Drug Benefit List - April 2009
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:08.04 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
ACETYLSALICYLIC ACID
- 80MG Chewable Tablet
- 02009013 ASAPHEN PMS
- 02269139 JAMP-ASA JMP
- 02202352 RIVASA RIV
- 80MG Delayed Release Tablet
- 02283905 ACETYLSALICYLIC
ACID JAP
- 02238545 ASAPHEN
EC PMS
- 162MG Delayed Release Tablet
- 02247550 ASAPHEN
EC PMS
- 325MG Delayed Release Tablet
- 02284529 PMS-ASA
EC PMS
- 650MG Delayed Release Tablet
- 02284537 PMS-ASA
EC PMS
- 81MG Enteric Coated Tablet
- 02243101 ASA PMS
- 02244993 ASA PMS
- 02237726 ASPIRIN BCD
- 02242281 ENTROPHEN
EC PED
- 325MG Enteric Coated Tablet
- 02010526 ASA VTH
- 00510696 APO-ASEN ECT APX
- 02150417 ASPIRIN BCD
- 02050161 ENTROPHEN WAM
- 00010332 ENTROPHEN-5 WAM
- 00216666 NOVASEN NOP
- 02285371 PMS-ASA
EC PMS
- 650MG Enteric Coated Tablet
- 00472476 ASA APX
- 00794244 ASA WSB
- 02046261 ASA FRS
- 01905392 ENTROPHEN-10 FRS
- 00229296 NOVASEN NOP
- 150MG Suppository
- 00785547 PMS-ASA PMS
- 650MG Suppository
- 00582867 ASA JNO
- 80MG Tablet
- 02150352 ASPIRIN BCD
- 02250675 EURO-ASA EUR
- 02311496 PRO-ASA 80MG EC TAB PRO
- 02311518 PRO-ASA 80MG TAB PRO
- 02202360 RIVASA RIV
- 325MG Tablet
- 00472468 APO-ASA APX
- 00036145 ASA PED
- 00230324 ASA NOP
- 00530336 ASA VTH *
- 02150328 ASPIRIN BCD
CELECOXIB
Limited use benefit (prior approval required).
For patients with osteoarthritis who have failed therapy with acetaminophen
and who:
- have failed to achieve adequate response with 2 other listed NSAIDs, or
- have experienced an adverse event attributable to 2 other listed NSAIDs,
or
- have a history of a serious gastrointestinal complication such as bleeding
or perforation.
For patients with rheumatoid arthritis who:
- have failed to achieve adequate response with 2 other listed NSAIDs, or
- have experienced an adverse event attributable to 2 other listed NSAIDs,
or
- have a history of a serious gastrointestinal complication such as bleeding
or perforation.
- 100MG Capsule
- 02239941 CELEBREX PFI
- 200MG Capsule
- 02239942 CELEBREX PFI
DICLOFENAC SODIUM
- 25MG Delayed Release Tablet
- 02302616 PMS-DICLOFENAC 25MG DR PMS
- 50MG Delayed Release Tablet
- 02302624 PMS-DICLOFENAC 50MG DR PMS
- 25MG Enteric Coated Tablet
- 00839175 APO-DICLO APX
- 00870951 DICLOFENAC-25 PDL
- 02231662 DOM-DICLOFENAC DPC
- 00808539 NOVO-DIFENAC NOP
- 00886017 NU-DICLO NXP
- 02231502 PMS-DICLOFENAC PMS
- 02261952 SANDOZ-DICLOFENAC SDZ
- 50MG Enteric Coated Tablet
- 00839183 APO-DICLO APX
- 00870978 DICLOFENAC-50 PDL
- 02231663 DOM-DICLOFENAC DPC
- 00808547 NOVO-DIFENAC NOP
- 00886025 NU-DICLO NXP
- 02231503 PMS-DICLOFENAC PMS
- 02261960 SANDOZ-DICLOFENAC SDZ
- 00514012 VOLTAREN NVR
- 50MG Suppository
- 02231506 PMS-DICLOFENAC PMS
- 02241224 SAB-DICLOFENAC SIL
- 02261928 SANDOZ-DICLOFENAC SDZ
- 00632724 VOLTAREN NVR
- 100MG Suppository
- 02231508 PMS-DICLOFENAC PMS
- 02241225 SAB-DICLOFENAC SIL
- 02261936 SANDOZ-DICLOFENAC SDZ
- 00632732 VOLTAREN NVR
- 75MG Sustained Release Tablet
- 02162814 APO-DICLO
SR APX
- 02224119 DICLOFENAC-SR PDL
- 02231664 DOM-DICLOFENAC
SR DPC
- 02158582 NOVO-DIFENAC
SR NOP
- 02228203 NU-DICLO
SR NXP
- 02231504 PMS-DICLOFENAC
