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Pennsylvania’s Children’s Health

Insurance Program (CHIP)


Member Formulary
This formulary was designed to be a useful tool if you have prescription drug coverage. It lists the
drugs covered by your benefit. Medications are listed in this formulary in easy-to-understand
groupings, but we encourage you to call our Pharmacy Service Team at (800) 988-4861 if you have
any questions about this information.

You can also view the formulary online by logging onto thehealthplan.com.

Specialty Vendor Drug Program


Certain medications require the use of a contracted specialty pharmacy vendor for purchase. Please
contact the Pharmacy Service Team at (800) 988-4861 for additional information on the program and
a complete list of the medications included.

A few things you should remember when using this formulary and your prescription benefit:
o All prescriptions must be filled at a participating pharmacy.
o You will pay the applicable copay, coinsurance or deductible when you receive the prescription.
o Coverage is for generic drugs when they have equivalent rating in the drug products list
(Orange Book---U.S. Department of Health and Human Services).
o Some medications on the formulary require prior authorization which your provider may
request through our Pharmacy Service Team at (800) 988-4861.
o If you require drugs or medications not listed on this formulary, your provider may request an
exception through our Pharmacy Service Team, except for those items listed as specific
exclusions.
o Prescriptions written by non-participating providers are not covered by your prescription drug
rider unless you subscribe to the point-of-service plan.
o Non-prescription (over-the-counter) medications are not covered.
o Brand name drugs which have a generic equivalent are covered only when medically necessary
via the prior authorization process. You can also elect the brand name drug and pay the
difference between the brand and generic, which can be substantial. In addition, you must pay
the applicable copay.
o Some medications and diabetic supplies may be restricted to a specific manufacturer, vendor or
supplier and may be subject to quantity limits.
o Quantity limits may apply to certain drugs.
o Prescriptions written by dentists are not covered unless your drug rider provides for this benefit.

Using this formulary


o Drug names followed by one asterisk (*) require prior authorization.
o Drug names followed by two asterisks (**) have a quantity limit. The same quantity limits apply
to both benefits. For more information on drugs with quantity limits or drugs that require prior
authorization, please call our Pharmacy Service Team at (800) 988-4861 or (570) 271-5673.
o This formulary is accurate as of September 1, 2009, and is subject to change.
o Restrictions in drug availability may result from use of a formulary.
(Please note: A percentage copay applies for human growth hormone and is dependent upon your
prescription drug rider.)

Please be aware that if you choose to obtain a non-formulary drug, you may be required to pay the full
price of that drug. For information about your specific prescription drug
benefits, please contact the Pharmacy Service Team at (800) 988-4861 or (570) 271-5673.

What is a drug formulary?


A drug formulary is a continually updated list of prescription medications. It represents the drugs
currently covered based upon the clinical judgment of the Pharmacy and Therapeutics Committee,
which is made up of pharmacists and physicians. (The formulary is continually updated due to the
high number of drugs currently on the market, as well as the continuous introduction of new drugs.)
This committee thoroughly reviews medical literature to first determine which drugs are likely to
produce the best results for patients. Then, if two or more drugs produce the same clinical results,
elements like cost and ease of use are considered.

A well-developed formulary enhances quality of patient care by encouraging physicians to prescribe


medications that are safe, effective, and likely to achieve the best possible outcome for the patient.
When you use a formulary medication, it is considered a ‘‘covered’’ medication and you pay your
particular co-pay or coinsurance for that drug.

The Plan recognizes that, in some situations, you may not respond well to a given formulary drug, or
may have an allergy or other condition that warrants the use of a non-formulary drug. An exception
process exists for these special instances. Your physician may initiate a request for a formulary
exception by contacting our Pharmacy Service Team. Your request will be reviewed, including review
of pertinent medical records, treatment and laboratory data. We respond to such requests within 48
hours of receiving all necessary information. If an exception is approved, the non-formulary drug will
be covered at your regular applicable copay. If your request is denied, the medication will be
excluded from coverage under your prescription drug benefits.

