enhanced formulary exclusions - Hometown Health

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ENHANCED FORMULARY EXCLUSIONS Excluded Drug List – List of medications that have been excluded from your plan’s formulary. If you choose to use an excluded drug, you may be required to pay 100% of the cost. In addition to the drugs listed below, certain classes of medication are not covered under your pharmacy benefit. These medication classes include: non-FDA approved drugs, over the counter (OTC) medications, drugs to treat impotency or sexual disorders, fertility agents, weight loss drugs, hemantinics, reusable needles, disposable syringes, ostomy supplies, infant formulas, dietary supplements, hypopigmentation agents, diagnostic agents, cosmetic medications, and compounded medications. Some drugs listed below may be covered under your medical benefit. Discuss this information with your doctor or health care provider. This information is not a substitute for medical advice or treatment. There may be additional plan restrictions. Please consult your plan for further information. This list is subject to change.

Abstral 100 Mcg Sublingual Tablet Abstral 200 Mcg Sublingual Tablet Abstral 300 Mcg Sublingual Tablet Abstral 400 Mcg Sublingual Tablet Abstral 600 Mcg Sublingual Tablet Abstral 800 Mcg Sublingual Tablet Acanya 1.2 %-2.5 % Topical Gel with Pump Accucaine Kit 10 Mg/Ml (1 %) Injection, Topical Acetylcysteine (pf) 10 % In Sterile Water Eye Drops Aciphex 20 Mg Tablet, delayed Release Acticlate 150 Mg Tablet Acticlate 75 Mg Tablet Active-pac 300 Mg-4 %-1 % Kit, capsule And Gel Addyi 100 Mg Tablet Adzenys XR-odt 12.5 Mg Extended Release Disintegrating Tablet Adzenys XR-odt 15.7 Mg Extended Release Disintegrating Tablet Adzenys XR-odt 18.8 Mg Extended Release Disintegrating Tablet Adzenys XR-odt 3.1 Mg Extended Release Disintegrating Tablet

Adzenys XR-odt 6.3 Mg Extended Release Disintegrating Tablet Adzenys XR-odt 9.4 Mg Extended Release Disintegrating Tablet Aflexeryl-lc 4 %-1 % Topical Patch Aflexeryl-mc 0.0375 %-5 % Topical Patch Afrezza 4 Unit (30)/8 Unit (60) Cartridge with Inhaler Afrezza 4 Unit (60)/8 Unit (30) Cartridge with Inhaler Afrezza 4 Unit (90)/8 Unit (90) Cartridge with Inhaler Afrezza 4 Unit Cartridge with Inhaler Afrezza 8 Unit (60)/12 Unit (30) Cartridge with Inhaler Alanine 1,000 Mg Oral Powder Packet Alevicyn Plus Topical Pack, cream and Gel Alfamino Infant 2.8-5-11 Gram/100 Kcal Oral Powder Alfamino Junior 15 Gram-460 Kcal/100 Gram Oral Powder Allevess Patch 0.05 %-5 % Topical Allzital 25 Mg-325 Mg Tablet Altoprev 20 Mg Tablet, extended Release Altoprev 40 Mg Tablet, extended Release Altoprev 60 Mg Tablet, extended Release Alunbrig 30 Mg Tablet

Ammonium Lactate 12 % Cream (g) Ammonium Lactate 12 % Lotion Amrix 15 Mg Capsule, extended Release Amrix 30 Mg Capsule, extended Release Anastia 2.75 % Lotion Antara 30 Mg Capsule Antara 90 Mg Capsule Appbutamone 75 Mg Oral Pack Appbutamone-d 75 Mg Oral Pack Appformin 500 Mg-40 Mg-267 Mg-101 Mg Oral Pack Appformin-d 500 Mg-383.5 Mg-41 Mg Oral Pack Apptrim 40.5 Mg-101 Mg Capsule Apptrim Program 40 Mg-101 Mg-267 Mg-41 Mg Capsule Apptrim-d 101 Mg Capsule Arestin 1 Mg Dental Cartridge Arginaid 4.5 Gram-156 Mg/9.2 Gram Oral Powder Packet Arginaid Extra 6 Gram-4.5 Gram-250 Mg Oral Liquid Arginine (l-arginine) 2,000 Mg Oral Powder Packet Arginine (l-arginine) 500 Mg Oral Powder Packet Arginine (l-arginine) 500 Mg Tablet Arginine (l-arginine) Oral Powder Aspirin/Omeprazole 325mg-40mg Tab IR DR Aspirin/Omeprazole 81 Mg-40mg Tab IR DR Atropine 0.01 % (in 0.9 % Sodium Chloride) Eye Drops Auvi-q 0.15 Mg/0.15 Ml Injection, autoinjector Auvi-q 0.3 Mg/0.3 Ml Injection, Autoinjector Availnex 750 Mg Chewable Tablet Axona 20 Gram Mcts/40 Gram Oral Powder Packet Bcad 2 24 Gram-410 Kcal/100 Gram Oral Powder Beau Rx Topical Gel

Belbuca 150 Mcg Buccal Film Belbuca 300 Mcg Buccal Film Belbuca 450 Mcg Buccal Film Belbuca 600 Mcg Buccal Film Belbuca 75 Mcg Buccal Film Belbuca 750 Mcg Buccal Film Belbuca 900 Mcg Buccal Film Belviq 10 Mg Tablet Benzaclin 1 %-5 % Topical Gel Benzaclin Pump 1 %-5 % Topical Gel Benzamycinpak 3 %-5 % Topical Gel Betaloan Suik 6 Mg/Ml Injection Suspension, Topical Spray Betaquik 21 Gram-189 Kcal/100 Ml Oral Emulsion Binosto 70 Mg Effervescent Tablet Botox Cosmetic 100 Unit Solution for Injection Botox Cosmetic 50 Unit Intramuscular Solution Brimonidine Tartrate 0.33 % Gel W/Pump Buprenorphine Hcl 74.2 Mg Implant Butrans 10 Mcg/Hour Transdermal Patch Butrans 15 Mcg/Hour Transdermal Patch Butrans 20 Mcg/Hour Transdermal Patch Butrans 5 Mcg/Hour Transdermal Patch Butrans 7.5 Mcg/Hour Transdermal Patch Camino Pro 15 Msud 0.11 Gram-1.06 Kcal/Ml Oral Suspension Camino Pro 15 Pe Msud 15 Gram-140 Kcal/140 Ml Oral Liquid in Packet Camino Pro 15 Pe Pku 15 Gram-140 Kcal/140 Ml Oral Liquid In Packet Camino Pro 15 Pku 0.11 Gram-1.06 Kcal/Ml Oral Suspension Camino Pro Bettermilk 15 Gram-190 Kcal/50 Gram Oral Powder Packet Camino Pro Bettermilk 27 Gram-375 Kcal/100 Gram Oral Powder Packet Camino Pro Pku 10 Gram-65 Kcal/100 Gram Oral Liquid In Packet

