suspension Kaopectate OTC; QL

px stomach relief oral suspension Kaopectate OTC; QL

px stomach relief oral tablet chewable Soothe OTC

qc diarrhea relief oral suspension Kaopectate OTC; QL

qc pink bismuth oral tablet chewable Soothe OTC

ra pink bismuth oral tablet chewable Soothe OTC

ra stomach relief oral suspension Kaopectate OTC; QL

ra stomach relief oral tablet chewable Soothe OTC

sm stomach relief oral suspension Kaopectate OTC; QL

sm stomach relief oral tablet chewable Soothe OTC

SOOTHE ORAL SUSPENSION OTC; QL

SOOTHE ORAL TABLET CHEWABLE OTC

stomach relief oral suspension Kaopectate OTC; QL

stomach relief oral tablet chewable Soothe OTC

AGENTES ENDÓCRINOS Y METABÓLICOS VARIOS

alendronate sodium oral solution QL

alendronate sodium oral tablet QL

cabergoline oral tablet QL

calcitonin (salmon) nasal solution Miacalcin

calcitriol oral capsule Rocaltrol PA

calcitriol oral solution Rocaltrol PA

clomiphene citrate oral tablet AL; QL

DDAVP RHINAL TUBE NASAL SOLUTION

desmopressin ace spray refrig nasal solution

desmopressin acetate oral tablet DDAVP QL

22


desmopressin acetate spray nasal solution DDAVP

levocarnitine oral tablet Carnitor

octreotide acetate injection solution SandoSTATIN PA; SP

raloxifene hcl oral tablet Evista

sodium phenylbutyrate oral powder Buphenyl PA; SP; QL

sodium phenylbutyrate oral tablet Buphenyl PA; SP; QL

ZOMACTON SUBCUTANEOUS SOLUTION RECONSTITUTED

PA; SP; QL

AGENTES GASTROINTESTINALES VARIOS

balsalazide disodium oral capsule Colazal QL

calcium acetate (phos binder) oral capsule PhosLo

calcium acetate (phos binder) oral tablet Calphron

calcium acetate oral tablet Calphron

cvs gas relief extra strength oral capsule Gas-X Extra Strength OTC

cvs gas relief extra strength oral tablet chewable

Phazyme OTC

cvs gas relief infants oral suspensionLittle Remedies for Tummys

OTC

cvs gas relief oral capsule Gas-X Extra Strength OTC

cvs gas relief oral tablet chewable Gas-X OTC

cvs gas relief ultra strength oral capsule Gas-X Ultra Strength OTC

cvs infants gas relief oral suspensionLittle Remedies for Tummys

OTC

drxchoice gas relief oral tablet chewable Gas-X OTC

enulose oral solution QL

eq gas relief extra strength oral tablet chewable

Phazyme OTC

eq gas relief oral capsule Gas-X Extra Strength OTC

eq gas relief oral tablet chewable Phazyme OTC

eq infants gas relief oral suspensionLittle Remedies for Tummys

OTC

eql gas gone oral tablet chewable Phazyme OTC

eql gas relief oral capsule Gas-X Extra Strength OTC

eql gas relief ultra strength oral capsule Gas-X Ultra Strength OTC

eql infants gas relief oral suspensionLittle Remedies for Tummys

OTC

gas relief drops infants oral suspensionLittle Remedies for Tummys

OTC

23


gas relief extra strength oral capsule Gas-X Extra Strength OTC

gas relief extra strength oral tablet chewable Phazyme OTC

gas relief infants oral suspensionLittle Remedies for Tummys

OTC

gas relief oral capsule Gas-X Ultra Strength OTC

gas relief oral suspensionLittle Remedies for Tummys

OTC

gas relief oral tablet chewable Gas-X OTC

gas relief ultra strength oral capsule Gas-X Ultra Strength OTC

GAS-X EXTRA STRENGTH ORAL CAPSULE

OTC

GAS-X ULTRA STRENGTH ORAL CAPSULE

OTC

generlac oral solution QL

gnp anti-gas oral capsule Gas-X Ultra Strength OTC

gnp gas relief extra strength oral capsule Gas-X Extra Strength OTC

gnp gas relief extra strength oral tablet chewable

Phazyme OTC

gnp gas relief max st oral tablet chewable Phazyme OTC

gnp gas relief oral tablet chewable Gas-X OTC

gnp infants gas relief oral suspensionLittle Remedies for Tummys

OTC

goodsense gas relief oral tablet chewable Phazyme OTC

hm gas relief extra strength oral capsule Gas-X Extra Strength OTC

hm gas relief infants drops oral suspensionLittle Remedies for Tummys

OTC

hm gas relief oral tablet chewable Phazyme OTC

infants gas relief oral suspensionLittle Remedies for Tummys

OTC

infants simethicone oral suspensionLittle Remedies for Tummys

OTC

lactulose encephalopathy oral solution QL

lanthanum carbonate oral tablet chewable Fosrenol

LITTLE REMEDIES FOR TUMMYS ORAL SUSPENSION

OTC

mesalamine er oral capsule extended release 24 hour

Apriso QL

mesalamine rectal enema QL

mesalamine-cleanser rectal kit Rowasa QL

metoclopramide hcl oral solution

24


metoclopramide hcl oral tablet Reglan

mi-acid gas relief oral tablet chewable Gas-X OTC

PHAZYME ORAL TABLET CHEWABLE OTC

px gas relief extra strength oral capsule Gas-X Extra Strength OTC

px gas relief infants oral suspensionLittle Remedies for Tummys

OTC

px gas relief ultra strength oral capsule Gas-X Ultra Strength OTC

qc anti-gas oral capsule Gas-X Ultra Strength OTC

qc gas relief extra strength oral tablet chewable

Phazyme OTC

qc gas relief oral capsule Gas-X Extra Strength OTC

qc gas relief oral tablet chewable Gas-X OTC

ra gas relief extra strength oral capsule Gas-X Extra Strength OTC

ra gas relief extra strength oral tablet chewable

Phazyme OTC

ra gas relief maximum strength oral tablet chewable

Phazyme OTC

ra gas relief oral capsule Gas-X Extra Strength OTC

ra gas relief oral tablet chewable Gas-X OTC

sb gas relief oral tablet chewable Phazyme OTC

sevelamer carbonate oral packet Renvela

sevelamer carbonate oral tablet Renvela QL

simethicone extra strength oral capsule Gas-X Extra Strength OTC

simethicone oral capsule Gas-X Ultra Strength OTC

simethicone oral suspensionLittle Remedies for Tummys

OTC

simethicone oral tablet chewable Phazyme OTC

sm gas relief antiflatuent oral capsule Gas-X Ultra Strength OTC

sm gas relief extra strength oral capsule Gas-X Extra Strength OTC

sm gas relief infants drops oral suspensionLittle Remedies for Tummys

OTC

sm gas relief infants oral suspensionLittle Remedies for Tummys

OTC

sm gas relief oral tablet chewable Gas-X OTC

sulfasalazine oral tablet Azulfidine QL

sulfasalazine oral tablet delayed release Azulfidine EN-tabs QL

tgt gas relief extra strength oral capsule Gas-X Extra Strength OTC

tgt gas relief extra strength oral tablet chewable

Phazyme OTC

25


ursodiol oral capsule Actigall

ursodiol oral tablet Urso 250

AGENTES GENITOURINARIOS VARIOS

alfuzosin hcl er oral tablet extended release 24 hour

Uroxatral QL

ARGYLE STERILE SALINE IRRIGATION SOLUTION

cytra k crystals oral packet Taron-Crystals

cytra-2 oral solution OTC

CYTRA-3 ORAL SYRUP OTC

cytra-k oral solution OTC

finasteride oral tablet Proscar QL

PHENAZO ORAL TABLET

potassium citrate er oral tablet extended release

Urocit-K 10

potassium citrate-citric acid oral solution

sod citrate-citric acid oral solution

sodium chloride irrigation solution Argyle Sterile Saline

tamsulosin hcl oral capsule Flomax QL

TARON-CRYSTALS ORAL PACKET

tricitrates oral solution

AGENTES HEMATOLÓGICOS VARIOS

anagrelide hcl oral capsule Agrylin

BERINERT INTRAVENOUS KIT PA; SP; QL

cilostazol oral tablet

clopidogrel bisulfate oral tablet 300 mg

clopidogrel bisulfate oral tablet 75 mg Plavix QL

dipyridamole oral tablet

HAEGARDA SUBCUTANEOUS SOLUTION RECONSTITUTED

PA; SP; QL

icatibant acetate subcutaneous solution Firazyr PA; SP; QL

KALBITOR SUBCUTANEOUS SOLUTION PA; SP; QL

pentoxifylline er oral tablet extended release

RUCONEST INTRAVENOUS SOLUTION RECONSTITUTED

PA; SP; QL

AGENTES HEMATOPOYÉTICOS

AIRAVITE ORAL TABLET

26


ARANESP (ALBUMIN FREE) INJECTION SOLUTION

PA; SP; QL

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 10 MCG/0.4ML, 100 MCG/0.5ML, 200 MCG/0.4ML, 25 MCG/0.42ML, 300 MCG/0.6ML, 40 MCG/0.4ML, 60 MCG/0.3ML