Formulary exclusions
There are certain medications that your plan will not cover under any circumstance. These are called
exclusions. Examples of exclusions include, but are not limited to, over-the-counter medications,
medications used for experimental, investigational or unproven drug therapies, medications used for
weight loss and weight management, life-style medications, medications used for cosmetic
purposes, and medications for erectile dysfunction. Exclusions are subject to change so you should
contact the Pharmacy Service Team when you are unsure whether a medication is covered.

Formulary development
When deciding whether or not a drug should be included in the formulary, the Pharmacy and
Therapeutics Committee carefully considers each drug for coverage or non-coverage in order to
ensure safety and effectiveness in the medications being prescribed. This information is then shared
with participating providers for review and feedback. Based upon the gathered information and
provider feedback, the Pharmacy and Therapeutics Committee will determine a drug’s inclusion or
exclusion in the formulary. For the specific criteria used to determine a drug’s inclusion or exclusion
in this formulary, please contact the Pharmacy Service Team at (800) 988-4861.

What are generics?


When a company develops a new drug, it receives a patent that protects the drug company’s right to
be the only manufacturer of that drug for a certain period of time, which means that no generic can
be manufactured. After that patent expires, other companies can then make the same drug and sell
it in its generic form. The generic form of a drug has the same active ingredients, the same strength,
and the same dosage as the brand name drug. The inactive ingredients (which provide texture,
shape and color) may be different, which is why a generic typically looks different than its brand
name counterpart. Generic drugs are usually less expensive than brand name drugs, but are just as
safe and effective. This is because generic manufacturers have lower advertising costs and greater
competition from other generic manufacturers. Additionally, the U.S. Food and Drug Administration
regulates all pharmaceuticals, including generics, to assure quality, strength, purity and potency.

Your prescription drug coverage is a generic-based plan and, whenever possible, you should use a
cost-effective generic drug.