SR PMS
- 02261901 SANDOZ-DICLOFENAC SR SDZ
- 00782459 VOLTAREN
SR NVR
- 100MG Sustained Release Tablet
- 02091194 APO-DICLO
SR APX
- 02224127 DICLOFENAC-SR PDL
- 02231665 DOM-DICLOFENAC
SR DPC
- 02048698 NOVO-DIFENAC
SR NOP
- 02228211 NU-DICLO
SR NXP
- 02231505 PMS-DICLOFENAC
SR PMS
- 02261944 SANDOZ-DICLOFENAC SR SDZ
- 00590827 VOLTAREN
SR NVR
DICLOFENAC SODIUM, MISOPROSTOL
- 50MG & 200MCG Tablet
- 01917056 ARTHROTEC PFI
- 75MG & 200MCG Tablet
- 02229837 ARTHROTEC PFI
DIFLUNISAL
- 250MG Tablet
- 02039486 APO-DIFLUNISAL APX
- 02048493 NOVO-DIFLUNISAL NOP
- 500MG Tablet
- 02039494 APO-DIFLUNISAL APX
- 02058413 NU-DIFLUNISAL NXP
FLURBIPROFEN
- 200MG Sustained Release Capsule
- 02223082 FROBEN
SR ABB
- 50MG Tablet
- 00647942 ANSAID PFI
- 01912046 APO-FLURBIPROFEN APX
- 01947729 FLURBIPROFEN PRO
- 02223066 FROBEN ABB
- 02100509 NOVO-FLURPROFEN NOP
- 02020661 NU-FLURBIPROFEN NXP
- 100MG Tablet
- 00600792 ANSAID PFI
- 01912038 APO-FLURBIPROFEN APX
- 01947737 FLURBIPROFEN PRO
- 02223074 FROBEN ABB
- 02100517 NOVO-FLURPROFEN NOP
- 02020688 NU-FLURBIPROFEN NXP
IBUPROFEN
- 200MG Capsule
- 02241769 ADVIL
LIQUI-GEL WRI
- 400MG Capsule
- 02248231 ADVIL
LIQUI-GEL WYE
- 100MG Chewable Tablet
- 02246403 ADVIL
JUNIOR STRENGTH WRI
- 40MG/ML Drop
- 02242522 ADVIL
PEDIATRIC WRI
- 02238626 CHILDREN'S
MOTRIN MCL
- 20MG/ML Oral Liquid
- 02232297 CHILDREN'S
ADVIL WRI
- 02242365 CHILDREN'S
MOTRIN JNO
- 100MG Tablet
- 02240527 MOTRIN
JUNIOR STRENGTH MCL
- 200MG Tablet
- 01933558 ADVIL WRI
- 00441643 APO-IBUPROFEN APX
- 00636517 IBUPROFEN PDL
- 02238004 IBUPROFEN VTH
- 02257912 IBUPROFEN PMT
- 02272849 IBUPROFEN VTH
- 02186934 MOTRIN MCL
- 300MG Tablet
- 00441651 APO-IBUPROFEN APX
- 00636525 IBUPROFEN PDL
- 02020696 NU-IBUPROFEN NXP
- 400MG Tablet
- 00506052 APO-IBUPROFEN APX
- 00636533 IBUPROFEN PDL
- 02020718 NU-IBUPROFEN NXP
- 00836133 PMS-IBUPROFEN PMS
- 600MG Tablet
- 00585114 APO-IBUPROFEN APX
- 00658804 IBUPROFEN PDL
- 00629359 NOVO-PROFEN NOP
- 02020726 NU-IBUPROFEN NXP
- 00839264 PMS-IBUPROFEN PMS
INDOMETHACIN
- 25MG Capsule
- 00611158 APO-INDOMETHACIN APX
- 00337420 NOVO-METHACIN NOP
- 00865850 NU-INDO NXP
- 00646261 PRO-INDO PDL
- 50MG Capsule
- 00611166 APO-INDOMETHACIN APX
- 00337439 NOVO-METHACIN NOP
- 00865869 NU-INDO NXP
- 00646288 PRO-INDO PDL
- 50MG Suppository
- 02231799 SANDOZ INDOMETHACIN SDZ
- 100MG Suppository
- 02176149 NOVO-METHACIN NOP
- 01934139 RATIO-INDOMETHACIN RPH
- 02231800 SANDOZ INDOMETHACIN SDZ
KETOPROFEN
- 50MG Capsule
- 00790427 APO-KETO APX
- 02044633 NU-KETOPROFEN NXP
- 02150808 PMS-KETOPROFEN PMS
- 50MG Enteric Coated Tablet
- 00790435 APO
KETO-E APX
- 02150816 PMS-KETOPROFEN PMS
- 100MG Enteric Coated Tablet
- 00842664 APO-KETO-E APX
- 01981536 NOVO-KETO-EC NOP
- 02150824 PMS-KETOPROFEN PMS
- 50MG Suppository
- 02148773 PMS-KETOPROFEN PMS
- 100MG Suppository
- 02156083 NOVO-KETO NOP
- 02015951 PMS-KETOPROFEN PMS
- 200MG Sustained Release Tablet
- 02172577 APO-KETO
SR APX
- 02210487 KETOPROFEN-SR PDL
MEFENAMIC ACID
- 250MG Capsule
- 02229452 APO-MEFENAMIC APX
- 02237826 DOM-MEFENAMIC
ACID DPC
- 02230408 MEFENAMIC PDL
- 02229569 NU-MEFENAMIC NXP
- 02231208 PMS-MEFENAMIC PMS
MELOXICAM
Limited use benefit (prior approval required).