Camino-pro Restore 2 Gram-34 Kcal/100 Ml Oral Liquid Camino-pro Restore 2 Gram-36.4 Kcal/100 Ml Oral Liquid Captracin 0.0375 %-5 % Topical Patch Capxib 200 Mg-0.0375 %-5 % Capsule and Patch Carac 0.5 % Topical Cream Carbzero 20 Gram-180 Kcal/100 Ml Oral Emulsion Cardiotek (bioperine) 100 Mg-200 Unit-50 Mg-800 Mcg Tablet Cardiotek 0.8 Mg Tablet Cardiotek Rx 2 Mg-50 Mg-500 Mcg-500 Mg Tablet Cardiotek-rx (bioperine) 2 Mg-500 Mg-500 Mcg-50 Mg Tablet Centany At 2 % Ointment Topical Kit Ceracade Topical Emulsion Cerefolin 6 Mg-5 Mg-50 Mg-1 Mg Tablet Cerefolin Nac (algal Oil) 6 Mg-600 Mg-2 Mg90.314 Mg Tablet Cerenx 500 Mg Capsule Cesinex Oral Suspension Cetirizine 1 Mg/Ml Oral Solution Cialis 10 Mg Tablet Cialis 20 Mg Tablet Ciprofloxacin Hcl/Fluocinolone 0.3-0.025% Vial Citrulline 200 200 Mg/4 Gram Oral Powder Packet Clarinex 2.5 Mg/5 Ml (0.5 Mg/Ml) Syrup Clarinex 5 Mg Tablet Clear 2 Go 7 Gram/7.5 Gram Oral Powder Clindacin Etz 1 % Topical Kit Clindacin Pac 1 % Topical Kit Clindagel 1 % Topical Clindamycin 1 %-benzoyl Peroxide 5 % Topical Gel with Pump Clobex 0.05 % Lotion Clobex 0.05 % Shampoo Clobex 0.05 % Topical Spray

Clodan 0.05 % Shampoo Clodan Kit 0.05 % Topical Kit, Shampoo and Cleanser Clotrimazole/Betameth Dip/Zinc 1-0.05-20% Combo. Pkg CMX 0.0375 %-5 % Topical Patch Colchicine 0.6 Mg Capsule Colcrys 0.6 Mg Tablet Complex Junior Msd 13 Gram-496 Kcal/100 Gram Oral Powder Creatine Monohydrate 5,000 Mg Oral Powder Packet Cyclobenzaprine 7.5 Mg Tablet Cyclobenzaprinepax 10 Mg-0.0375 %-5 % Combo Pack, Tablet and Patch Cyclopentolate 1 %-tropicam 1 %phenylephrine 2.5 % In Water Eye Drops Cyto B-2 343 Mg/Gram Oral Powder Cyto B7 5 Mg/Ml Oral Liquid Cyto-q 80 Mg/10 Ml Oral Liquid Cyto-q T-f 8 Mg/Ml Oral Liquid Cytotine 1.5 Gram/15 Ml Oral Liquid Cytra K Crystals 3,300 Mg-1,002 Mg Oral Packet Cytra-2 500 Mg-334 Mg/5 Ml Oral Solution Cytra-k 1,100 Mg-334 Mg/5 Ml Oral Solution Deplin (algal Oil) 15 Mg-90.314 Mg Capsule Deplin (algal Oil) 7.5 Mg-90.314 Mg Capsule Deplin 15 Mg Tablet Deplin 7.5 Mg Tablet Dermacinrx Cinlone-i Cpi 40 Mg/Ml-2.5 %2.5 % Kit, suspension And Cream Dermacinrx Clorhexacin 2 %-4 %-5 % Topical Kit Dermacinrx Lexitral 1.5 %-0.025 % Topical, Solution and Cream Dermacinrx Phn Pak 5 % Kit, Patch, Medicated and Cream Dermacinrx Purefolix 5,000 Unit-1 Mg Tablet Dermacinrx Silapak 0.1 %-5 % Topical Kit Dermacinrx Silazone 0.1 % Topical Kit

Dermacinrx Surgical Pharmapak 2 %-4 %-5 % Topical Kit Dermacinrx Therazole Pak 1 %-0.05 %-20 % Topical Combo Pack Dermacinrx Zrm Pak 5 %-5 % Kit, Patch, Medicated and Cream Dermapak Plus 0.025 %-0.44 %-20.6 % Topical Kit Dermasilkrx Diclopak 75 Mg-0.025 % Kit Dermasilkrx Sds 0.1 %-5 % Topical Kit Dermawerx Sds 0.1 %-5 % Topical Kit Dermawerx Surgical Plus Pak 2 %-4 %-5 % Topical Kit Dermazone 0.1 % Topical Kit Dermazyl Kit 5 %-5 % Kit, Patch, Medicated and Cream Desoxyn 5 Mg Tablet Dexeryl Topical Cream Dexilant 30 Mg Capsule, Delayed Release Dexilant 60 Mg Capsule, Delayed Release Diclegis 10 Mg-10 Mg Tablet, delayed Release Diclo Gel-xrylix Sheet 1 % Topical Kit Diclofenac 1.5 % Topical Drops Diclofenac Potassium 50 Mg Powder Pack Diclofenac Sodium/Capsaicin 1.5-0.025% Kit Cr Diclofenac Sodium/Capsaicin 75mg-.025% Kit Diclotral 1.5 %-0.025 % Topical, Solution and Cream Diclozor 1 % Topical Kit Diff-stat 471 Mg Capsule Diff-stat 7.5 Billion Cell-1 Billion Cell Oral Powder Packet Doxycycline Hyclate 50 Mg Tablet Doxycycline Monohydrate 40 Mg Capsule, immediate - delayed Release Drospirenone/Estradiol 0.5 Mg-1mg Tablet Ds Prep Pak 1 %-0.13 % Topical Kit, Gel and Towelette Duexis 800 Mg-26.6 Mg Tablet Duloxetine 40 Mg Capsule, delayed Release

Durlaza 162.5 Mg Capsule, extended Release Dutoprol 100 Mg-12.5 Mg Tablet, extended Release Dutoprol 25 Mg-12.5 Mg Tablet, extended Release Dutoprol 50 Mg-12.5 Mg Tablet, extended Release Dyanavel XR 2.5 Mg/Ml Oral 24 Hr. Extended Release Suspension Edarbi 40 Mg Tablet Edarbi 80 Mg Tablet Edarbyclor 40 Mg-12.5 Mg Tablet Edarbyclor 40 Mg-25 Mg Tablet Edluar 10 Mg Sublingual Tablet Edluar 5 Mg Sublingual Tablet Efudex 5 % Topical Cream Eha 4 % Lotion Elecare Jr 14.3 Gram-469 Kcal/100 Gram Oral Powder Elenzapatch 4 %-1 % Topical Elfolate Plus 2.72 Mg-3 Mg-43.75 Mg Tablet Eligen B12 1,000 Mcg-100 Mg Tablet Emollient Combination No.10 Emulsion (g) Emollient Combination No.43 Cream (g) Emollient Combination No.53 Cream (g) Endoxcin 4 %-1 % Topical Patch Enlyte (iron Glycine) 1.5 Mg Iron-8.73 Mg Capsule, immed/delay Release Enteragam 5 Gram Oral Powder Packet Entty Topical Spray Envarsus Xr 0.75 Mg Tablet, extended Release Envarsus Xr 1 Mg Tablet, extended Release Envarsus Xr 4 Mg Tablet, extended Release Epaned 1 Mg/Ml Oral Powder for Solution Epaned 1 Mg/Ml Oral Solution Eprosartan 600 Mg Tablet Eteplirsen 100 Mg/2ml Vial Eteplirsen 500mg/10ml Vial Evekeo 10 Mg Tablet Evekeo 5 Mg Tablet