Geisinger Choice is offered through Geisinger Quality Options, Inc. and affiliate of Geisinger Health Plan, which has more
than 20 years of experience providing health insurance coverage to Pennsylvania residents.
Quantity Limits (**)
Axert 6 tablets
copay/coinsurance 6 tablets per copay/coinsurance
Chantix 24 weeks of therapy covered per lifetime
Epipen 2 injections per copayment/coinsurance
Exjade 15-day supply per copay/coinsurance
60 mL or 120 tablets per
Fluoride supplements copay/coinsurance
Glucagon 2 injections per copayment/coinsurance
Humira 1 copay/coinsurance per injection
Ketorolac 20 tablets per copay/coinsurance
Leukine 7-day limit per copay/coinsurance
Maxalt 6 tablets per copay/coinsurance
50 mL or 100 tablets per
MVI w/fluoride copay/coinsurance
Neulasta 7-day limit per copay/coinsurance
Neumega 7-day limit per copay/coinsurance
Neupogen 7-day limit per copay/coinsurance
Nexavar 1 copay/coinsurance per 15 days supply
Prenatal vitamins 100 tablets per copay/coinsurance
Revatio 2 copays/coinsurances per 34 day supply
Sumatriptan injection 2 kits (4 injections) per copay/coinsurance
Sumatriptan nasal 4 per copay/coinsurance
Sumatriptan tablets 6 tablets per copay/coinsurance
Sutent 1 copay/coinsurance per 15 days supply
Twinject 1 kit per copay/coinsurance
zaleplon 15 tablets per copay/coinsurance
zolpidem 15 capsules per copay/coinsurance
Drug Tier Drug Tier Drug Tier
Allergy, Cough, and Lung Cefdinir 1 Penicillin 1
Medications Cefprozil 1 Prezista 2
Accolate* 2 Cefuroxime Axetil 1 Primaquine 1
Acetylcysteine 1 Cephalexin 1 Pyrazinamide 1
Advair inhaler 2 Chlorhexidene rinse 1 Rescriptor 2
Albuterol solution 1 Chloroquine 1 Reyataz 2
Allegra 1 Ciprofloxacin 1 Ribavirin 1
Allegra-D* 2 Clarithromycin 1 Rifampin 1
Atrovent inhaler 2 Cleocin oral solution 2 Rifater 2
Azmacort 2 Clindamycin 1 Selzentry 2
Benzonatate 1 Clotrimazole Troches 1 Stavudine 2
Brovana* 2 Combivir 2 Sulfamethoxazole+Trimethopri
Combivent inhaler 2 Crixivan 2 m 1
Cyproheptadine 1 Cytovene 2 Sulfisoxazole 1
Epipen** 2 Dapsone 1 Sustiva 2
Flovent inhaler 2 Daraprim 2 Tetracycline 1
Flunisolide nasal 1 Dicloxacillin 1 Tobi* 2
Fluticasone nasal 1 Didanosine 1 Trimethoprim 1
Foradil inhaler 2 Doxycycline 1 Trizivir 2
Guaifenesin+codeine 1 Emtriva 2 Truvada 2
Guaifenesin+PSE+codeine 1 Epivir 2 Tyzeka 2
Hydrocodone+homatropine Epivir HBV 2 Valcyte 2
syrup 1 Epzicom 2 Valtrex 2
Hydroxyzine HCl 1 Erthrocin 2 Vancocin 2
Hydroxyzine pamoate 1 Erythromycin 1 Viracept 2
Intal inhaler 2 Erythromycin+sulfisoxazole 1 Viramune 2
Ipratropium solution 1 Ethambutol 1 Virazole 2
Ipratropium/albuterol solution 1 Famciclovir 1 Viread 2
Maxair inhaler 2 Fansidar 2 Yodoxin 2
Nasonex nasal 2 Fluconazole 1 Ziagen 2
Perforomist* 2 Fuzeon 2 Zidovudine 1
Promethazine 1 Gantrisin 2 Zyvox* 2
Promethazine DM 1 Grifulvin V 2 Cancer & organ transplant
Promethazine+codeine 1 Gris Peg 2 Medications
Pulmicort inhaler 2 Hepsera 2 Actimmune* 2
Pulmozyme* 2 Humatin 2 Alkeran 2
QVAR inhaler 2 Hydroxychloroquine 1 Aranesp* 2
Rhinocort AQ nasal 2 Intelence 2 Arimidex 2