For patients with osteoarthritis who have failed therapy with acetaminophen
and who:
- have failed to achieve adequate response with 2 other listed NSAIDs, or
- have experienced an adverse event attributable to 2 other listed NSAIDs,
or
- have a history of a serious gastrointestinal complication such as bleeding
or perforation.
For patients with rheumatoid arthritis who:
- have failed to achieve adequate response with 2 other listed NSAIDs, or
- have experienced an adverse event attributable to 2 other listed NSAIDs,
or
- have a history of a serious gastrointestinal complication such as bleeding
or perforation.
- 7.5MG Tablet
- 02248973 APO-MELOXICAM APX
- 02250012 CO-MELOXICAM COB
- 02248605 DOM-MELOXICAM DPC
- 02255987 GEN-MELOXICAM GEN
- 02242785 MOBICOX BOE
- 02258315 NOVO-MELOXICAM NOP
- 02248607 PHL-MELOXICAM PHH
- 02248267 PMS-MELOXICAM PMS
- 02247889 RATIO-MELOXICAM RPH
- 15MG Tablet
- 02248974 APO-MELOXICAM APX
- 02250020 CO-MELOXICAM COB
- 02248606 DOM-MELOXICAM DPC
- 02255995 GEN-MELOXICAM GEN
- 02242786 MOBICOX BOE
- 02258323 NOVO-MELOXICAM NOP
- 02248608 PHL-MELOXICAM PHH
- 02248268 PMS-MELOXICAM PMS
- 02248031 RATIO-MELOXICAM RPH
NAPROXEN
- 250MG Enteric Coated Tablet
- 02246699 APO-NAPROXEN
EC APX
- 02162792 NAPROSYN
E HLR
- 02243312 NOVO-NAPROX NOP
- 375MG Enteric Coated Tablet
- 02246700 APO-NAPROXEN
EC APX
- 02162415 NAPROSYN
E HLR
- 02243313 NOVO-NAPROX NOP
- 02294702 PMS-NAPROXEN
EC PMS
- 500MG Enteric Coated Tablet
- 02246701 APO-NAPROXEN
EC APX
- 02241024 GEN-NAPROXEN
EC GEN
- 02162423 NAPROSYN
E HLR
- 02243314 NOVO-NAPROX NOP
- 02294710 PMS-NAPROXEN
EC PMS
- 02310953 PRO-NAPROXEN EC PDL
- 500MG Suppository
- 02230477 NAPROXEN SAB
- 25MG/ML Suspension
- 02162431 NAPROSYN HLR
- 750MG Sustained Release Tablet
- 02162466 NAPROSYN
SR HLR
- 125MG Tablet
- 00522678 APO-NAPROXEN APX
- 00590754 NAPROXEN PDL
- 00865621 NU-NAPROX NXP
- 250MG Tablet
- 00522651 APO-NAPROXEN APX
- 00590762 NAPROXEN PDL
- 00565350 NOVO-NAPROX NOP
- 00865648 NU-NAPROX NXP
- 00615315 RATIO-NAPROXEN RPH
- 02240786 RIVA-NAPROXEN RIV
- 375MG Tablet
- 00600806 APO-NAPROXEN APX
- 02243432 GEN-NAPROXEN GEN
- 00655686 NAPROXEN PDL
- 00627097 NOVO-NAPROX NOP
- 00865656 NU-NAPROX NXP
- 00615323 RATIO-NAPROXEN RPH
- 02240787 RIVA-NAPROXEN RIV
- 500MG Tablet
- 00592277 APO-NAPROXEN APX
- 00618721 NAPROXEN PDL
- 00589861 NOVO-NAPROX NOP
- 00865664 NU-NAPROX NXP
- 00615331 RATIO-NAPROXEN RPH
- 02240788 RIVA-NAPROXEN RIV
NAPROXEN SODIUM
- 275MG Tablet
- 02162725 ANAPROX HLR
- 00784354 APO-NAPRO
NA APX
- 00887056 NAPROXEN
NA PDL
- 00778389 NOVO-NAPROX
SODIUM NOP
- 550MG Tablet
- 02162717 ANAPROX
DS HLR
- 01940309 APO-NAPRO
NA DS APX
- 02153386 NAPROXEN-NA
DF PDL
- 02026600 NOVO-NAPROX