Evoclin 1 % Topical Foam Evzio 0.4 Mg/0.4 Ml Injection, auto-injector Evzio 2 Mg/0.4 Ml Injection, auto-injector Fentora 100 Mcg Buccal Tablet, Effervescent Fentora 200 Mcg Buccal Tablet, Effervescent Fentora 400 Mcg Buccal Tablet, Effervescent Fentora 600 Mcg Buccal Tablet, Effervescent Fentora 800 Mcg Buccal Tablet, Effervescent Fexmid 7.5 Mg Tablet Fiber Flow 7 Gram/15 Ml Oral Liquid Flexepax 10 Mg-0.0375 %-5 % Combo Pack, Tablet and Patch Fluocinolone/Tretinoin/H-quin 0.01-.05-4 Cream (g) Fluoroplex 1 % Topical Cream Fluvastatin Er 80 Mg Tablet, extended Release 24 Hr. Folixapure 5,000 Unit-1 Mg Tablet Foltx 2 Mg-1.13 Mg-25 Mg Tablet Forfivo XL 450 Mg Tablet, extended Release Fosteum 27 Mg-20 Mg-200 Unit Capsule Fosteum Plus 500 Mg-70 Mg-27 Mg-400 Unit Capsule Fovex 800 Mg-10 Mg-2 Mg Capsule Ga Express 15 60 Gram-297 Kcal/100 Gram Oral Powder Packet Ga Gel 41.7 Gram-338 Kcal/100 Gram Oral Powder Packet Ga-1 Anamix Early Years 13.5 Gram-473 Kcal/100 Gram Oral Powder Gabadone 343 Mg-20 Mg-10 Mg-56 Mg Capsule Gabazolamine 0.25 Mg Oral Pack Gabitidine 150 Mg Oral Pack Gaboxetine 10 Mg Capsule Galaxtra 400 Kcal/100 Gram Oral Powder Geriaide 40 Mg-20 Mg-65 Kcal/2.5 Gram Oral Powder Packet Gialax 17 Gram/Scoop Oral Kit Glucoless 60 Mg-15 Unit-70 Mg-385 Mg Capsule

Glumetza 1,000 Mg Tablet, extended Release Glumetza 500 Mg Tablet, extended Release Glutament 10 Gram Oral Powder Packet Glutarade Amino Acid Blend 81 Gram-324 Kcal/100 Gram Oral Powder Glutarade Ga-1 25 Gram-385 Kcal/100 Gram Oral Powder Glutarade Junior 10 Gram-410 Kcal/100 Gram Oral Powder Glutasolve 15 Gram Oral Powder Packet Glycine 1.5 % Urologic Solution for Irrigation Glycine 500 Mg Oral Powder Packet Glycine Oral Powder Glycopyrrolate 1 Mg/5 Ml Solution Glycosade 0.3 Gram-214 Kcal/60 Gram Oral Powder Packet Glycotrol 500 Mcg-400 Mcg-10 Mg-400 Mg Capsule Glytactin 10 Pe Bettermilk 27 Gram-378 Kcal/100 Gram Oral Powder Packet Glytactin 10 Pe Complete 10 Gram-210 Kcal/54 Gram Oral Bar Glytactin 10 Pe Complete 10 Gram-220 Kcal/54 Gram Oral Bar Glytactin 15 Pe Bettermilk 29 Gram-385 Kcal/100 Gram Oral Powder Packet Glytactin 15 Pe Bettermilk 31 Gram-327 Kcal/100 Gram Oral Powder Packet Glytactin 20pe Bettermilk Lite 39 Gram-294 Kcal/100 Gram Oral Powder Packet Glytactin Restore 5 Pe 25 Gram-363 Kcal/100 Gram Oral Powder Packet Glytactin Rtd 10 Pe 4 Gram-61 Kcal/100 Ml Oral Liquid Glytactin Rtd 15 Pe 6 Gram-80 Kcal/100 Ml Oral Liquid Gonitro 400 Mcg Sublingual Powder in a Packet Gralise 300 Mg Tablet, extended Release Gralise 30-day Starter Pack 300 Mg (9)-600 Mg (69) Tablet, Ext. Release Gralise 600 Mg Tablet, extended Release

Hcu Anamix Early Years 13.5 Gram-473 Kcal/100 Gram Oral Powder Hcu Anamix Next 28 Gram-385 Kcal/100 Gram Oral Powder Hcu Express20 60 Gram-297 Kcal/100 Gram Oral Powder Packet Hcu Lophlex 20 Gram-120 Kcal/125 Ml Oral Liquid in Packet Hemangeol 4.28 Mg/Ml Oral Solution Hemocyte-plus 106 Mg Iron-1 Mg Capsule Hepament 15 Gram-12.3 Gram/86.2 Gram Oral Powder Packet Hetlioz 20 Mg Capsule Homactin A Plus 20 Pe 8 Gram-74 Kcal/100 Ml Oral Liquid Horizant Er 300 Mg Tablet, extended Release Horizant Er 600 Mg Tablet, extended Release Hrt Base Botanical Cream Hycofenix 2.5 Mg-30 Mg-200 Mg/5 Ml Oral Solution Hyfiber 3 Gram/4 Gram Oral Powder Hyfiber 3 Gram/4 Gram Packet Hyfiber with Fos 11 Gram/30 Ml Oral Liquid In Packet Hyfiber with Fos 12 Gram/30 Ml Oral Liquid Hyfiber with Fos 12 Gram/30 Ml Oral Liquid In Packet Hylatopicplus Lotion Hypertensa 14 Mg-47 Mg Capsule Hypertensolol 50 Mg Oral Pack Hypochlorous Acid/Sodium Chlor 0.01 % Spray Hysingla ER 100 Mg Tablet, Crush Resistant, Extended Release Hysingla ER 120 Mg Tablet, Crush Resistant, Extended Release Hysingla ER 20 Mg Tablet, Crush Resistant, Extended Release Hysingla ER30 Mg Tablet, Crush Resistant, Extended Release Hysingla ER 40 Mg Tablet, Crush Resistant, Extended Release