PA; SP

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 150 MCG/0.3ML, 500 MCG/ML

PA; SP; QL

bp vit 3 oral capsule Taliva

CENTRATEX ORAL CAPSULE

cyanocobalamin injection solution

DROXIA ORAL CAPSULE

EPOGEN INJECTION SOLUTION PA; SP

eql b-12 oral tablet OTC

fabb oral tablet Virt-Gard

fa-vitamin b-6-vitamin b-12 oral tablet

fe tabs oral tablet delayed release OTC

FERATE ORAL TABLET OTC; QL

FER-IN-SOL ORAL SOLUTION OTC

FEROSUL ORAL TABLET OTC; QL

ferraplus 90 oral tablet

ferrotabs oral tablet Ferate OTC; QL

ferrous fumarate oral tablet Hemocyte OTC

ferrous gluconate oral tablet OTC

ferrous sulfate oral elixir OTC

ferrous sulfate oral solution Fer-In-Sol OTC

ferrous sulfate oral tablet FeroSul OTC; QL

ferrous sulfate oral tablet delayed release OTC; QL

ferrousul oral tablet FeroSul OTC; QL

folbee oral tablet Airavite

folic acid injection solution

folic acid oral tablet 1 mg

folic acid oral tablet 400 mcg OTC

FOLIVANE-F ORAL CAPSULE

FOLIVANE-PLUS ORAL CAPSULE

folplex 2.2 oral tablet

27


FULPHILA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PA; SP; QL

gnp iron oral tablet FeroSul OTC; QL

GOODSENSE IRON ORAL TABLET OTC; QL

HEMATOGEN FA ORAL CAPSULE

hemetab oral tablet

HEMOCYTE ORAL TABLET OTC

hydroxocobalamin acetate intramuscular solution

iron supplement oral elixir OTC

meijer ferrous sulfate oral tablet FeroSul OTC; QL

MULTIGEN FOLIC ORAL TABLET

MULTIGEN ORAL TABLET

MULTIGEN PLUS ORAL TABLET

na ferric gluc cplx in sucrose intravenous solution

Ferrlecit

nat-rul iron oral tablet FeroSul OTC; QL

NEULASTA ONPRO SUBCUTANEOUS PREFILLED SYRINGE KIT

PA; SP; QL

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PA; SP; QL

NUFOL ORAL TABLET

polysaccharide iron complex oral capsule Nu-Iron OTC

px folic acid oral tablet OTC

qc ferrous sulfate oral tablet FeroSul OTC; QL

qc vitamin b12 oral tablet OTC

RETACRIT INJECTION SOLUTION PA; SP

TALIVA ORAL CAPSULE

taron forte oral capsule

VIRT-GARD ORAL TABLET

VITAMEZ ORAL CAPSULE

vitamin b 12 oral tablet OTC

vitamin b12 oral tablet OTC

vitamin b-12 oral tablet OTC

yl folic acid oral tablet OTC

ZARXIO INJECTION SOLUTION PREFILLED SYRINGE

PA; SP

28


AGENTES HEMOSTÁTICOS

aminocaproic acid oral tablet Amicar QL

tranexamic acid oral tablet Lysteda QL

AGENTES LIBERADORES DE POTASIO

sodium polystyrene sulfonate oral suspension

SPS

sodium polystyrene sulfonate rectal suspension

SPS ORAL SUSPENSION

AGENTES NASALES - SISTÉMICOS Y TÓPICOS

12 hour decongestant nasal solution QlearQuil OTC

12 hour nasal decongestant nasal solution QlearQuil OTC

12 hour nasal relief spray nasal solution QlearQuil OTC

12 hour nasal spray nasal solution QlearQuil OTC

AFRIN SALINE NASAL MIST NASAL SOLUTION

AL; OTC; QL

allergy relief nasal suspension ClariSpray OTC; QL

allergy spray 24 hour nasal aerosol Nasacort Allergy 24HR OTC; QL

allergy spray 24 hour nasal suspension ClariSpray OTC; QL

altamist spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

anefrin spray nasal solution QlearQuil OTC

AYR NASAL SOLUTION AL; OTC; QL

AYR SALINE NASAL DROPS NASAL SOLUTION

OTC; QL

azelastine hcl nasal solution QL

BABY AYR SALINE NASAL SOLUTION AL; OTC; QL

budesonide nasal suspension Rhinocort Allergy OTC; QL

CLARISPRAY NASAL SUSPENSION OTC; QL

cromolyn sodium nasal aerosol solution NasalCrom OTC

cvs budesonide nasal suspension Rhinocort Allergy OTC; QL

cvs fluticasone propionate nasal suspension ClariSpray OTC; QL

cvs nasal allergy spray nasal aerosol Nasacort Allergy 24HR OTC; QL

cvs nasal decongestant oral tabletShopko Nasal Decongestant Max

AL; OTC

cvs nasal decongestant pe oral tablet Sudogest PE OTC

cvs nasal mist nasal aerosol solution Simply Saline OTC

29


cvs nasal mist nasal solution QlearQuil OTC

cvs nasal spray nasal solution QlearQuil OTC

cvs saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

cvs sinus pe decongestant oral tablet Sudogest PE OTC

decongestant oral tabletShopko Nasal Decongestant Max

AL; OTC

deep sea nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

eq allergy relief nasal suspension ClariSpray OTC; QL

eq budesonide nasal nasal suspension Rhinocort Allergy OTC; QL

eq nasal allergy nasal aerosol Nasacort Allergy 24HR OTC; QL

eq nasal spray nasal solution QlearQuil OTC

eq saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

eq suphedrine oral tabletShopko Nasal Decongestant Max

AL; OTC

eql fluticasone childrens nasal suspension ClariSpray OTC; QL

eql fluticasone propionate nasal suspension ClariSpray OTC; QL

eql nasal decongestant oral tabletShopko Nasal Decongestant Max

AL; OTC

eql nasal decongestant pe oral tablet Sudogest PE OTC

eql nasal spray 12 hour nasal solution QlearQuil OTC

eql nasal spray no drip nasal solution QlearQuil OTC

eql saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

fluticasone propionate nasal suspension ClariSpray OTC; QL

genaphed oral tabletShopko Nasal Decongestant Max

AL; OTC

gnp 24 hour nasal allergy nasal aerosol Nasacort Allergy 24HR OTC; QL

gnp budesonide nasal spray nasal suspension

Rhinocort Allergy OTC; QL

gnp fluticasone propionate chl nasal suspension

ClariSpray OTC; QL

gnp fluticasone propionate nasal suspension ClariSpray OTC; QL

gnp nasal decongestant oral tabletShopko Nasal Decongestant Max

AL; OTC

gnp nasal decongestant pe oral tablet Sudogest PE OTC

gnp nasal moisturizing nasal solution Afrin Saline Nasal Mist AL; OTC; QL

gnp nasal spray extra moist nasal solution QlearQuil OTC

gnp nasal spray nasal solution QlearQuil OTC

gnp no drip nasal spray nasal solution QlearQuil OTC

gnp suphedrin oral liquid Sudafed Childrens OTC

30


goodsense nasal allergy spray nasal aerosol Nasacort Allergy 24HR OTC; QL

hm allergy relief nasal suspension ClariSpray OTC; QL

hm nasal decongestant oral tabletShopko Nasal Decongestant Max