Serevent Diskus inhaler 2 Invirase 2 Azathioprine 1
Singulair 2 Isentress 2 Casodex 2
Spiriva inhaler 2 Isoniazid 1 Ceenu 2
Symbicort 2 Itraconazole* 1 Cellcept 2
Terbutaline 1 Kaletra 2 Cyclophosphamide 1
Theophylline 1 Ketoconazole 1 Cyclosporine 1
Twinject** 2 Lariam 2 Cytradren 2
Ventolin HFA inhaler 1 Levaquin 2 Emcyt 2
Antibiotics & Other Lexiva 2 Epogen* 2
Medications used for Mebendazole 1 Femara 2
Infection Mepron 2 Flutamide 1
Acyclovir (oral) 1 Metronidazole 1 Gleevec* 2
Agenerase 2 Minocycline 1 Hexalen 2
Amantadine 1 Mycobutin 2 Hydroxyurea 1
Amoxicillin 1 Nebupent 2 Intron-A 2
Amoxicillin/Clavulanate 1 Neomycin 1 Leucovorin 1
Atripla 2 Nitrofurantoin 1 Leukeran 2
Avelox 2 Norvir 2 Leukine*,** 2
Azithromycin 1 Noxafil* 2 Lysodren 2
Baraclude 2 Nystatin 1 Matulane 2
Drug Tier Drug Tier Drug Tier
Megestrol 1 Lancets 2 Dorzolamide solution 1
Mercaptopurine 1 Lantus vials 2 Dorzolamide+timolol 1
Methotrexate 1 Levemir vials and pens 2 Epinephrine 1
Mycophenolate mofetil 1 Levoxyl 1 Erythromycin ointment 1
Mycophenolate sodium 1 Metformin 1 Fluorometholone suspension 1
Myfortic 2 Metformin, extended release 1 Flurbiprofen solution 1
Myleran 2 Methimazole 1 FML ointment 2
Neoral 2 Methylprednisolone 1
Neulasta*,** 2 Novolin and Novolog vials, Gentamycin ointment, solution 1
Neumega** 2 pens, and cartridges 2 Homatropine 1
Neupogen*,** 2 One Touch Basic glucose test Isopto Hyoscine 2
Nexavar*,** 2 strips** 2 Isopto-Carbachol 2
Nilandron 2 One Touch FastTake glucose Maxidex 2
Pegasys* 2 test strips** 2 Methazolamide 1
PEG-Intron* 2 One Touch II glucose test Natacyn 2
Pilocarpine (oral) 1 strips** 2 Neo+bacitracin+poly-b
Procrit* 2 One Touch Profile glucose test ointment 1
Prograf 2 strips** 2
Rapamune* 2 One Touch SureStep glucose Neo+poly-b+gramicidin solution 1
Roferon-A 2 test strips** 2 Neo+poly-b+hc ointment,
Sandimmune 2 One Touch Ultra glucose test suspension 1
Sprycel*,** 2 strips** 2 Ofloxacin solution 1
Sutent*,** 2 Prandin 2 Pataday 2
Tamoxifen 1 Prednisolone 1 Phospholine Iodide 2
Tarceva* 2 Prednisone 1 Pilocarpine solution 1
Tasigna*,** 2 Prednisone syrup 1 Pilopine HS gel 2
Thalomid 2 Propylthiouracil 1 Poly-B+ bacitracin ointment 1
Thioguanine 1 Somatuline* 2 Poly-B+neo+dexamethasone
Tykerb* 2 Synarel nasal spray 2 ointment, suspension 1
Vepesid 2 Ear Medications Poly-B+trimethoprim solution 1
Xeloda 2 Acetic acid+aluminum acetate
Diabetic, Thyroid, Steroid & solution 1 Pred-G ointment, suspesnsion 2
Other Miscellaneous Benzocaine+antipyrine+glyceri Prednisolone acetate
Hormonal Medications ne solution 1 suspension 1
Acarbose 1 Cerumenex 2 Prednisolone sodium
Actos* 2 Ciprodex 2 phosphate solution 1
Androderm 2 Hydrocortison+acetic acid Restasis* 2
AndroGel* 2 solution 1 Sulfacetamide 10% ointment,
Aredia 2 Neo+poly-b+HC solution, solution 1
Avandia* 2 suspension 1 Timolol solution, gel solution 1
Byetta* 2 Ofloxacin solution 1 Tobradex ointment 2
Chlorpropamide 1 Eye Medications Tobramycin solution 1
Cortisone 1 Acetazolamide 1 Tobramycin+dexamathasone
Danazol 1 Acular 2 suspension 1