Hysingla ER 60 Mg Tablet, Crush Resistant, Extended Release Hysingla ER 80 Mg Tablet, Crush Resistant, Extended Release Inderal XL 120 Mg Capsule, extended Release Inderal XL 80 Mg Capsule, extended Release Inflammacin 75 Mg-0.025 % Kit Inflamma-k 1.5 %-10 %-6 %-3.1 % Kit, topical Drops and a Patch Innopran XL 120 Mg Capsule, extended Release Innopran XL 80 Mg Capsule, extended Release Insulin Regular, Human 4 Unit Cart Inhal Insulin Regular, Human 4 Unit (30) Cart Inhal Insulin Regular, Human 4 Unit (60) Cart Inhal Insulin Regular, Human 4 Unit (90) Cart Inhal Insulin Regular, Human 8 Unit (60) Cart Inhal Intermezzo 1.75 Mg Sublingual Tablet Intermezzo 3.5 Mg Sublingual Tablet Iodoquinol/Aloe P-saccharide 1 1.25%-1% Gel (gram) Irenka 40 Mg Capsule, delayed Release Isovactin A Plus 20 Pe 8 Gram-74 Kcal/100 Ml Oral Liquid Iva Anamix Early Years 13.5 Gram-473 Kcal/100 Gram Oral Powder Iva Anamix Next 28 Gram-377 Kcal/100 Gram Oral Powder Jublia 10 % Topical Solution with Applicator Kadian 10 Mg Capsule, extended Release Kadian 100 Mg Capsule, extended Release Kadian 20 Mg Capsule, extended Release Kadian 200 Mg Capsule, extended Release Kadian 30 Mg Capsule, extended Release Kadian 40 Mg Capsule, extended Release Kadian 50 Mg Capsule, extended Release Kadian 60 Mg Capsule, extended Release Kadian 80 Mg Capsule, extended Release Karbinal Er 4 Mg/5 Ml Oral Suspension, extended Release

Ketocal 4:1 (milk-soy) 14.4 Gram-701 Kcal/100 Gram Oral Powder Ketocal 4:1 (milk-soy) 3.09 Gram-150 Kcal/100 Ml Oral Liquid Ketogen 14.5 Gram-686 Kcal/100 Gram Oral Powder Ketovie 3.4 Gram-144 Kcal/100 Ml Oral Liquid Ketovie 3.4 Gram-156 Kcal/100 Ml Oral Liquid Ketovie Peptide 4:1 3.3 Gram-171 Kcal/100 Ml Oral Liquid Ketovolve 14.5 Gram-686 Kcal/100 Gram Oral Powder Ketovolve 14.5 Gram-712 Kcal/100 Gram Oral Powder Khedezla 100 Mg Tablet, extended Release Khedezla 50 Mg Tablet, extended Release Klofensaid Ii 1.5 % Topical Drops Kyleena 17.5 Mcg/24 Hour (5 Years) Intrauterine Device Lacrisert 5 Mg Eye Inserts Lartruvo 10 Mg/Ml Intravenous Solution Latisse 0.03 % Eyelash Drops Lazanda 100 Mcg/Spray Nasal Spray Lazanda 300 Mcg/Spray Nasal Spray Lazanda 400 Mcg/Spray Nasal Spray Lenzapatch 4 %-1 % Topical Lescol XL 80 Mg Tablet, extended Release Leu-free Cooler 11.5 Gram-79 Kcal/100 Ml Oral Liquid Levitra 10 Mg Tablet Levitra 2.5 Mg Tablet Levitra 20 Mg Tablet Levitra 5 Mg Tablet Levomefolate Dha 27 Mg-400 Mcg-1.13 Mg250 Mg Capsule Levomefolate/Algal Oil 15-90.314 Capsule Levonorgestrel 0.75 Mg Tablet Levonorgestrel 1.5 Mg Tablet Librax (with Clidinium) 5 Mg-2.5 Mg Capsule Lidall Patches 4 %-1 % Topical

Lidocaine 3 % Lotion Lidocaine Hcl 3 % Gel W/Pump Lidocaine/Menthol 5 %-8 % Kit Oint Sp Lidodextrapine 4 %-1 % Topical Patch Lido-k 3 % Lotion Lidopatch 4 %-1 % Topical Lidorxkit 5 % Topical Pack, ointment And Cream Lidotral 3.88 % Topical Cream Lidotrans 5 Pak 5 %-6 Cm X 7 Cm Topical Kit Lidoxib 200 Mg-4 %-1 % Capsule and Patch Liletta 18.6 Mcg/24 Hour (3 Years) Intrauterine Device Limbrel 250 Mg Capsule Limbrel 500 Mg Capsule Limbrel525 525 Mg-50 Mg Capsule Liquid Fiber Flow 7 Gram/15 Ml Oral Lisinopril 1 Mg/Ml Solution Lister-v 24 Mg-21 Mg Capsule Livalo 1 Mg Tablet Livalo 2 Mg Tablet Livalo 4 Mg Tablet Lophlex 10 Gram-41 Kcal/14.3 Gram Oral Powder Packet Loprox Kit 0.77 % Topical Combo Pack Loprox Kit 0.77 %, Suspension and Cleanser Lorcaserin Hcl 20 Mg Tab ER 24h Lorenza Patch 4 %-1 % Topical Lps 15-30 15 Gram-100 Kcal/30 Ml Oral Liquid Lps Critical Care 17 Gram-100 Kcal/30 Ml Oral Liquid Lunglaid for Asthma 1 Gram/Ml Oral Emulsion Lysine Acetate 4,000 Mg Oral Powder Packet Lytensopril 20 Mg Oral Pack Lytensopril-90 20 Mg Oral Pack Mac 0.0375 %-5 % Topical Patch Marvona Suik (pf) 0.5 % (5 Mg/Ml) Injection Solution and Topical Spray Mct Oil 7.7 Kcal/Ml Oral

Medroloan Suik 40 Mg/Ml Injection Suspension and Topical Spray Medrox (without Methyl Salicylate) 0.0375 %-5 % Topical Patch Medrox 0.0375 %-20 %-5 % Topical Ointment Medrox 0.0375 %-20 %-5 % Topical Patch Medrox-rx 0.05 %-20 %-7 % Topical Ointment Mentax 1 % Topical Cream Meperidine Hcl 100 Mg/Ml Syringe Meperidine Hcl 25 Mg/Ml Syringe Meperidine Hcl 50 Mg/Ml Syringe Meperidine Hcl/Pf 100 Mg/Ml Syringe Meperidine Hcl/Pf 25 Mg/Ml Syringe Meperidine Hcl/Pf 50 Mg/Ml Syringe Metanx (algal Oil) 3 Mg-35 Mg-2 Mg-90.314 Mg Capsule Metformin ER 1,000 Mg 24 Hr. Tablet, extended Release Metformin ER 500 Mg 24 Hr. Tablet, extended Release Methaver 27 Mg-29 Mg-50 Mg-1 Mg-2 Mg Capsule Metrogel 1 % Topical Metrogel 1 % Topical Gel with Pump Migranow 50 Mg-10 %-4 % Kit, Gel and Tablet Minoxidil 2 % Topical Solution Minoxidil 5 % Topical Solution Mirena 20 Mcg/24 Hr (5 Years) Intrauterine Device Mirvaso 0.33 % Topical Gel Mirvaso 0.33 % Topical Gel with Pump Mitigare 0.6 Mg Capsule Mma-pa Anamix Early Years 13.5 Gram-473 Kcal/100 Gram Oral Powder Mma-pa Anamix Next 28 Gram-377 Kcal/100 Gram Oral Powder Monogen 12.9 Gram-444 Kcal/100 Gram Oral Powder Monogen Oral Powder Morgidox 100 Mg Capsule