AL; OTC

hm nasal decongestant pe oral tablet Sudogest PE OTC

hm nasal spray nasal solution QlearQuil OTC

hm saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

hm sinus nasal spray nasal solution QlearQuil OTC

ipratropium bromide nasal solution

KLS ALLER-FLO NASAL SUSPENSION OTC; QL

kls nasal decongestant spray nasal solution QlearQuil OTC

kp pseudoephedrine hcl oral tabletShopko Nasal Decongestant Max

AL; OTC

LITTLE NOSES SALINE NASAL SOLUTION

AL; OTC; QL

LITTLE NOSES STUFFY NOSE KIT NASAL SOLUTION

AL; OTC; QL

meijer nasal decongestant oral tabletShopko Nasal Decongestant Max

AL; OTC

meijer saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

nasal allergy 24 hour nasal aerosol Nasacort Allergy 24HR OTC; QL

nasal decongestant max st oral tabletShopko Nasal Decongestant Max

AL; OTC

nasal decongestant oral tabletShopko Nasal Decongestant Max

AL; OTC

nasal decongestant pe max st oral tablet Sudogest PE OTC

nasal decongestant pe oral tablet Sudogest PE OTC

nasal decongestant spray nasal solution QlearQuil OTC

NASAL MOIST NASAL SOLUTION AL; OTC; QL

nasal moisturizing spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

nasal relief nasal solution QlearQuil OTC

nasal spray 12 hour nasal solution QlearQuil OTC

nasal spray extra moisturizing nasal solution QlearQuil OTC

nasal spray nasal solution QlearQuil OTC

nasal spray no drip nasal solution QlearQuil OTC

nasal spray sinus nasal solution QlearQuil OTC

no drip nasal spray nasal solution QlearQuil OTC

non-pseudo sinus decongestant oral tablet Sudogest PE OTC

OCEAN FOR KIDS NASAL SOLUTION AL; OTC; QL

31


OCEAN NASAL SPRAY NASAL SOLUTION

AL; OTC; QL

pseudoephedrine hcl oral tabletShopko Nasal Decongestant Max

AL; OTC

px nasal decongestant oral tabletShopko Nasal Decongestant Max

AL; OTC

px nasal decongestant pe oral tablet Sudogest PE OTC

px nasal spray moisturizing nasal solution QlearQuil OTC

px no drip nasal spray nasal solution QlearQuil OTC

px original nasal spray nasal solution QlearQuil OTC

px saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

qc allergy relief nasal suspension ClariSpray OTC; QL

qc fluticasone propionate nasal suspension ClariSpray OTC; QL

qc saline nasal relief nasal solution Afrin Saline Nasal Mist AL; OTC; QL

qc suphedrine oral tabletShopko Nasal Decongestant Max

AL; OTC

qc suphedrine pe oral tablet Sudogest PE OTC

QLEARQUIL NASAL SOLUTION OTC

ra 12 hour nasal spray nasal solution QlearQuil OTC

ra budesonide nasal suspension Rhinocort Allergy OTC; QL

ra nasal allergy nasal aerosol Nasacort Allergy 24HR OTC; QL

ra nasal decongestant pe oral tablet Sudogest PE OTC

ra saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

ra sinus/congestion relief pe oral tablet Sudogest PE OTC

ra sterile saline nasal mist nasal solution Simply Saline OTC

ra suphedrine oral tabletShopko Nasal Decongestant Max

AL; OTC

RHINOCORT ALLERGY NASAL SUSPENSION

OTC; QL

saline mist spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

sb 12hr nasal spray nasal solution QlearQuil OTC

sb saline nose nasal solution Afrin Saline Nasal Mist AL; OTC; QL

SHOPKO NASAL DECONGESTANT MAX ORAL TABLET

AL; OTC

sinus nasal spray nasal solution QlearQuil OTC

sinus relief nasal solution QlearQuil OTC

sm allergy relief nasal suspension ClariSpray OTC; QL

32


sm nasal decongestant max st oral tabletShopko Nasal Decongestant Max

AL; OTC

sm nasal decongestant pe oral tablet Sudogest PE OTC

sm nasal spray 12 hour nasal solution QlearQuil OTC

sm nasal spray moisturizing nasal solution QlearQuil OTC

sm nasal spray nasal solution QlearQuil OTC

sm nasal spray saline nasal solution Afrin Saline Nasal Mist AL; OTC; QL

sm nasal spray sinus nasal solution QlearQuil OTC

SUDOGEST MAXIMUM STRENGTH ORAL TABLET

AL; OTC

SUDOGEST ORAL TABLET AL; OTC

SUDOGEST PE ORAL TABLET OTC

tgt nasal decongestant 12-hour nasal solution

QlearQuil OTC

tgt nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

tgt saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC; QL

triamcinolone acetonide nasal aerosol Nasacort Allergy 24HR OTC; QL

WAL-PHED ORAL TABLET AL; OTC

WAL-PHED PE ORAL TABLET OTC

AGENTES NEUROMUSCULARES

riluzole oral tablet Rilutek PA; SP

AGENTES OFTÁLMICOS

ak-poly-bac ophthalmic ointment Polycin

AKWA TEARS OPHTHALMIC OINTMENT OTC

ALAWAY CHILDRENS ALLERGY OPHTHALMIC SOLUTION

OTC; QL

ALAWAY OPHTHALMIC SOLUTION OTC; QL

ALTAFRIN OPHTHALMIC SOLUTION

apraclonidine hcl ophthalmic solution

artificial tears ophthalmic solution Tears Again OTC

atropine sulfate ophthalmic solution Isopto Atropine QL

azelastine hcl ophthalmic solution QL

bacitracin ophthalmic ointment QL

bacitracin-polymyxin b ophthalmic ointment Polycin

bacitra-neomycin-polymyxin-hc ophthalmic ointment

Neo-Polycin HC

betaxolol hcl ophthalmic solution

brimonidine tartrate ophthalmic solution QL

33


carteolol hcl ophthalmic solution QL

ciprofloxacin hcl ophthalmic solution Ciloxan

CLARITIN EYE OPHTHALMIC SOLUTION OTC; QL

cromolyn sodium ophthalmic solution QL

dexamethasone sodium phosphate ophthalmic solution

diclofenac sodium ophthalmic solution

dorzolamide hcl ophthalmic solution Trusopt QL

dorzolamide hcl-timolol mal ophthalmic solution

Cosopt QL

epinastine hcl ophthalmic solution QL

erythromycin ophthalmic ointment

eye itch relief ophthalmic solution Alaway OTC; QL

fluorometholone ophthalmic suspension FML Liquifilm

flurbiprofen sodium ophthalmic solution

gatifloxacin ophthalmic solution Zymaxid

GENTAK OPHTHALMIC OINTMENT QL

gentamicin sulfate ophthalmic solution QL

GENTEAL SEVERE OPHTHALMIC GEL OTC

GENTEAL TEARS MODERATE PF OPHTHALMIC SOLUTION

OTC

GENTEAL TEARS OPHTHALMIC SOLUTION

OTC

GENTEAL TEARS PF OPHTHALMIC SOLUTION

OTC

gnp artificial tears ophthalmic solution Clear Eyes All Seasons OTC