SODIUM DS NOP
- 02240828 RIVA-NAPROXEN
SODIUM RIV
PIROXICAM
- 10MG Capsule
- 00642886 APO-PIROXICAM APX
- 02171813 GEN-PIROXICAM GEN
- 00865761 NU-PIROX NXP
- 00658839 PIROXICAM PDL
- 00836249 PMS-PIROXICAM PMS
- 20MG Capsule
- 00642894 APO-PIROXICAM APX
- 02239536 DOM-PIROXICAM DPC
- 02171821 GEN-PIROXICAM GEN
- 00865788 NU-PIROX NXP
- 00658820 PIROXICAM PDL
- 00836230 PMS-PIROXICAM PMS
- 10MG Suppository
- 02154420 PMS-PIROXICAM PMS
- 20MG Suppository
- 02154463 PMS-PIROXICAM PMS
- 10MG Tablet
- 00695718 NOVO-PIROCAM NOP
- 20MG Tablet
- 00695696 NOVO-PIROCAM NOP
SULINDAC
- 150MG Tablet
- 00778354 APO-SULIN APX
- 00745588 NOVO-SUNDAC NOP
- 02042576 NU-SULINDAC NXP
- 00808628 SULINDAC PDL
- 200MG Tablet
- 00778362 APO-SULIN APX
- 00745596 NOVO-SUNDAC NOP
- 02042584 NU-SULINDAC NXP
- 02239164 PENTA-SULINDAC PEN
- 00808636 SULINDAC PDL
TIAPROFENIC ACID
- 200MG Tablet
- 02179679 NOVO-TIAPROFENIC NOP
- 02231249 PENTA-TIAPROFENIC PEN
- 02230827 PMS-TIAPROFENIC PMS
- 300MG Tablet
- 02136120 APO-TIAPROFENIC APX
- 02231060 DOM-TIAPROFENIC DPC
- 02179687 NOVO-TIAPROFENIC NOP
- 02146886 NU-TIAPROFENIC NXP
- 02231250 PENTA-TIAPROFENIC PEN
- 02230828 PMS-TIAPROFENIC PMS
- 02145014 TIAPROFENIC PDL
28:08.08 OPIATE AGONISTS
ACETAMINOPHEN, CAFFEINE CITRATE, CODEINE PHOSPHATE
- 300MG & 30MG & 15MG Tablet
- 00293504 ATASOL-15 HOR
- 02232388 EXDOL-15 PED
- 300MG & 30MG & 30MG Tablet
- 00293512 ATASOL-30 HOR
- 02232389 EXDOL-30 PED
ACETAMINOPHEN, CAFFEINE, CODEINE PHOSPHATE
- 300MG & 15MG & 15MG Tablet
- 00706515 PMS-ACET
2 PMS
- 00653241 RATIO-LENOLTEC
NO.2 RPH
- 02163934 TYLENOL
WITH CODEINE NO.2 JNO
- 300MG & 15MG & 30MG Tablet
- 00653276 RATIO-LENOLTEC
NO.3 RPH
- 02163926 TYLENOL
WITH CODEINE NO.3 JNO
ACETAMINOPHEN, CODEINE PHOSPHATE
- 32MG & 1.6MG/ML Elixir
- 00816027 PMS-ACETAMINOPHEN
WITH CODEINE PMS
- 02163942 TYLENOL
WITH CODEINE JNO
- 300MG & 30MG Tablet
- 01999648 ACET
CODEINE 30 PMS
- 00608882 RATIO-EMTEC-30 RPH
- 00789828 TRIATEC-30 TRI
- 300MG & 60MG Tablet
- 00621463 LENOLTEC
NO.4 RPH
- 02163918 TYLENOL
WITH CODEINE NO.4 JNO
ACETAMINOPHEN, OXYCODONE HCL
- 325MG & 2.5MG Tablet
- 01916491 PERCOCET
DEMI BMS
- 325MG & 5MG Tablet
- 01916548 ENDOCET EDM
- 02307898 NOVO-OXYCODONE ACET NOP
- 01916475 PERCOCET BMS
- 02245758 PMS-OXYCODONE
ACETAMINOPHEN PMS
- 00608165 RATIO-OXYCOCET RPH
- 02242468 RIVACOCET RIV
ACETYLSALICYLIC ACID, CAFFEINE CITRATE, CODEINE PHOSPHATE
- 375MG & 30MG & 15MG Tablet
- 02234510 282 PED
- 375MG & 30MG & 30MG Tablet
- 02238645 292 PED
ACETYLSALICYLIC ACID, OXYCODONE HCL
- 325MG & 5MG Tablet
- 01916572 PERCODAN BMS
- 00608157 RATIO-OXYCODAN RPH
CODEINE MONOHYDRATE, CODEINE SULFATE TRIHYDRATE
Limited use benefit (prior approval required).