Morgidox 1x 50 50 Mg Kit Morgidox 1x100 100 Mg Kit Morgidox 2x100 100 Mg Kit Morgidox 50 Mg Capsule Morphine ER 10 Mg Capsule, extended Release Pellets Morphine ER 100 Mg Capsule, extended Release Pellets Morphine ER 20 Mg Capsule, extended Release Pellets Morphine ER 30 Mg Capsule, extended Release Pellets Morphine ER 60 Mg Capsule, extended Release Pellets Morphine ER 80 Mg Capsule, extended Release Pellets Morphine Sulfate 1 Mg/Ml Vial Morphine Sulfate 5 Mg/Ml Vial Morphine Sulfate In 0.9 % Nacl 150mg/30ml Pca Syringe Morphine Sulfate In 0.9 % Nacl 30 Mg/30ml Pca Syringe Morphine Sulfate/Pf 0.5 Mg/Ml Vial Morphine Sulfate/Pf 150mg/30ml Pca Vial Moxatag 775 Mg Tablet, extended Release Msud Anamix Early Years 13.5 Gram-473 Kcal/100 Gram Oral Powder Msud Express20 60 Gram-297 Kcal/100 Gram Oral Powder Packet Msud Lophlex 20 Gram-120 Kcal/125 Ml Oral Liquid in Packet Mtx 4 %-1 % Topical Patch Muse 1,000 Mcg Urethral Suppository Muse 125 Mcg Urethral Suppository Muse 250 Mcg Urethral Suppository Muse 500 Mcg Urethral Suppository Naltrexone Hcl/Bupropion Hcl 8 Mg-90 Mg Tablet ER Naprelan Cr 375 Mg Tab, extended Release 24 Hr. Naprelan Cr 500 Mg Tab, extended Release 24 Hr.

Naprelan Cr 750 Mg Tab, extended Release 24 Hr. Napropak Cool 550 Mg-4 % Kit Napropax 500 Mg-0.0375 %-5 % Combo Pack, Oral Tablet and Topical Patch Naproxen Sodium ER 375 Mg Tablet, extended Release 24hr Naproxen Sodium ER 500 Mg Tablet, extended Release 24hr Naproxenpax 500 Mg-0.0375 %-5 % Combo Pack, Tablet and Patch Narcan 4 Mg/Actuation Nasal Spray Natesto 5.5 Mg/0.122 Gram per Actuation Nasal Gel Pump Neevo Dha 27 Mg Iron-400 Mcg-1 Mg-250mg Capsule Neevo Dha 27 Mg-400 Mcg-1.13 Mg-250 Mg Capsule Neocate Junior with Prebiotics 16 Gram-459 Kcal/100 Gram Oral Powder Neocate Junior with Prebiotics 16 Gram-469 Kcal/100 Gram Oral Powder Neocate Junior with Prebiotics 16 Gram-478 Kcal/100 Gram Oral Powder Neocate Nutra 8.2 G-472 Kcal/100 Gram Oral Powder Neocate One + 10 Gram-400 Kcal/100 Gram Oral Powder Packet Neocate One + Oral Packet Neocate Splash 0.03 Gram-1 Kcal/Ml Oral Liquid Neoke Alcar 1 Gram/Scoop Oral Powder Neoke Mct70 5.84 Kcal/Gram Oral Powder Neoke Ra Lipoic 145 Mg/Scoop Oral Powder Neophe 0.4 Gram-2.2 Kcal Tablet Neophe 60 Gram-315 Kcal/100 Gram Oral Powder Neurepa 1 Gram Capsule Neuvaxin 0.0375 %-5 % Topical Patch Nexium 20 Mg Capsule, delayed Release Nexium 40 Mg Capsule, delayed Release Nexium Packet 10 Mg Granules Delayed Release for Susp

Nexium Packet 2.5 Mg Granules Delayed Release for Susp Nexium Packet 20 Mg Granules Delayed Release for Susp Nexium Packet 40 Mg Granules Delayed Release for Susp Nexium Packet 5 Mg Granules Delayed Release for Susp Nitroglycerin 400 Mcg Powd Pack Noritate 1 % Topical Cream Novacort (with Aloe) 2 %-1 %-1 % Topical Gel Novacort 2 %-1 % Topical Gel Novasource Renal 2 Cal 0.09 Gram-2 Kcal/Ml Oral Liquid Noxifol-d3 2,500 Unit-1 Mg Tablet Noxipak 0.01 %-20 % Topical Kit Nplate 250 Mcg Subcutaneous Solution Nplate 500 Mcg Subcutaneous Solution Nudiclo Solupak 1.5 %-0.025 % Kit, Cream and Solution Nudiclo Tabpak 75 Mg-0.025 % Kit Nutriarx 0.1 %-5 % Topical Kit Nutrihep 0.04 Gram-1.5 Kcal/Ml Oral Liquid Nuvessa 1.3 % Vaginal Gel Nyata (with Curatin) 100,000 Unit/Gram Topical Pack, Gel and Powder Nyata 100,000 Unit/Gram Topical Powder Nystatin-triamcinolone 100,000 Unit/G-0.1 % Topical Cream Obeticholic Acid 10 Mg Tablet Obeticholic Acid 5 Mg Tablet Obredon 2.5 Mg-200 Mg/5 Ml Oral Solution Omeprazole 20 Mg-sodium Bicarbonate 1.1 Gram Capsule Onexton 1.2 % (1 % Base)-3.75 % Topical Gel Onexton 1.2 % (1 % Base)-3.75 % Topical Gel with Pump Onzetra Xsail 11 Mg Powder for Nasal Inhalation Oracea 40 Mg Capsule, immediate - Delay Release Oracit 490 Mg-640 Mg/5 Ml Oral Solution