Dexamethasone 1 Alphagan-P 2 Tobrex Ointment 2
Fludrocortisone 1 Atropine ointment, solution 1 Travatan 2
Fluoxymesterone 1 Azasite 2 Trifluridine solution 1
Glimepiride 1 Azopt 2 Xalatan 2
Glipizide 1 Bacitracin ointment 1 Female, Hormone
Glipizide, extended release 1 Betoptic S 2 Replacement, and Birth
Glucagon** 2 Blephamide 2 Control Medications
Glyburide 1 Brimonidine solution 1 AVC 2
Glyburide+metformin 1 Ciloxan ointment 2 Chorionic gonadotropins 1
Glyset 2 Ciprofloxacin solution 1 Climara 2
Human growth hormone* 20% Dexamethasone ointment, Clindamycin vaginal cream 1
Hydrocortisone (oral) 1 solution 1 Clindesse 2
Insulin syringes, needles 2 Diclofenac solution 1 Clomiphene 1
Januvia* 2 Dipivefrin solution 1 Combipatch 2
Drug Tier Drug Tier Drug Tier
Crinone* 2 Benazepril+hctz 1 Pravastatin 1
Desogestrel+ethinyl estradiol 1 Bisoprolol+hctz 1 Prazosin 1
Dostinex* 2 Bumetanide 1 Procanbid 2
Estraderm 2 Captopril 1 Procainamide 1
Estradiol oral, transdermal 1 Captopril+hctz 1 Propafenone 1
Estring 2 Carvedilol 1 Propranolol 1
Estrogens, esterified+ Catapres TTS 2 Quinapril 1
methyltestosterone 1 Chlorthalidone 1 Quinidex 2
Estropipate 1 Cholestyramine Resin (bulk Quinidine gluconate 1
Follistim AQ 2 packages only) 1 Quinidine sulfate 1
Ganirelix 1 Clonidine 1 Ramipril 1
Jolessa; Quasense 1 Remodulin 2
Levonorgestrel+ethinyl Colestipol (bulk packages only) 1 Revatio*,** 2
estradiol 1 Cozaar 2 Simvastatin 1
Loestrin 24 Fe* 2 Crestor 2 Sotalol 1
Medroxyprogesterone 1 Dibenzyline 2 Spironolactone 1
Methergine 2 Digoxin 1 Spironolactone+hctz 1
Metronidazole vaginal gel 1 Diltiazem 1 Tarka* 2
Norethindrone 1 Dipyridamole 1 Terazosin 1
Norethindrone acetate+ethinyl Disopyramide 1 Tikosyn 2
estradiol 1 Diuril suspension 2 Torsemide 1
Doxazosin 1 Tracleer*,** 2
Norethindrone acetate+ethinyl Enalapril 1 Trandolapril 1
estradiol+iron 1 Enalapril+hctz 1 Triamterene+hctz 1
Eplerenone* 2 Triamterene+hctz 1
Norethindrone+ethinyl estradiol 1 Ethmozine 2 Tricor 2
Norethindrone+mestranol 1 Felodipine 1 Trilipix 2
Fenofibrate 1 Ventavis* 2
Norgestimate+ethinyl estradiol 1 Flecainide 1 Verapamil 1
Norgestrel+ethinyl estradiol 1 Furosemide 1 Verapamil 1
Nuvaring* 2 Gemfibrozil 1 Zetia 2
Ocella 1 Guanabenz acetate 1
Orto Tri-Cyclen Lo* 2 Guanfacine 1 Pain, Nervous System, and
Premarin 2 Hydralazine 1 Mental Health Medications
Premarin vaginal 2 Hydrochlorothiazide (HCTZ) 1 Abilify 2
Premphase 2 Hyzaar 2 Allopurinol 1
Prempro 2 Innopran XL 2 Alprazolam 1
Prempro Low Dose 2 Isosorbide dinitrate 1 Amantadine 1
Prochieve* 2 Isosorbide mononitrate 1 Amitriptyline 1
Progesterone suppositories 2 Isradipine 2 Antabuse 2
Prometrium* 2 Labetalol 1 APAP+dichloralphenazone+iso
Repronex 2 Lisinopril 1 metheptene 1
Seasonique* 2 Lisinopril+hctz 1 Apokyn 2
Terconazole 1 Lovastatin 1 Arava 2
Tilia 1 Methyldopa 1 Aricept 2
Trilegest 1 Metolazone 1 Avinza 2
Triple sulfa vaginal cream 1 Metoprolol 1 Axert** 2
Vivelle DOT 2 Mexiletine 1 Azilect 2
Yaz* 2 Midodrine 1 Baclofen 1
Minoxidil 1 Benztropine 1
Heart, Blood Pressure, and Nadolol 1 Betaseron 2