For treatment of:
- chronic pain and palliative care patients as an alternative to products
containing codeine in combination with acetaminophen or ASA with or without
caffeine, or
- chronic pain and palliative care patients as an alternative to regular
release codeine tablets when large doses are required.
- 50MG Long Acting Tablet
- 02230302 CODEINE
CONTIN CR PFR
- 100MG Long Acting Tablet
- 02163748 CODEINE
CONTIN CR PFR
- 150MG Long Acting Tablet
- 02163780 CODEINE
CONTIN CR PFR
- 200MG Long Acting Tablet
- 02163799 CODEINE
CONTIN CR PFR
CODEINE PHOSPHATE
- 30MG/ML Injection
- 00544884 CODEINE SDZ *
- 00497282 CODEINE
PHOSPHATE ABB *
- 60MG/ML Injection
- 00497290 CODEINE
PHOSPHATE ABB *
- 2MG/ML Liquid
- 00380571 LINCTUS
CODEINE ATL
- 5MG/ML Syrup
- 00050024 CODEINE
PHOSPHATE ATL
- 00779474 RATIO-CODEINE RPH
- 15MG Tablet
- 00779458 CODEINE RPH
- 02009889 CODEINE RIV
- 02243978 PMS-CODEINE PMS
- 00593435 RATIO-CODEINE RPH
- 30MG Tablet
- 02009757 CODEINE RIV
- 00593451 CODEINE
PHOSPHATE RPH
- 02243979 PMS-CODEINE PMS
FENTANYL
Limited use benefit (prior approval required).
For the management of chronic pain in patients who are unresponsive or intolerant
to at least one long-acting oral sustained released product, such as morphine,
hydromorphone and oxycodone, despite appropriate dose titration and adjunctive
therapy including laxatives and antiemetics.
- 12MCG/H Patch
- 02280345 DURAGESIC
12 JNO
- 02311925 RATIO-FENTANYL TRANSDERMAL SYSTEM RPH
- 25MCG/H Patch
- 01937383 DURAGESIC
25 JNO
- 02249391 RAN-FENTANYL
TRANSDERMAL SYSTEM RBY
- 02282941 RATIO-FENTANYL
TRANSDERMAL SYSTEM RPH
- 50MCG/H Patch
- 01937391 DURAGESIC
50 JNO
- 02249413 RAN-FENTANYL
TRANSDERMAL SYSTEM RBY
- 02282968 RATIO-FENTANYL
TRANSDERMAL SYSTEM RPH
- 75MCG/H Patch
- 01937405 DURAGESIC
75 JNO
- 02249421 RAN-FENTANYL
TRANSDERMAL SYSTEM RBY
- 02282976 RATIO-FENTANYL
TRANSDERMAL SYSTEM RPH
- 100MCG/H Patch
- 01937413 DURAGESIC
100 JNO
- 02249448 RAN-FENTANYL
TRANSDERMAL SYSTEM RBY
- 02282984 RATIO-FENTANYL
TRANSDERMAL SYSTEM RPH
HYDROMORPHONE HCL
Limited use benefit. Prior approval required for controlled
release capsules only. Regular release dosage forms are full benefits and do
not require prior approval.
For treatment of moderate to severe chronic pain when other opioids such as
morphine have been ineffective in controlling pain or in patients experiencing
intolerable side effects.