Orthodiet 100 Mg-67 Mcg-333 Mg-333 Mg Tablet Osphena 60 Mg Tablet Oxycodone Myristate 13.5 Mg Cap Spr 12 Oxycodone Myristate 18 Mg Cap Spr 12 Oxycodone Myristate 27 Mg Cap Spr 12 Oxycodone Myristate 36 Mg Cap Spr 12 Oxycodone Myristate 9 Mg Cap Spr 12 Oxymorphone Hcl 1 Mg/Ml Ampule Pain Relief (capsaicin) 0.0375 %-5 % Topical Patch Pain Relief (menthol) Topical Gel Pain Relief (with Salicylamide) 162 Mg-110 Mg-152 Mg-32.4 Mg Tablet Pain Relief 160 Mg/5 Ml Oral Liquid Pain Relief 500 Mg Capsule Pain Relief 500 Mg Tablet Pain Relief 650 Mg Tablet, extended Release Pain Relief Cream 4 %-30 %-10 % Topical Pain Relief Extra Strength 500 Mg Tablet Pain Relief Regular Strength 325 Mg Tablet Pain Relief (lidocaine-menthol) 5 %-1 % Topical Patch Paragard T 380a 380 Square Mm Intrauterine Device Pedipak 8 %-20 % Kit Pennsaid 1.5 % Topical Drops Pennsaid 20 Mg/Gram/Actuation (2 %) Topical Soln in Metered-dose Pump Peptamen Junior with Prebio1 0.03 Gram-1 Kcal/Ml Oral Liquid Peptamen Os 0.05 Gram-1 Kcal/Ml Oral Liquid Peptamen Os 0.07 G-1.5 Kcal/Ml Oral Liquid Percura 35.2 Mg-10.2 Mg-35.2 Mg Capsule Pexeva 10 Mg Tablet Pexeva 20 Mg Tablet Pexeva 30 Mg Tablet Pexeva 40 Mg Tablet Phenactin A Plus 20 Pe 8 Gram-74 Kcal/100 Ml Oral Liquid Phentermine Hcl 8 Mg Tablet

Phentermine/Topiramate 15 Mg-92mg 24hr Phentermine/Topiramate 7.5mg-46mg 24hr Phenylade Gmp 30 Gram-396 Kcal/100 Gram Oral Powder Phenylade Gmp 30 Gram-396 Kcal/100 Gram Oral Powder Packet Phenylade Rtd Pku 10 10 Gram-60 Kcal/75 Ml Oral Liquid Phenyl-free 2 Pku 22 Gram-410 Kcal/100 Gram Oral Powder Phenyl-free 2hp Pku 40 Gram-390 Kcal/100 Gram Oral Powder Phlexy-10 8.33 Gram-35 Kcal/10 Tablet Phlexy-10 Drink Mix Powder 8.33 Gram-69 Kcal/20 Gram Oral Powder Pack Phytonadione (vit K1) 10 Mg/Ml Ampule Phytonadione (vit K1) 1mg/0.5ml Ampule Phytonadione (vit K1) 1mg/0.5ml Syringe Pku 2 Tomato 10 G-185 Kcal/45 Gram Oral Powder Packet Pku Easy 15 Gram-97.5 Kcal/130 Ml Oral Liquid In Packet Pku Easy Microtabs 70.8 Gram-362 Kcal/110 Gram Delayed Granules Pku Express20 60 Gram-279 Kcal/100 Gram Oral Powder Packet Pku Express20 60 Gram-297 Kcal/100 Gram Oral Powder Packet Pku Gel Powder 41.7 Gram-317 Kcal/100 Gram Oral Powder Packet Pku Gel Powder 41.7 Gram-338 Kcal/100 Gram Oral Powder Packet Pku Go 50 Gram-325 Kcal/100 Gram Oral Powder Packet Pku Periflex Early Years 13.5 Gram-473 Kcal/100 Gram Oral Powder Pku Periflex Junior Plus 28 Gram-377 Kcal/100 Gram Oral Powder Pku Periflex Junior Plus 28 Gram-385 Kcal/100 Gram Oral Powder Podiapn 35 Mg-5 Mg-2 Mg-300 Mg Capsule Polycitra 550 Mg-500 Mg-334 Mg/5 Ml Oral Solution

Polycitra-k 1,100 Mg-334 Mg/5 Ml Oral Solution Polycitra-k Crystals 3,300 Mg-1,002 Mg Oral Packet Polycitra-k Crystals Oral Packet Polycitra-lc 550 Mg-500 Mg-334 Mg/5 Ml Oral Solution Portagen 16.5 Gram-470 Kcal/100 Gram Oral Powder Portagen Oral Powder Potassium Citrate-citric Acid 1,100 Mg-334 Mg/5 Ml Oral Solution Potassium Citrate-citric Acid 3,300 Mg-1,002 Mg Oral Packet Prazolamine 350 Mg Oral Pack Pre B2 2.75 Gram Oral Powder Packet Preflin 113 Mg Capsule Prekunil 0.4 Gram-2.2 Kcal Tablet Pre-protein (whey) 6 Gram-25 Kcal/7.4 Gram Oral Powder Pre-protein 15 Gram-60 Kcal/30 Ml Oral Liquid Pre-protein 6 Gram-25 Kcal/7.4 Gram Oral Powder Packet Prestalia 14 Mg-10 Mg Tablet Prestalia 3.5 Mg-2.5 Mg Tablet Prestalia 7 Mg-5 Mg Tablet Previdolrx plus Analgesic Pak 75 Mg-0.025 % Kit Primlev 10 Mg-300 Mg Tablet Primlev 5 Mg-300 Mg Tablet Primlev 7.5 Mg-300 Mg Tablet Probarimin Qt 4 Mg-0.3 Mg Disintegrating Tablet Pro-cal 187.5 Mg-40 Mg-7.5 Mg Tablet Procysbi 25 Mg Capsule, delayed Release Sprinkle Procysbi 75 Mg Capsule, delayed Release Sprinkle Progesterone, Micronized 8 % Gel/Pf App Promod Protein Oral Liquid Prosource Plus 15 Gram-100 Kcal/30 Ml Oral Liquid

Prosource Plus 15 Gram-100 Kcal/30 Ml Oral Liquid in Packet Prosource Tf 11 Gram-40 Kcal/45 Ml Tube Feed Liquid In Packet Pro-stat Max 11 Gram-80 Kcal/30 Ml Oral Liquid Pro-stat Max 11 Gram-80 Kcal/30 Ml Oral Liquid in Packet Pro-stat Sugar Free With Fiber 15 Gram-90 Kcal/30 Ml Oral Liquid Pro-stat Sugar Free With Fiber 15 Gram-90 Kcal/30 Ml Oral Liquid Pack Protectives Combination No.2 Cream (g) Proteinex Wc 15 Gram-100 Kcal/30 Ml Oral Liquid Proteolin 1,280 Mg Tablet Proteolin 640 Mg Capsule Provenza Patch 4 %-1 % Topical Pryflex 400 Mg-300 Mg-425 Mg Tablet Pulmophylline-pulmona 100 Mg-6.25 Mg162.5 Mg Oral Pack Puramino Toddler 13.9 Gram-500 Kcal/100 Gram Oral Powder Puroxcin 4 %-1 % Topical Patch Qh Liquid 100 Mg/Ml Oral Qroxin 0.0375 %-5 % Topical Patch Quflora Fe 9 Mg-0.25 Mg Chewable Tablet Quillichew Er 20 Mg Chewable Tablet, Extended Release Quillichew Er 30 Mg Chewable Tablet, Extended Release Quillichew Er 40 Mg Chewable, Extended Release Tablet Quinzyme 90 Mg Disintegrating Tablet Radiaguard 1 % Lotion Rayaldee 30 Mcg Capsule, extended Release Rayos 1 Mg Tablet, delayed Release Rayos 2 Mg Tablet, delayed Release Rayos 5 Mg Tablet, delayed Release Reciphexamine 4 %-1 % Topical Patch Relamine 400 Mg-300 Mg-425 Mg Tablet Reliever Patch 0.05 %-5 % Topical