Cholesterol Medications Niaspan 2 Bromocriptine 1
Acebutolol 1 Nifedipine 1 Bupropion SR 1
Amiodarone 1 Nimodipine 1 Bupropion XL 1
Amlodipine 1 Nitroglycerin 1 Buspirone 1
Amlodipine+benazepril 1 Nitro-Dur 2 Butalbital+APAP+caffeine 1
Atenolol 1 Norpace-CR 2 Butalbital+ASA+caffeine 1
Benazepril 1 Pindolol 1
Drug Tier Drug Tier Drug Tier
Butalbital+ASA+caffeine+codei Humira*,** 2 Propoxyphene
ne 2 Hydrocodone+APAP 1 napsylate+APAP 1
Butorphanol nasal spray 1 Hydromorphone 1 Prostigmine 2
Carbamazepine 1 Hydroxychloroquine 1 Ridaura 2
Carbatrol 2 Ibuprofen 1 Rilutek* 2
Carisoprodol 1 Imipramine 1 Risperidone 1
Chloral Hydrate 1 Indomethacin 1 Ropinirole 1
Chlordiazepoxide 1 Keppra 2 Roxicodone 1
Chlorpromazine 1 Ketoprofen 1 Salsalate 1
Chlorzoxazone 1 Ketorolac** 1 Selegiline 1
Lamotrigine 2 Seroquel 2
Choline magnesium salicylate 1 Levodopa 1 Seroquel XR 2
Citalopram 1 Levodopa+carbidopa 1 Sertraline 1
Clomipramine 1 Levorphanol 1 Skelaxin 2
Clonazepam 1 Lithium carbonate 1 Stalevo 2
Clorazepate 1 Lithium citrate syrup 1 Sulfinpyrazone 1
Clozapine 1 Lorazepam 1 Sulindac 1
Codeine sulfate 1 Lyrica* 2 Sumatriptan tablets, nasal
Codeine+APAP 1 Maprotiline 1 spray, injection** 1
Colchicine 1 Maxalt** 2 Tasmar 2
Colchicine+Probenecid 1 Meclofenamate 1 Tegretol XR 2
Comtan 2 Meperidine 1 Temazepam 1
Copaxone 2 Mephobarbital 1 Thioridazine 1
Cyclobenzaprine 1 Mestinon 2 Thiothixene 1
Dantrolene 1 Metadate CD 2 Tizanidine 1
Depakote ER 2 Methadone 1 Tolmetin 1
Depen 2 Methocarbamol 1 Topamax 2
Desipramine 1 Methotrexate 1 Tramadol 1
Dexmethylphenidate 1 Methylphenidate 1 Transderm-Scop 2
Dextroamphetamine 1 Migranal 2 Trazodone 1
Dextroamphetamine+ampheta Mirapex 2 Trifluoperazine 1
mine 1 Mirtazapine 1 Trihexyphenidyl 1
DHE-45 2 Morphine sulfate 1 Valproic Acid 1
Diastat 2 Nabumetone 1 Venlafaxine 1
Diazepam 1 Namenda 2 Xenazine* 2
Diclofenac 1 Naproxen Sodium 1 Zaleplon** 1
Diflunisal 1 Nardil 2 Zolpidem** 1
Dilantin infatab 2 Nortriptyline 1 Zyprexa 2
Divalproex 1 Orap 2 Skin Medications
Doxepin 1 Oxaprozin 1 Accuzyme 2
Effexor-XR 2 Oxazepam 1 Alclometasone cream/oint 2
Enbrel*,** 2 Oxcarbazepine 1 Aldara* 2
Ergotamine+caffeine 1 Oxycodone+APAP 1 Augmented betamethasone
Ethosuximide 1 Oxycontin 2 dipropionate cream, ointment,
Etodolac 1 Parnate 2 lotion 1
Exelon 2 Paroxetine 1 Bactroban cream 2
Felbatol 2 Perphenazine 1 Benzoyl peroxide 1
Fenoprofen 1 Phenobarbital 1 Betamethasone valerate 0.1%
Fentanyl transdermal 1 Phenytek 2 cream, ointment 1
Fluoxetine 1 Phenytoin 1 Loporx cream, gel 2
Fluphenazine 1 Phrenelin Forte 2 Clindamycin gel, solution,
Flurbiprofen 1 Phrenilin 2 swabs 1
Fluvoxamine 1 Piroxicam 1 Clobetasol 0.05% cream,
Gabapentin 1 Primidone 1 ointment, scalp lotion 1
Gabitril 2 Probenecid 1
Galantamine 1 Prochlorperazine 1 Clotrimazole+ betamethasone 1
Geodon* 2 Promethazine 1 Condylox gel 2
Haloperidol 1 Propoxyphene HCl+APAP 1 Differin* 2
Drug Tier Drug Tier Drug Tier
Belladonna+phenobarbital 1 Renagel* 2
Diflorasone diacetate ointment 1 Canasa Suppositories 2 Sodium citrate+citric acid