- 3MG Controlled Release Capsule
- 02125323 HYDROMORPH
CONTIN PFR
- 6MG Controlled Release Capsule
- 02125331 HYDROMORPH
CONTIN PFR
- 12MG Controlled Release Capsule
- 02125366 HYDROMORPH
CONTIN PFR
- 18MG Controlled Release Capsule
- 02243562 HYDROMORPH
CONTIN PFR
- 24MG Controlled Release Capsule
- 02125382 HYDROMORPH
CONTIN PFR
- 30MG Controlled Release Capsule
- 02125390 HYDROMORPH
CONTIN PFR
- 2MG/ML Injection
- 00627100 DILAUDID ABB
- 02145901 HYDROMORPHONE SDZ
- 10MG/ML Injection
- 00622133 DILAUDID
HP ABB
- 02145928 HYDROMORPHONE
HP 10 SDZ
- 20MG/ML Injection
- 02146118 DILAUDID
HP PLUS ABB
- 02145936 HYDROMORPHONE
HP 20 SDZ
- 50MG/ML Injection
- 02145863 DILAUDID
XP ABB
- 02146126 HYDROMORPHONE
HP 50 SDZ
- 99003163 HYDROMORPHONE
HP 50 SIL
- 1MG/ML Oral Liquid
- 00786535 DILAUDID ABB
- 01916386 PMS-HYDROMORPHONE PMS
- 3MG Suppository
- 00125105 DILAUDID ABB
- 01916394 PMS-HYDROMORPHONE PMS
- 1MG Tablet
- 00705438 DILAUDID ABB
- 02192101 PHL-HYDROMORPHONE PHH
- 00885444 PMS-HYDROMORPHONE PMS
- 2MG Tablet
- 00125083 DILAUDID ABB
- 02249928 PHL-HYDROMORPHONE PHH
- 00885436 PMS-HYDROMORPHONE PMS
- 4MG Tablet
- 00125121 DILAUDID ABB
- 02249936 PHL-HYDROMORPHONE PHH
- 00885401 PMS-HYDROMORPHONE PMS
- 8MG Tablet
- 00786543 DILAUDID ABB
- 02192144 PHL-HYDROMORPHONE PHH
- 00885428 PMS-HYDROMORPHONE PMS
MEPERIDINE HCL
Limited use benefit (prior approval not required).
Limited to 2 weeks supply for acute pain. Coverage will be limited to 60 tablets
per one month period.
- 25MG/ML Injection
- 00497444 PETHIDINE ABB *
- 50MG/ML Injection
- 02242003 DEMEROL ABB
- 00725765 MEPERIDINE SDZ
- 00497452 PETHIDINE ABB
- 75MG/ML Injection
- 02242004 DEMEROL ABB
- 00725757 MEPERIDINE SDZ
- 00497460 PETHIDINE ABB *
- 100MG/ML Injection
- 02242005 DEMEROL ABB
- 00725749 MEPERIDINE SDZ
- 00497479 PETHIDINE ABB
- 50MG Tablet
- 02138018 DEMEROL SAC
MORPHINE HCL
- 30MG Sustained Release Tablet
- 00776181 M.O.S.
SR VAE
- 60MG Sustained Release Tablet
- 00776203 M.O.S.
SR VAE
- 1MG/ML Syrup
- 00614491 DOLORAL
1 ATL
- 00607762 RATIO-MORPHINE RPH
- 5MG/ML Syrup
- 00614505 DOLORAL
5 ATL
- 00607770 RATIO-MORPHINE RPH
- 10MG/ML Syrup
- 00632503 M.O.S.
10 VAE
- 00690783 RATIO-MORPHINE RPH
- 20MG/ML Syrup
- 00632481 M.O.S.
20 VAE
- 00690791 RATIO-MORPHINE RPH
- 50MG/ML Syrup
- 00690236 M.O.S.
50 VAE
- 10MG Tablet
- 00690198 M.O.S.
10 VAE
- 20MG Tablet
- 00690201 M.O.S.
20 VAE
- 40MG Tablet
- 00690228 M.O.S.
40 VAE
- 60MG Tablet
- 00690244 M.O.S.