gnp eye drops ophthalmic solution Refresh Tears OTC

gnp eye itch relief ophthalmic solution Alaway OTC; QL

gnp itchy eye ophthalmic solution Alaway OTC; QL

gnp lubricant pm ophthalmic ointment Puralube OTC

gnp lubricating plus eye drops ophthalmic solution

Refresh Plus OTC

goodsense lubricating eye drop ophthalmic solution

Refresh Plus OTC

hm dry eye relief ophthalmic solution Visine Dry Eye OTC

hm lubricating plus ophthalmic solution Refresh Plus OTC

hm lubricating tears ophthalmic solution Systane OTC

latanoprost ophthalmic solution Xalatan QL

levobunolol hcl ophthalmic solution

34


levofloxacin ophthalmic solution

liquitears ophthalmic solution Tears Again OTC

lubricant eye drops ophthalmic solution Systane OTC

lubricating eye drops ophthalmic solution Systane OTC

lubricating plus eye drops ophthalmic solution

Refresh Plus OTC

lubrifresh p.m. ophthalmic ointment Puralube OTC

moxifloxacin hcl ophthalmic solution Vigamox QL

MURO 128 OPHTHALMIC OINTMENT OTC

MURO 128 OPHTHALMIC SOLUTION OTC

natural balance tears ophthalmic solution GenTeal Tears OTC

neomycin-bacitracin zn-polymyx ophthalmic ointment

Neo-Polycin QL

neomycin-polymyxin-dexameth ophthalmic ointment

Maxitrol

neomycin-polymyxin-dexameth ophthalmic suspension

Maxitrol

neomycin-polymyxin-gramicidin ophthalmic solution

QL

neomycin-polymyxin-hc ophthalmic suspension

NEO-POLYCIN HC OPHTHALMIC OINTMENT

NEO-POLYCIN OPHTHALMIC OINTMENT QL

ofloxacin ophthalmic solution Ocuflox QL

phenylephrine hcl ophthalmic solution Altafrin

pilocarpine hcl ophthalmic solution Isopto Carpine

POLYCIN OPHTHALMIC OINTMENT

polymyxin b-trimethoprim ophthalmic solution

Polytrim QL

polyvinyl alcohol ophthalmic solution Tears Again OTC

prednisolone acetate ophthalmic suspension Pred Forte

prednisolone sodium phosphate ophthalmic solution

PURALUBE OPHTHALMIC OINTMENT OTC

ra antihistamine eye drops ophthalmic solution

Alaway OTC; QL

ra eye itch relief ophthalmic solution Alaway OTC; QL

REFRESH CELLUVISC OPHTHALMIC GEL

OTC

35


REFRESH LACRI-LUBE OPHTHALMIC OINTMENT

OTC

REFRESH OPHTHALMIC SOLUTION OTC

REFRESH OPTIVE MEGA-3 OPHTHALMIC SOLUTION

OTC

REFRESH OPTIVE PF OPHTHALMIC SOLUTION

OTC

REFRESH P.M. OPHTHALMIC OINTMENT OTC

REFRESH PLUS OPHTHALMIC SOLUTION

OTC

REFRESH RELIEVA OPHTHALMIC SOLUTION

OTC

REFRESH TEARS OPHTHALMIC SOLUTION

OTC

sm lubricant eye drops ophthalmic solution Systane OTC

sm lubricating plus ophthalmic solution Refresh Plus OTC

sodium chloride (hypertonic) ophthalmic ointment

Muro 128 OTC

sodium chloride (hypertonic) ophthalmic solution

Muro 128 OTC

sulfacetamide sodium ophthalmic ointment QL

sulfacetamide sodium ophthalmic solution Bleph-10 QL

sulfacetamide-prednisolone ophthalmic solution

QL

SYSTANE COMPLETE OPHTHALMIC SOLUTION

OTC

SYSTANE NIGHTTIME OPHTHALMIC OINTMENT

OTC

SYSTANE OPHTHALMIC SOLUTION OTC

SYSTANE OVERNIGHT THERAPY OPHTHALMIC GEL

OTC

SYSTANE PRESERVATIVE FREE OPHTHALMIC SOLUTION

OTC

SYSTANE ULTRA OPHTHALMIC SOLUTION

OTC

SYSTANE ULTRA PF OPHTHALMIC SOLUTION

OTC

TEARS AGAIN OPHTHALMIC SOLUTION OTC

THERATEARS ALLERGY OPHTHALMIC SOLUTION

OTC; QL

THERATEARS OPHTHALMIC GEL OTC

36


THERATEARS OPHTHALMIC SOLUTION OTC

timolol maleate ophthalmic gel forming solution

Timoptic-XE QL

timolol maleate ophthalmic solution Timoptic QL

tobramycin ophthalmic solution Tobrex QL

tobramycin-dexamethasone ophthalmic suspension

TobraDex QL

trifluridine ophthalmic solution QL

ultra lubricating eye drops ophthalmic solution

Systane OTC

ZADITOR OPHTHALMIC SOLUTION OTC; QL

AGENTES ÓTICOS

acetic acid otic solution

auraphene-b otic solutionClearcanal Earwax Softener

OTC

ciprofloxacin hcl otic solution Cetraxal QL

CLEARCANAL EARWAX SOFTENER OTIC SOLUTION

OTC

CORTIC-ND OTIC SOLUTION

cvs ear drops otic solutionClearcanal Earwax Softener

OTC

cvs ear wax removal system otic solutionClearcanal Earwax Softener

OTC

cvs earwax removal kit otic solutionClearcanal Earwax Softener

OTC

ear drops earwax aid otic solutionClearcanal Earwax Softener

OTC

ear drops otic solutionClearcanal Earwax Softener

OTC

ear wax removal drops otic solutionClearcanal Earwax Softener

OTC

ear wax removal kit otic solutionClearcanal Earwax Softener

OTC

ear wax removal system otic solutionClearcanal Earwax Softener

OTC

earwax removal kit otic solutionClearcanal Earwax Softener

OTC

earwax removal otic solutionClearcanal Earwax Softener

OTC

eq ear wax removal aid otic solutionClearcanal Earwax Softener

OTC

37


exotic-hc otic solution Cortic-ND

gnp ear drops otic solutionClearcanal Earwax Softener

OTC

gnp ear systems otic solutionClearcanal Earwax Softener

OTC

gnp earwax removal drops otic solutionClearcanal Earwax Softener

OTC

gnp earwax removal kit otic solutionClearcanal Earwax Softener

OTC

goodsense ear wax kit otic solutionClearcanal Earwax Softener

OTC

goodsense ear wax removal otic solutionClearcanal Earwax Softener

OTC

hm earwax removal aid otic solutionClearcanal Earwax Softener

OTC

hm earwax removal kit otic solutionClearcanal Earwax Softener

OTC

MURINE EAR WAX REMOVAL SYSTEM OTIC SOLUTION

OTC

neomycin-polymyxin-hc otic solution

neomycin-polymyxin-hc otic suspension

ofloxacin otic solution QL

OTICIN HC NR OTIC SOLUTION

OTIX OTIC SOLUTION OTC

qc ear wax removal otic solutionClearcanal Earwax Softener

OTC

qc earwax removal otic solutionClearcanal Earwax Softener

OTC

ra ear drops otic solutionClearcanal Earwax Softener

OTC

ra earwax removal kit otic solutionClearcanal Earwax Softener

OTC

sm ear drops otic solutionClearcanal Earwax Softener

OTC

AGENTES PARA EL CUIDADO DE BOCA/GARGANTA/DIENTES

CAVAREST DENTAL GEL

chlorhexidine gluconate mouth/throat solution

Paroex QL

clotrimazole mouth/throat lozenge QL

clotrimazole mouth/throat troche QL

38


lidocaine hcl mouth/throat solution QL