Relyyks 4 %-5 % Topical Patch Relyyt 0.025 %-5 % Topical Patch Rena Start 7.5 Gram-494 Kcal/100 Gram Oral Powder Renalcal (whey) 0.03 Gram-2 Kcal/Ml Oral Liquid Renovo 0.0375 %-5 % Topical Patch Retin-a Micro Pump 0.08 % Topical Gel Rezyst Im 150 Mg (3 Billion Cell) Chewable Tablet Rheumate 1 Mg-1 Mg-500 Mg Capsule Rimantalist 100 Mg Oral Pack Rozerem 8 Mg Tablet Rynoderm 37.5 % Topical Cream Rytary 23.75 Mg-95 Mg Capsule, extended Release Rytary 36.25 Mg-145 Mg Capsule, extended Release Rytary 48.75 Mg-195 Mg Capsule, extended Release Rytary 61.25 Mg-245 Mg Capsule, extended Release S.o.s. 10 80 Kcal/21 Gram Oral Powder Packet S.o.s. 20 160 Kcal/42 Gram Oral Powder Packet Sanadermrx 0.1 %-5 % Topical Kit Savaysa 15 Mg Tablet Savaysa 30 Mg Tablet Savaysa 60 Mg Tablet Scar Patch 5 %-2 %-30 % Topical Scar Topical Gel Senophylline 50 Mg Oral Pack Sentra Am 290 Mg-40 Mg-35 Mg-70 Mg Capsule Sentra Pm 290 Mg-40 Mg-15 Mg-45.5 Mg Capsule Sentradine 150 Mg Oral Pack Sentroxatine 10 Mg Capsule Shohl's Modified 500 Mg-300 Mg/5 Ml Oral Solution Silazone-ii 0.1 % Topical Kit

Silvera 1 %-0.0375 %-5 % Topical Patch Sinecatechins 15 % Oint. (g) Sinelee 0.0375 %-5 % Topical Patch Sinelee 0.05 %-5 % Topical Patch Sitavig 50 Mg Buccal Tablet Skyla 14 Mcg/24 Hour (3 Years) Intrauterine Device Smartrx Gabakit 300 Mg-4 %-1 % Kit, Cream and Capsule Smartrx Gaba-v Kit 300 Mg-0.037 %-20 %-5 % Kit, Cream and Capsule Sod Anamix Early Years 13.5 Gram-473 Kcal/100 Gram Oral Powder Sod Picosulf/Mag Ox/Citric Ac 10 Mg-12 G Powder Pack Sodium Polysulthionate-folic Acid 400 Mg-1 Mg Capsule Solaice 0.05 %-5 % Topical Patch Soliqua 100/33 100 Unit-33 Mcg/Ml Subcutaneous Insulin Pen Solodyn 105 Mg Tablet, extended Release Solodyn 115 Mg Tablet, extended Release Solodyn 55 Mg Tablet, extended Release Solodyn 65 Mg Tablet, extended Release Solodyn 80 Mg Tablet, extended Release Solupak 5 %-10 %-3 % Kit, Ointment and Spray Soolantra 1 % Topical Cream Spinraza (pf) 12 Mg/5 Ml Intrathecal Solution Strazepam 15 Mg Capsule Striant 30 Mg Buccal System, sustained Release Subsys 1,200 Mcg (600 Mcg/Spray X2) Sublingual Spray Subsys 1,600 Mcg (800 Mcg/Spray X2) Sublingual Spray Subsys 100 Mcg/Spray Sublingual Spray Subsys 200 Mcg/Spray Sublingual Spray Subsys 400 Mcg/Spray Sublingual Spray Subsys 600 Mcg/Spray Sublingual Spray Subsys 800 Mcg/Spray Sublingual Spray

Sulfzix (folic Acid) 400 Mg-1 Mg Capsule Sulfzix (folic Acid) 400 Mg-500 Mcg Capsule Sulfzix 400 Mg-500 Mcg Capsule Sulfzix 400 Mg-500 Mcg/0.4 Gram Oral Powder Sumatriptan Succinate 6 Mg/0.5ml Ndl Fr Inj Sure Result Dss Premium Pack 1.5 %-0.025 % Topical, Solution and Cream Sure Result TAC Pak 0.1 %-5 % Topical Kit Suvorexant 10 Mg Tablet Synalar Ts 0.01 % Topical Kit Synerderm Topical Spray Synvexia Patch 4 %-1 % Topical Tavaborole 5 % Sol W/Appl Tears Again Hydrate 250 Mg-125 Mg-12.5 Mg Capsule Teveten 600 Mg Tablet Therabenzaprine-60 10 Mg Oral Pack Theracodophen-325 10 Mg-325 Mg Oral Pack Theracodophen-low-90 5 Mg-500 Mg Oral Pack Therafeldamine 20 Mg Oral Pack Theramine 62.5 Mg-100 Mg Capsule Theramine Plus 62.5 Mg-100 Mg-9 Gram Oral Powder Packet Therapentin-60 300 Mg Capsule Theraprofen-60 600 Mg Oral Pack Theraproxen 250 Mg Oral Pack Theraproxen-90 250 Mg Oral Pack Ticalast 137 Mcg-50 Mcg-0.9 % Kit, Spray Suspension and Spray Ticanase 50 Mcg-0.9 % Kit, Spray Suspension and Spray Ticaspray 50 Mcg-0.9 % Kit, Spray Suspension and Spray Tirosint 100 Mcg Capsule Tirosint 112 Mcg Capsule Tirosint 125 Mcg Capsule Tirosint 13 Mcg Capsule Tirosint 137 Mcg Capsule Tirosint 150 Mcg Capsule