60 VAE
MORPHINE SULFATE
- 20MG/ML Drop
- 00621935 STATEX PMS
- 50MG/ML Drop
- 00705799 STATEX PMS
- 0.5MG/ML Injection
- 02021056 MORPHINE
LP SDZ
- 01949047 MORPHINE
SULFATE ABB
- 1MG/ML Injection
- 02021048 MORPHINE
LP SIL *
- 01949055 MORPHINE
SULFATE ABB
- 01980696 MORPHINE
SULFATE SDZ
- 2MG/ML Injection
- 02242484 MORPHINE
SULFATE SDZ
- 00850314 MORPHINE
SULFATE ABB
- 01964437 MORPHINE
SULFATE SDZ
- 5MG/ML Injection
- 01964429 MORPHINE
SULFATE SDZ
- 10MG/ML Injection
- 00392588 MORPHINE
SULFATE SDZ
- 00850322 MORPHINE
SULFATE ABB
- 15MG/ML Injection
- 00392561 MORPHINE
SULFATE SDZ
- 25MG/ML Injection
- 00676411 MORPHINE
HP 25 SDZ
- 50MG/ML Injection
- 00617288 MORPHINE
HP 50 SDZ
- 02137267 MORPHINE
SULFATE FAU
- 5MG Suppository
- 00632228 STATEX PMS
- 10MG Suppository
- 00632201 STATEX PMS
- 20MG Suppository
- 00596965 STATEX PMS
- 10MG Sustained Release Capsule
- 02242163 KADIAN MAY
- 02019930 M-ESLON SAC
- 15MG Sustained Release Capsule
- 02177749 M-ESLON SAC
- 20MG Sustained Release Capsule
- 02184435 KADIAN
SR MAY
- 30MG Sustained Release Capsule
- 02019949 M-ESLON
SR SAC
- 50MG Sustained Release Capsule
- 02184443 KADIAN
SR MAY
- 60MG Sustained Release Capsule
- 02019957 M-ESLON
SR SAC
- 100MG Sustained Release Capsule
- 02184451 KADIAN
SR MAY
- 02019965 M-ESLON
SR SAC
- 200MG Sustained Release Capsule
- 02177757 M-ESLON
SR SAC
- 15MG Sustained Release Tablet
- 02015439 MS
CONTIN SR PFR
- 02302764 NOVO-MORPHINE SR NOP
- 02245284 PMS-MORPHINE
SULFATE PMS
- 02244790 RATIO-MORPHINE
SULFATE SR RPH
- 30MG Sustained Release Tablet
- 02014297 MS
CONTIN SR PFR
- 02302772 NOVO-MORPHINE SR NOP
- 02245285 PMS-MORPHINE
SULFATE PMS
- 02244791 RATIO-MORPHINE
SULFATE SR RPH
- 60MG Sustained Release Tablet
- 02014300 MS
CONTIN SR PFR
- 02302780 NOVO-MORPHINE SR NOP
- 02245286 PMS-MORPHINE
SULFATE PMS
- 02244792 RATIO-MORPHINE
SULFATE SR RPH
- 100MG Sustained Release Tablet
- 02014319 MS
CONTIN SR PFR
- 02302799 NOVO-MORPHINE SR NOP
- 02245287 PMS-MORPHINE SR PMS
- 200MG Sustained Release Tablet
- 02014327 MS
CONTIN SR PFR
- 02302802 NOVO-MORPHINE SR NOP
- 02245288 PMS-MORPHINE SR PMS
- 1MG/ML Syrup
- 00591467 STATEX PMS
- 5MG/ML Syrup
- 00591475 STATEX PMS
- 10MG/ML Syrup
- 00647217 STATEX PMS
- 5MG Tablet
- 02009773 M.O.S.
SULFATE VAE
- 02014203 MS
IR PFR
- 00594652 STATEX PMS
- 10MG Tablet
- 02009765 M.O.S.
SULFATE VAE
- 02014211 MS
IR PFR
- 00594644 STATEX PMS
- 20MG Tablet
- 02014238 MS
IR PFR
- 25MG Tablet
- 02009749 M.O.S.
SULFATE VAE
- 00594636 STATEX PMS
- 30MG Tablet
- 02014254 MS
IR PFR
- 50MG Tablet
- 02009706 M.O.S.
SULFATE VAE
- 00675962 STATEX PMS
- 100mg Sustained Release Tablet
- 02245287 PMS-MORPHINE SR PMS
- 200mg Sustained Release Tablet
- 02245288 PMS-MORPHINE SR PMS
OXYCODONE HCL
Limited use benefit. Prior approval required for controlled
release tablets only. Regular release dosage forms are full benefits and do
not require prior approval.
For treatment of moderate to severe chronic pain when other opioids such as
morphine have been ineffective in controlling pain or in patients experiencing
intolerable side effects.