lidocaine viscous hcl mouth/throat solution QL

neutral sodium fluoride mouth/throat solution PreviDent

nystatin mouth/throat suspension

ORALONE MOUTH/THROAT PASTE

PAROEX MOUTH/THROAT SOLUTION QL

PERIOGARD MOUTH/THROAT SOLUTION

QL

pilocarpine hcl oral tablet Salagen QL

triamcinolone acetonide mouth/throat paste Oralone

AGENTES PARA EL TRATAMIENTO OSTEOMUSCULAR

baclofen oral tablet

carisoprodol oral tablet Soma QL

carisoprodol-aspirin oral tablet QL

carisoprodol-aspirin-codeine oral tablet AL; QL

chlorzoxazone oral tablet

cyclobenzaprine hcl oral tablet 10 mg QL

cyclobenzaprine hcl oral tablet 5 mg

dantrolene sodium oral capsule Dantrium

EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

PA; SP; QL

GELSYN-3 INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

PA; SP; QL

methocarbamol oral tablet QL

orphenadrine citrate er oral tablet extended release 12 hour

QL

SUPARTZ FX INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

PA; SP; QL

tizanidine hcl oral tablet QL

AGENTES PARA LA GOTA

allopurinol oral tablet Zyloprim

colchicine-probenecid oral tablet

probenecid oral tablet

AGENTES PARA LA HEPATITIS C - COMBINACIONES

MAVYRET ORAL TABLET PA; SP; QL

sofosbuvir-velpatasvir oral tablet Epclusa PA; SP; QL

39


AGENTES PSICOTERAPÉUTICOS Y NEUROLÓGICOS VARIOS

acamprosate calcium oral tablet delayed release

QL

AUBAGIO ORAL TABLET PA; SP; QL

AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT

PA; SP; QL

AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT

PA; SP; QL

BETASERON SUBCUTANEOUS KIT PA; SP; QL

bupropion hcl er (smoking det) oral tablet extended release 12 hour

QL

CHANTIX CONTINUING MONTH PAK ORAL TABLET

AL; QL

CHANTIX ORAL TABLET AL; QL

CHANTIX STARTING MONTH PAK ORAL TABLET

QL

chlordiazepoxide-amitriptyline oral tablet

cvs nicotine mouth/throat gum KLS Quit2 OTC; QL

cvs nicotine mouth/throat lozenge KLS Quit2 OTC; QL

cvs nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL

cvs nicotine polacrilex mouth/throat lozenge KLS Quit2 OTC; QL

cvs nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL

disulfiram oral tablet Antabuse

donepezil hcl oral tablet 10 mg, 5 mg Aricept QL

donepezil hcl oral tablet 23 mg Aricept PA; QL

donepezil hcl oral tablet dispersible QL

eq nicotine mouth/throat gum KLS Quit4 OTC; QL

eq nicotine mouth/throat lozenge KLS Quit4 OTC; QL

eq nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL

eq nicotine polacrilex mouth/throat lozenge KLS Quit2 OTC; QL

eq nicotine step 3 transdermal patch 24 hour Nicoderm CQ OTC; QL

eq nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL

eql nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL

eql nicotine polacrilex mouth/throat lozenge KLS Quit2 OTC; QL

EXTAVIA SUBCUTANEOUS KIT PA; SP; QL

fluoxetine hcl (pmdd) oral tablet Sarafem QL

galantamine hydrobromide er oral capsule extended release 24 hour

Razadyne ER

40


galantamine hydrobromide oral solution

galantamine hydrobromide oral tablet Razadyne QL

glatiramer acetate subcutaneous solution prefilled syringe 20 mg/ml

Glatopa PA; SP; QL

glatiramer acetate subcutaneous solution prefilled syringe 40 mg/ml

Glatopa PA; SP

GLATOPA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML

PA; SP; QL

GLATOPA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 40 MG/ML

PA; SP

gnp nicotine mini mouth/throat lozenge KLS Quit2 OTC; QL

gnp nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL

gnp nicotine polacrilex mouth/throat lozenge KLS Quit2 OTC; QL

gnp nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL

goodsense nicotine mouth/throat gum KLS Quit4 OTC; QL

goodsense nicotine mouth/throat lozenge KLS Quit4 OTC; QL

hm nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL

hm nicotine polacrilex mouth/throat lozenge KLS Quit2 OTC; QL

hm nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL

KLS QUIT2 MOUTH/THROAT GUM OTC; QL

KLS QUIT2 MOUTH/THROAT LOZENGE OTC; QL

KLS QUIT4 MOUTH/THROAT GUM OTC; QL

KLS QUIT4 MOUTH/THROAT LOZENGE OTC; QL

memantine hcl oral solution

memantine hcl oral tablet Namenda QL

NAMENDA TITRATION PAK ORAL TABLET

QL

NICODERM CQ TRANSDERMAL PATCH 24 HOUR

OTC; QL

NICORELIEF MOUTH/THROAT GUM OTC; QL

NICORETTE MINI MOUTH/THROAT LOZENGE

OTC; QL

NICORETTE MOUTH/THROAT GUM OTC; QL

NICORETTE MOUTH/THROAT LOZENGE OTC; QL

NICORETTE STARTER KIT MOUTH/THROAT GUM

OTC; QL

nicotine mini mouth/throat lozenge KLS Quit2 OTC; QL

nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL

nicotine polacrilex mouth/throat lozenge KLS Quit2 OTC; QL

41


nicotine step 1 transdermal patch 24 hour Nicoderm CQ OTC; QL



nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL

NICOTROL INHALATION INHALER

NICOTROL NS NASAL SOLUTION

perphenazine-amitriptyline oral tablet

pimozide oral tablet PA

px stop smoking aid mouth/throat gum KLS Quit2 OTC; QL

px stop smoking aid mouth/throat lozenge KLS Quit2 OTC; QL

ra mini nicotine mouth/throat lozenge KLS Quit2 OTC; QL

ra nicotine gum mouth/throat gum KLS Quit2 OTC; QL

ra nicotine mouth/throat gum KLS Quit2 OTC; QL

ra nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL

ra nicotine polacrilex mouth/throat lozenge KLS Quit4 OTC; QL

ra nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL

REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR

PA; SP

REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

PA; SP

REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PA; SP

REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PA; SP

rivastigmine tartrate oral capsule

sm nicotine mouth/throat gum KLS Quit4 OTC; QL

sm nicotine mouth/throat lozenge KLS Quit2 OTC; QL

sm nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL

sm nicotine polacrilex mouth/throat lozenge KLS Quit4 OTC; QL

sm nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL

sr nicotine mouth/throat gum KLS Quit2 OTC; QL

tgt nicotine mouth/throat gum KLS Quit4 OTC; QL

tgt nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL

tgt nicotine polacrilex mouth/throat lozenge KLS Quit4 OTC; QL

tgt nicotine step one transdermal patch 24 hour

Nicoderm CQ OTC; QL

42


tgt nicotine step three transdermal patch 24 hour

Nicoderm CQ OTC; QL

tgt nicotine step two transdermal patch 24 hour

Nicoderm CQ OTC; QL

THRIVE MOUTH/THROAT GUM OTC; QL

AGENTES RESPIRATORIOS VARIOS

PULMOZYME INHALATION SOLUTION PA; SP; QL

AGENTES TIROIDEOS

EUTHYROX ORAL TABLET

LEVO-T ORAL TABLET

levothyroxine sodium oral tablet Euthyrox

LEVOXYL ORAL TABLET

liothyronine sodium oral tablet Cytomel

methimazole oral tablet Tapazole

propylthiouracil oral tablet

SYNTHROID ORAL TABLET

UNITHROID ORAL TABLET

AMINOGLUCÓSIDOS

neomycin sulfate oral tablet

paromomycin sulfate oral capsule

tobramycin inhalation nebulization solution Kitabis Pak SP; QL

ANALGÉSICOS - ANTIINFLAMATORIOS

ADDAPRIN ORAL TABLET OTC; QL

childrens ibuprofen 100 oral suspension Childrens Medi-Profen OTC; QL

childrens ibuprofen oral suspension Childrens Medi-Profen OTC; QL

CHILDRENS MEDI-PROFEN ORAL SUSPENSION

OTC; QL

cvs childrens ibuprofen oral suspension Childrens Medi-Profen OTC; QL

cvs ibuprofen childrens oral suspension Childrens Medi-Profen OTC; QL

cvs ibuprofen infants oral suspension Medi-Profen OTC; QL

cvs ibuprofen oral capsule Medi-Profen OTC

cvs ibuprofen oral tablet Addaprin OTC; QL

diclofenac potassium oral tablet

diclofenac sodium er oral tablet extended release 24 hour

PA

diclofenac sodium oral tablet delayed release

43


dyspel oral tablet Addaprin OTC; QL

ENBREL MINI SUBCUTANEOUS SOLUTION CARTRIDGE

PA; SP; QL

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PA; SP; QL

ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED

PA; SP; QL

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

PA; SP; QL

eq ibuprofen childrens oral suspension Childrens Medi-Profen OTC; QL

eq ibuprofen infants oral suspension Medi-Profen OTC; QL

eq ibuprofen oral capsule Medi-Profen OTC

eq ibuprofen oral tablet Addaprin OTC; QL

eql childrens ibuprofen oral suspension Childrens Medi-Profen OTC; QL

eql ibuprofen infants oral suspension Medi-Profen OTC; QL

eql ibuprofen oral capsule Medi-Profen OTC

eql ibuprofen oral tablet Addaprin OTC; QL

etodolac er oral tablet extended release 24 hour

etodolac oral capsule

etodolac oral tablet Lodine

fenoprofen calcium oral capsule Nalfon

fenoprofen calcium oral tablet Nalfon QL

flurbiprofen oral tablet

genpril oral tablet Addaprin OTC; QL

gnp childrens ibuprofen oral suspension Childrens Medi-Profen OTC; QL

gnp ibuprofen infants oral suspension Medi-Profen OTC; QL

gnp ibuprofen oral capsule Medi-Profen OTC

gnp ibuprofen oral tablet Addaprin OTC; QL

goodsense ibuprofen childrens oral suspension

Childrens Medi-Profen OTC; QL

goodsense ibuprofen infants oral suspension Medi-Profen OTC; QL

goodsense ibuprofen oral capsule Medi-Profen OTC

goodsense ibuprofen oral tablet Addaprin OTC; QL

hm ibuprofen childrens oral suspension Childrens Medi-Profen OTC; QL

hm ibuprofen ib oral tablet Addaprin OTC; QL

hm ibuprofen infants oral suspension Medi-Profen OTC; QL

hm ibuprofen oral capsule Medi-Profen OTC

44


hm ibuprofen oral tablet Addaprin OTC; QL

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT

PA; SP; QL

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT

PA; SP; QL

HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT

PA; SP; QL

HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT

PA; SP; QL

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT

PA; SP; QL

HYVEE IBUPROFEN CHILDRENS ORAL SUSPENSION

OTC; QL

IBU ORAL TABLET

ibu-200 oral tablet Addaprin OTC; QL

ibuprofen childrens oral suspension Childrens Medi-Profen OTC; QL

ibuprofen infants drops oral suspension Medi-Profen OTC

ibuprofen infants oral suspension Medi-Profen OTC; QL

ibuprofen oral capsule Medi-Profen OTC

ibuprofen oral suspension Childrens Medi-Profen QL

ibuprofen oral tablet 200 mg Addaprin OTC; QL

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

IBU

indomethacin er oral capsule extended release

indomethacin oral capsule

infants ibuprofen oral suspension Medi-Profen OTC; QL

ketoprofen er oral capsule extended release 24 hour

QL

ketoprofen oral capsule

ketorolac tromethamine oral tablet QL

kls ibuprofen oral tablet Addaprin OTC; QL

ks ibuprofen oral capsule Medi-Profen OTC

leflunomide oral tablet Arava

meclofenamate sodium oral capsule QL

MEDI-PROFEN ORAL CAPSULE OTC

MEDI-PROFEN ORAL SUSPENSION OTC; QL

MEDI-PROFEN ORAL TABLET OTC; QL

45


mefenamic acid oral capsule PA; QL

meijer ibuprofen oral tablet Addaprin OTC; QL

meloxicam oral tablet 15 mg Mobic

meloxicam oral tablet 7.5 mg Mobic PA

MOTRIN IB ORAL CAPSULE OTC

MOTRIN IB ORAL TABLET OTC; QL

nabumetone oral tablet

naproxen oral suspension Naprosyn

naproxen oral tablet

naproxen sodium oral tablet Anaprox DS

oxaprozin oral tablet Daypro

piroxicam oral capsule Feldene PA

PROVIL ORAL TABLET OTC; QL

px childrens profen ib oral suspension Childrens Medi-Profen OTC; QL

px ibuprofen oral tablet Addaprin OTC; QL

px infants profen ib oral suspension Medi-Profen OTC; QL

qc childrens ibuprofen oral suspension Childrens Medi-Profen OTC; QL

qc ibuprofen ib oral tablet Addaprin OTC; QL

qc ibuprofen infants oral suspension Medi-Profen OTC; QL

qc ibuprofen oral tablet Addaprin OTC; QL

ra ibuprofen childrens oral suspension Childrens Medi-Profen OTC; QL

ra ibuprofen infants oral suspension Medi-Profen OTC; QL

ra ibuprofen oral capsule Medi-Profen OTC

ra ibuprofen oral suspension Childrens Medi-Profen OTC; QL

ra ibuprofen oral tablet Addaprin OTC; QL