Dovonex 2 Chlordiazepoxide+clindinium 1 solution 1
Dritho-scalp 2 Cimetidine 1 Vesicare 2
Econazole 1 Dicyclomine 1 Urocrit-K 2
Efudex 2 Dipentum 2
Elidel* 2 Diphenoxylate+atropine 1 Vitamins, Electrolytes, Bone,
Dronabinol 1 Blood and Miscellaneous
Erythromcyin+benzoyl peroxide 1 Entocort EC 2 Medications
Erythromycin solution, gel Famotidine 1 Actonel 2
swabs 1 Glycopyrrolate 1 Actonel with calcium 2
Fluocinolone acetonide 0.01% Granisetron** 1 Agrylin 2
solution 1 HalfLytely 2 Alendronate 1
Fluocinolone acetonide Hydrocortisone enema 1 Aminocaproic Acid 1
0.025%; cream, ointment 1 Hydrocortisone suppository 1 Boniva tablets** 2
Fluocinonide 0.05% cream, Hyoscyamine 1 Bupropion 1
ointment, gel 1 Kristalose 2 Calcitriol 1
Fluticasone propionate cream, Lactulose 1 Chantix** 2
ointment 1 Lialda 2 DDAVP tabs 2
Gentamicin cream, ointment 1 Meclizine 1 Desmopressin nasal 1
Hydrocortisone 2.5% cream, Mesalamine enema 1 DHT 2
ointment, lotion 1 Metoclopramide 1 Didronel 2
Isotretinoin 1 Misoprostol 1 Ergocalciferol, 50,000 units 1
Kenalog aerosol 2 Nizatidine capsules 1 Evista* 2
Octreotide 1 Exjade** 2
Ketoconazole cream, shampoo 1 Omeprazole 1 Folic acid 1 mg 1
Lidocaine, viscous 1 Ondansetron** 1 Fosamax plus vitamin D 2
Lindane shampoo, lotion 1 Pancrelipase 1 Gelclair* 2
Loprox cream;gel 2 Pantoprazole 1 Hectorol 2
metronidazole 1 Pentasa 2 Lovenox 2
Miconazole, topical 1 Polyethylene glycol electrolyte Mephyton 2
solution 1 Miacalcin 2
Mometasone cream, ointment 1 Prevacid* 2 Pentoxifylline 1
Mupirocin ointment 1 Prochlorperazine 1 Plavix 2
Naftin 2 Promethazine 1 Potassium bicarbonate 1
Permethrin 2 Propantheline 1 Potassium chloride 1
Podofilox solution 1 Ranitidine 1 Potassium gluconate 1
Proctofoam-HC 2 Relistor*,** 2 Prenatal vitamins** 1
Protopic* 2 Sucralfate tablets 1 Promacta* 2
Retin-A Microsphere* 2 Sulfasalazine 1 Sensipar* 2
Santyl 2 Ultrase-MT 2 Sodium fluoride chewable-
Selenium Sulfide 1 Ursodiol 1 dissolve tablet, drops** 1
Silver sulfadiazine 1 Visicol 2 Sodium fluoride topical dental
Sulfacetamide+sulfur 1 Urinary and Prostate cream 1
Tazorac* 2 Medications Sodium fluoride
Tretinoin cream, gel 1 Avodart 2 w/multivitamins and Iron** 1
Triamcinolone cream, B&O Supprettes 2 Sodium fluoride
ointment, lotion 1 Bethanechol 1 w/multivitamins** 1
Triamcinolone+nystatin 1 Phoslo 2 Sodium fluoride with vitamins
Stomach, Ulcer, and Bowel Cystagon 2 A, D and C and iron** 1
Medications Detrol* 2 Sodium fluoride with vitamins
Alinia 2 Finasteride 1 A, D and C** 1
Amylase/lipase/protease 1 Fosrenol 2
Amitiza* 2 K-Phos 2 Sodium polystyrene sulfonate 1
Asacol 2 Lithostat 2 Stimate 2
Atropine+scopolamine+hyoscy Oxybutynin 1 Thera-Flur** 2
amine+phenobarbital 1 Phenazopyridine 1 Ticlopidine 1
Balsalazide 1 Polycitra 2 Vitamin A, 50,000 units 1
Warfarin 1
Zavesca* 2
Zemplar 2

Note abbreviations:
PSE = Pseudoephedrine
DM = Dextromethorphan
Poly-B = Polymyxin-B
HC = Hydrocortisone
Neo = Neomycin
HCTZ = hydrochlorothiazide
ASA = aspirin
APAP = acetaminophen
HCl = Hydrochloride

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