Tirosint 25 Mcg Capsule Tirosint 50 Mcg Capsule Tirosint 75 Mcg Capsule Tirosint 88 Mcg Capsule Tis-u-sol Pentalyte 800-40-20-8.75-6.25 Mg/100 Ml Irrigation Solution Tivorbex 20 Mg Capsule Tivorbex 40 Mg Capsule Toronova Ii Suik 30 Mg/Ml Kit Tozal 3.33 Mg-200 Mg Capsule Trazamine 50 Mg Oral Pack Trepadone (with Bromelain) 116 Mg-100 Mg Capsule Tretin-x 0.0375 % Topical Cream Tretin-x 0.075 % Topical Cream Tretin-x Cream 0.025 % Topical Kit Tretin-x Cream 0.05 % Topical Kit Tretin-x Cream 0.1 % Topical Kit Trezix 320.5 Mg-30 Mg-16 Mg Capsule Triloan Suik 40 Mg/Ml Injection Solution and Topical Spray Tri-sila 0.1 %-5 % Topical Kit Tussicaps 10 Mg-8 Mg Capsule, extended Release Tussicaps 5 Mg-4 Mg Capsule, extended Release Tuzistra Xr 14.7 Mg-2.8 Mg/5 Ml Oral Suspension, extended Release Tylactin Restore 10 Pe 2 Gram-34 Kcal/100 Ml Oral Liquid Tyr Anamix Early Years 13.5 Gram-473 Kcal/100 Gram Oral Powder Tyr Anamix Next 28 Gram-385 Kcal/100 Gram Oral Powder Tyr Express20 60 Gram-297 Kcal/100 Gram Oral Powder Packet Tyr Gel Powder 41.7 Gram-338 Kcal/100 Gram Oral Powder Packet Tyr Lophlex 20 Gram-120 Kcal/125 Ml Oral Liquid in Packet Ucd Anamix Junior 12 Gram-385 Kcal/100 Gram Oral Powder

Ucd Trio 15 Gram-393 Kcal/100 Gram Oral Powder Ultra Glycemx Plus 360 15 Gram-120 Kcal/47 Gram Oral Powder Ultra Inflamx Plus 360 15 Gram-200 Kcal/52 Gram Oral Powder Ultracare for Kids 8 Gram-120 Kcal/30 Gram Oral Powder Ultraclear Renew Oral Powder Urea 37.5 % Cream (g) Vandazole 0.75 % Vaginal Gel Vascazen 900 Mg-110 Mg-680 Mg Capsule Vascepa 0.5 Gram Capsule Vascepa 1 Gram Capsule Vasculera 630 Mg Tablet Vaxchora Vaccine 4x10exp8 to 2x10exp9 Cf Unit Oral Suspension Vayacog 100 Mg-19.5 Mg-6.5 Mg Capsule Vayarin 75 Mg-8.5 Mg-21.5 Mg Capsule Vayarol 0.63 Gram-232.5 Mg-92.5 Mg Capsule Velma 4 %-16 %-2 % Topical Patch Veltassa 16.8 Gram Oral Powder Packet Veltassa 25.2 Gram Oral Powder Packet Veltassa 8.4 Gram Oral Powder Packet Veltin 1.2 %-0.025 % Topical Gel Vexa 4 %-2 %-30 % Topical Patch Viagra 100 Mg Tablet Viagra 25 Mg Tablet Viagra 50 Mg Tablet Viberzi 100 Mg Tablet Viberzi 75 Mg Tablet Vilactin A Plus 20 Pe 8 Gram-74 Kcal/100 Ml Oral Liquid Vimovo 375 Mg-20 Mg Tablet, immediate And Delay Release Vimovo 500 Mg-20 Mg Tablet, immediate And Delay Release Vitajoule 384 Kcal/100 Gram Oral Powder Vital High Protein 0.09 Gram-1 Kcal/Ml Oral Liquid Vitamax 200 Mcg-200 Mcg Chewable Tablet

Vitamax 300 Mcg/Ml Oral Drops Vitapro 75 Gram-390 Kcal/100 Gram Oral Powder Vivlodex 10 Mg Capsule Vivlodex 5 Mg Capsule Voltaren 1 % Topical Gel Vonvendi 650 (+/-) Unit Range Intravenous Solution Vopac Mds 1.5 % Topical Kit Vsl#3 112.5 Billion Cell Capsule Vsl#3 450 Billion Cell Oral Powder Packet Vsl#3 Ds 900 Billion Cell Oral Powder Packet Vsl#3 Junior 225 Billion Cell Oral Powder Packet Whytederm Surgipak 2 %-4 %-2 % Topical Kit Whytederm Tdpak 0.1 %-2 % Topical Kit Whytederm Trilasil Pak 0.1 %-2 % Topical Kit Xaquil Xr 30 Mg Tablet, extended Release Xartemis Xr 7.5 Mg-325 Mg Tablet Extended Release, Oral Only Xelitral 1.5 %-0.025 % Topical, Solution and Cream Xenaflamm 75 Mg-0.025 % Kit Xifaxan 200 Mg Tablet Xilapak 0.01 % Topical Kit Xizflus 400 Mg-500 Mcg/0.4 Gram Oral Powder Xmet Xcys Maxamaid 25 Gram-309 Kcal/100 Gram Oral Powder Xryliderm 5 % Topical Kit Xrylix 1.5 % Topical Kit Xtracal Plus 14 Gram-230 Kcal/45 Ml Oral Liquid in Packet Xultophy 100/3.6 100 Unit-3.6 Mg/Ml (3 Ml) Subcutaneous Insulin Pen Xyzal 2.5 Mg/5 Ml Oral Solution Xyzal 5 Mg Tablet Yosprala 325 Mg-40 Mg Tablet, immediate And Delay Release Yosprala 81 Mg-40 Mg Tablet, immediate And Delay Release

Zecuity 6.5 Mg/4 Hour Transdermal Iontophoresis Patch Zegerid 20 Mg-1,680 Mg Oral Packet Zegerid 20 Mg-1.1 Gram Capsule Zegerid 40 Mg-1,680 Mg Oral Packet Zegerid 40 Mg-1.1 Gram Capsule Zembrace Symtouch 3 Mg/0.5 Ml Subcutaneous Pen Injector Zeruvia 4 %-1 % Topical Patch Zervalx 1 Mg Tablet Zim's Max-freeze (lidocaine-menthol) 4 %-1 % Topical Patch Zinplava 25 Mg/Ml Intravenous Solution Zipsor 25 Mg Capsule Zolpidem 1.75 Mg Sublingual Tablet Zolpidem 3.5 Mg Sublingual Tablet Zolpimist 5 Mg/Spray (0.1 Ml) Oral Spray Zorvolex 18 Mg Capsule Zorvolex 35 Mg Capsule Zuplenz 4 Mg Oral Soluble Film Zuplenz 8 Mg Oral Soluble Film Zurampic 200 Mg Tablet Zyclara 2.5 % Topical Cream Pump Zyclara 3.75 % Topical Cream Packet Zyclara 3.75 % Topical Cream Pump Zyflo 600 Mg Tablet Zyflo Cr 600 Mg Tablet, extended Release

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enhanced formulary exclusions - Hometown Health

ENHANCED FORMULARY EXCLUSIONS Excluded Drug List – List of medications that have been excluded from your plan’s formulary. If you choose to use an exc...

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