ra pain relief ibuprofen oral tablet Addaprin OTC; QL

RIDAURA ORAL CAPSULE

sb ibuprofen oral tablet Addaprin OTC; QL

sb infants ibuprofen oral suspension Medi-Profen OTC; QL

sm childrens ibuprofen oral suspension Childrens Medi-Profen OTC; QL

sm ibuprofen ib oral tablet Addaprin OTC; QL

sm ibuprofen oral capsule Medi-Profen OTC

sm ibuprofen oral tablet Addaprin OTC; QL

sm infants ibuprofen oral suspension Medi-Profen OTC; QL

sulindac oral tablet

tgt childrens ibuprofen oral suspension Childrens Medi-Profen OTC; QL

tgt ibuprofen childrens oral suspension Childrens Medi-Profen OTC; QL

46


tgt ibuprofen oral capsule Medi-Profen OTC

tgt ibuprofen oral tablet Addaprin OTC; QL

tgt infants ibuprofen oral suspension Medi-Profen OTC; QL

tolmetin sodium oral capsule

tolmetin sodium oral tablet

WAL-PROFEN ORAL CAPSULE OTC

WAL-PROFEN ORAL TABLET OTC; QL

ANALGÉSICOS - NO NARCÓTICOS

8 hour arthritis pain reliever oral tablet extended release

Midol OTC; QL

8 hour pain reliever oral tablet extended release

Midol OTC; QL

8hr muscle aches & pain oral tablet extended release

Midol OTC; QL

acetaminophen childrens oral solution OTC; QL

acetaminophen childrens oral suspension PediaCare Children OTC; QL

acetaminophen childrens oral tablet chewable

Mapap Childrens OTC

acetaminophen er oral tablet extended release

Midol OTC; QL

acetaminophen extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

acetaminophen infants oral suspension PediaCare Children OTC; QL

acetaminophen oral liquid Little Remedies for Fever OTC; QL

acetaminophen oral solution OTC; QL

acetaminophen oral suspension PediaCare Children OTC; QL

acetaminophen oral tablet 325 mg Pharbetol OTC

acetaminophen oral tablet 500 mgHealthy Mama Shake That Ache

OTC; QL

acetaminophen oral tablet chewable 160 mg Mapap Childrens OTC

acetaminophen oral tablet chewable 80 mg Childrens Medi-Tabs OTC; QL

acetaminophen rectal suppository FeverAll Adults OTC

adult aspirin regimen oral tablet delayed release

Aspir-Low OTC; QL

aminofen oral tablet Pharbetol OTC

arthritis pain relief oral tablet extended release

Midol OTC; QL

arthritis pain reliever oral tablet extended release

Midol OTC; QL

47


aspirin 81 oral tablet chewable Bayer Low Dose OTC; QL

aspirin 81 oral tablet delayed release Aspir-Low OTC; QL

aspirin adult low dose oral tablet delayed release

Aspir-Low OTC; QL

aspirin adult low strength oral tablet chewable

Bayer Low Dose OTC; QL

aspirin adult low strength oral tablet delayed release

Aspir-Low OTC; QL

aspirin adult oral tabletBayer Advanced Aspirin Reg St

OTC; QL

aspirin childrens oral tablet chewable Bayer Low Dose OTC; QL

aspirin ec adult low strength oral tablet delayed release

Aspir-Low OTC; QL

aspirin ec low dose oral tablet delayed release

Aspir-Low OTC; QL

aspirin ec low strength oral tablet delayed release

Aspir-Low OTC; QL

aspirin ec oral tablet delayed release Aspir-Low OTC; QL

aspirin low dose oral tablet chewable Bayer Low Dose OTC; QL

aspirin low dose oral tablet delayed release Aspir-Low OTC; QL

aspirin low strength oral tablet chewable Bayer Low Dose OTC; QL

aspirin oral tabletBayer Advanced Aspirin Reg St

OTC; QL

aspirin oral tablet chewable Bayer Low Dose OTC; QL

aspirin oral tablet delayed release Aspir-Low OTC; QL

aspirin rectal suppository OTC

ASPIR-LOW ORAL TABLET DELAYED RELEASE

OTC; QL

aspirtab oral tablet delayed release Bayer Aspirin OTC; QL

back & body extra strength oral tablet Bayer Back & Body OTC

BAYER ADVANCED ASPIRIN REG ST ORAL TABLET

OTC; QL

BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE

OTC; QL

BAYER ASPIRIN ORAL TABLET OTC; QL

BAYER ASPIRIN ORAL TABLET DELAYED RELEASE

OTC; QL

BAYER LOW DOSE ORAL TABLET CHEWABLE

OTC; QL

48


BAYER LOW DOSE ORAL TABLET DELAYED RELEASE

OTC; QL

BAYER MIGRAINE ORAL TABLET OTC

betatemp childrens oral suspension PediaCare Children OTC; QL

butalbital-acetaminophen oral capsule QL

butalbital-acetaminophen oral tablet Tencon QL

butalbital-apap-caffeine oral capsule Esgic QL

butalbital-apap-caffeine oral tablet Esgic QL

butalbital-aspirin-caffeine oral capsule Fiorinal QL

butalbital-aspirin-caffeine oral tablet QL

CAREALL ASPIRIN ORAL TABLET CHEWABLE

OTC; QL

childrens acetaminophen oral suspension PediaCare Children OTC; QL

childrens apap oral tablet chewable Childrens Medi-Tabs OTC; QL

childrens aspirin low strength oral tablet chewable


childrens aspirin oral tablet chewable Bayer Low Dose OTC; QL

CHILDRENS MEDI-TABS ORAL TABLET CHEWABLE

OTC; QL

childrens non-aspirin oral tablet chewable Childrens Medi-Tabs OTC; QL

childrens pain reliever oral tablet chewable Childrens Medi-Tabs OTC; QL

childrens silapap oral liquid Little Remedies for Fever OTC; QL

childrens tactinal oral tablet chewable Childrens Medi-Tabs OTC; QL

choline-mag trisalicylate oral liquid

cvs 8hr arthritis pain relief oral tablet extended release

Midol OTC; QL

cvs 8hr muscle aches & pain oral tablet extended release

Midol OTC; QL

cvs acetaminophen ex st oral tabletHealthy Mama Shake That Ache

OTC; QL

cvs arthritis pain relief oral tablet extended release

Midol OTC; QL

cvs aspirin adult low dose oral tablet chewable


cvs aspirin adult low strength oral tablet delayed release

Aspir-Low OTC; QL

cvs aspirin ec oral tablet delayed release Aspir-Low OTC; QL

cvs aspirin low dose oral tablet delayed release

Aspir-Low OTC; QL

49


cvs aspirin low strength oral tablet delayed release

Aspir-Low OTC; QL

cvs aspirin oral tabletBayer Advanced Aspirin Reg St

OTC; QL

cvs back & body extra strength oral tablet Bayer Back & Body OTC

cvs buffered aspirin oral tablet Bufferin OTC

cvs childs non-aspirin oral tablet chewable Childrens Medi-Tabs OTC; QL

cvs fever reducing childrens rectal suppository

FeverAll Childrens OTC

cvs headache relief oral tablet Bayer Migraine OTC

cvs infants pain relief drops oral suspension PediaCare Children OTC; QL

cvs migraine relief oral tablet Bayer Migraine OTC

cvs non-aspirin childrens oral tablet chewable

Childrens Medi-Tabs OTC; QL

cvs non-aspirin extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

cvs pain & fever childrens oral suspension PediaCare Children OTC; QL

cvs pain & fever infants oral suspension PediaCare Children OTC; QL

cvs pain relief childrens oral suspension PediaCare Children OTC; QL

cvs pain relief childrens oral tablet chewable Mapap Childrens OTC

cvs pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

cvs pain relief oral tabletHealthy Mama Shake That Ache

OTC; QL

cvs pain relief oral tablet extended release Midol OTC; QL

cvs pain relief regular st oral tablet Pharbetol OTC

diflunisal oral tablet

ECOTRIN LOW STRENGTH ORAL TABLET DELAYED RELEASE

OTC; QL

ECOTRIN ORAL TABLET DELAYED RELEASE

OTC; QL

ECPIRIN ORAL TABLET DELAYED RELEASE

OTC; QL

ed-apap oral liquid Little Remedies for Fever OTC; QL

eq 8hr arthritis pain relief oral tablet extended release

Midol OTC; QL

eq acetaminophen oral tablet 325 mg Pharbetol OTC

eq acetaminophen oral tablet 500 mgHealthy Mama Shake That Ache

OTC; QL

eq arthritis pain oral tablet extended release Midol OTC; QL

50


eq aspirin adult low dose oral tablet delayed release

Aspir-Low OTC; QL

eq aspirin low dose oral tablet chewable Bayer Low Dose OTC; QL

eq aspirin oral tabletBayer Advanced Aspirin Reg St

OTC; QL

eq aspirin oral tablet delayed release 325 mg

Bayer Aspirin OTC; QL

eq aspirin oral tablet delayed release 500 mg

Ecotrin Maximum Strength

OTC

eq buffered aspirin oral tablet Bufferin OTC

eq childrens aspirin oral tablet chewable Bayer Low Dose OTC; QL

eq childrens pain reliever oral tablet chewable

Childrens Medi-Tabs OTC; QL

eq pain & fever childrens oral suspension PediaCare Children OTC; QL

eq pain & fever childrens oral tablet chewable

Mapap Childrens OTC

eq pain & fever infants oral suspension PediaCare Children OTC; QL

eq pain reliever oral tablet 325 mg Pharbetol OTC

eq pain reliever oral tablet 500 mgHealthy Mama Shake That Ache

OTC; QL

eql acetaminophen childrens oral suspension

PediaCare Children OTC; QL

eql acetaminophen ex st oral tabletHealthy Mama Shake That Ache

OTC; QL

eql acetaminophen infants oral suspension PediaCare Children OTC; QL

eql acetaminophen oral tablet Pharbetol OTC

eql arthritis pain relief oral tablet extended release

Midol OTC; QL

eql aspirin ec oral tablet delayed release Bayer Aspirin OTC; QL

eql aspirin low dose oral tablet chewable Bayer Low Dose OTC; QL

eql aspirin low dose oral tablet delayed release

Aspir-Low OTC; QL

eql aspirin oral tabletBayer Advanced Aspirin Reg St

OTC; QL

eql headache relief ex str oral tablet Bayer Migraine OTC

eql migraine formula oral tablet Bayer Migraine OTC

extraprin oral tablet Bayer Migraine OTC

fever reducer childrens rectal suppository FeverAll Childrens OTC

FEVERALL ADULTS RECTAL SUPPOSITORY

OTC

51


FEVERALL CHILDRENS RECTAL SUPPOSITORY

OTC

FEVERALL INFANTS RECTAL SUPPOSITORY

OTC

FEVERALL JUNIOR STRENGTH RECTAL SUPPOSITORY

OTC

gnp 8 hour pain reliever oral tablet extended release

Midol OTC; QL

gnp acetaminophen ex st oral capsule OTC; QL

gnp acetaminophen oral tablet Pharbetol OTC

gnp adult aspirin low strength oral tablet chewable


gnp arthritis pain relief oral tablet extended release

Midol OTC; QL

gnp aspirin low dose oral tablet delayed release

Aspir-Low OTC; QL

gnp aspirin oral tabletBayer Advanced Aspirin Reg St

OTC; QL

gnp aspirin oral tablet delayed release Bayer Aspirin OTC; QL

gnp headache relief extra str oral tablet Bayer Migraine OTC

gnp infants pain relief oral suspension PediaCare Children OTC; QL

gnp infants pain/fever oral suspension PediaCare Children OTC; QL

gnp migraine relief oral tablet Bayer Migraine OTC

gnp pain & fever childrens oral suspension PediaCare Children OTC; QL

gnp pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

gnp pain relief oral tablet Pharbetol OTC

goodsense arthritis pain oral tablet extended release

Midol OTC; QL

goodsense aspirin adult low st oral tablet chewable


goodsense aspirin low dose oral tablet delayed release

Aspir-Low OTC; QL

goodsense aspirin oral tabletBayer Advanced Aspirin Reg St

OTC; QL

goodsense aspirin oral tablet chewable Bayer Low Dose OTC; QL

goodsense aspirin oral tablet delayed release

Bayer Aspirin OTC; QL

goodsense migraine formula oral tablet Bayer Migraine OTC

goodsense pain & fever child oral suspension


52


goodsense pain & fever infants oral suspension


goodsense pain relief extra st oral tabletHealthy Mama Shake That Ache

OTC; QL

goodsense pain relief oral tablet extended release

Midol OTC; QL

headache relief oral tablet Bayer Migraine OTC

HEALTHY MAMA SHAKE THAT ACHE ORAL TABLET

OTC; QL

hm acetaminophen childrens oral tablet chewable

Mapap Childrens OTC

hm arthritis pain relief oral tablet extended release

Midol OTC; QL

hm aspirin ec low dose oral tablet delayed release

Aspir-Low OTC; QL

hm aspirin ec oral tablet delayed release Bayer Aspirin OTC; QL

hm aspirin oral tabletBayer Advanced Aspirin Reg St

OTC; QL

hm aspirin oral tablet chewable Bayer Low Dose OTC; QL

hm aspirin oral tablet delayed release Bayer Aspirin OTC; QL

hm migraine relief oral tablet Bayer Migraine OTC

hm pain & fever childrens oral suspension PediaCare Children OTC; QL

hm pain & fever infants oral suspension PediaCare Children OTC; QL

hm pain relief extra strength oral tabletHealthy Mama Shake That Ache

OTC; QL

hm pain reliever oral tablet Pharbetol

Documents

Lista de medicamentos preferidos aprobada por Medicaid...New York Health and Recovery Plan (HARP) Lista de medicamentos preferidos aprobada por Medicaid En vigencia desde el 1 de febrero