- 5MG Controlled Release Tablet
- 02258129 OXYCONTIN PFR
- 10MG Controlled Release Tablet
- 02202441 OXYCONTIN PFR
- 20MG Controlled Release Tablet
- 02202468 OXYCONTIN PFR
- 40MG Controlled Release Tablet
- 02202476 OXYCONTIN PFR
- 80MG Controlled Release Tablet
- 02202484 OXYCONTIN PFR
- 10MG Suppository
- 00392480 SUPEUDOL SIL
- 20MG Suppository
- 00392472 SUPEUDOL SIL
- 5MG Tablet
- 02231934 OXY-IR PFR
- 02319977 PMS-OXYCODONE PMS
- 00789739 SUPEUDOL SDZ
- 10MG Tablet
- 02240131 OXY-IR PFR
- 02319985 PMS-OXYCODONE PMS
- 00443948 SUPEUDOL SDZ
- 20MG Tablet
- 02240132 OXY-IR PFR
- 02319993 PMS-OXYCODONE PMS
- 02262983 SUPEUDOL SDZ
28:08.12 OPIATE PARTIAL AGONISTS
PENTAZOCINE HCL
- 50MG Tablet
- 02137984 TALWIN SAC
PENTAZOCINE LACTATE
- 30MG/ML Injection
- 02241976 TALWIN ABB
28:08.92 MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
ACETAMINOPHEN
- 80MG Chewable Tablet
- 02129957 ACETAMIN
CHILD WTR
- 01905856 ACETAMINOPHEN TRI
- 02017458 ACETAMINOPHEN RIV
- 02015676 CHILDREN'S
ACETAMINOPHEN TAN
- 02263815 PEDIAPHEN CHEWABLE EUR
- 160MG Chewable Tablet
- 02017431 ACETAMINOPHEN RIV
- 02231011 FEVERHALT PED
- 02263823 PEDIAPHEN CHEWABLE EUR
- 02230934 TANTAPHEN
GRAPE TAN
- 00876038 TEMPRA
CHILDREN MJO
- 80MG/ML Drop
- 01904140 ACETAMINOPHEN TAN
- 01905864 ACETAMINOPHEN TRI
- 00631353 ATASOL HOR
- 02230787 FEVERHALT PED
- 02263793 PEDIAPHEN EUR
- 02027801 PEDIATRIX RPH
- 00887587 PMS-ACETAMINOPHEN PMS
- 00875988 TEMPRA MJO
- 02046059 TYLENOL
GRAPE MCL
- 16MG/ML Liquid
- 01905848 ACETAMINOPHEN TRI
- 02263807 PEDIAPHEN EUR
- 00792713 PMS-ACETAMINOPHEN PMS
- 01934805 ROBIGESIC WRI *
- 00884553 TEMPRA MJO
- 32MG/ML Liquid
- 01958836 ACETAMINOPHEN TRI
- 01901389 ACETAMINOPHEN JAP
- 02263831 PEDIAPHEN EUR
- 02027798 PEDIATRIX RPH
- 00792691 PMS-ACETAMINOPHEN PMS
- 00875996 TEMPRA
DOUBLE STRENGTH MJO
- 02046040 TYLENOL MCL
- 120MG Suppository
- 01919385 ABENOL PED
- 02230434 ACET
120 PMS
- 02046660 PMS-ACETAMINOPHEN PMS
- 160MG Suppository
- 02230435 ACET PMS
- 325MG Suppository
- 01919393 ABENOL PED
- 02230436 ACET
325 PMS
- 02046687 PMS-ACETAMINOPHEN PMS
- 650MG Suppository
- 01919407 ABENOL PED
- 02230437 ACET
650 PMS
- 02046695 PMS-ACETAMINOPHEN PMS
- 80MG Tablet
- 02238295 CHILDREN'S
TYLENOL SOFT CHEWS JNO
- 160MG Tablet
- 02142805 ACETAMINOPHEN WTR
- 02021420 CEPHANOL RIV
- 02241361 TYLENOL
JUNIOR STRENGTH JNO
- 325MG Tablet
- 00374148 ACETAMINOPHEN WAM
- 00382752 ACETAMINOPHEN PRO
- 00589241 ACETAMINOPHEN PMS
- 00605751 ACETAMINOPHEN VTH *
- 00743542 ACETAMINOPHEN PMT
- 00789801 ACETAMINOPHEN TRI
- 01938088 ACETAMINOPHEN JMP
- 02022214 ACETAMINOPHEN RIV
- 02229873 APO-ACETAMINOPHEN APX
- 00544981 APO-ACETAMINOPHEN APX
- 00293482 ATASOL HOR
- 00389218 NOVO-GESIC NOP
- 00891177 PMS-ACETAMINOPHEN PMS *
- 00559393 TYLENOL MCL
- 00723894 TYLENOL MCL
- 500MG Tablet
- 00386626 ACETAMINOPHEN PDL
- 02252813 ACETAMINOPHEN PMT
- 02255251 ACETAMINOPHEN PMT
- 00549703 ACETAMINOPHEN PMT
- 00567663 ACETAMINOPHEN PED
- 00589233 ACETAMINOPHEN PMS
- 00605778 ACETAMINOPHEN VTH
- 00789798 ACETAMINOPHEN TRI
- 01939122 ACETAMINOPHEN JMP
- 02022222 ACETAMINOPHEN RIV
- 02229977 APO-ACETAMINOPHEN APX
- 00545007 APO-ACETAMINOPHEN APX
- 00013668 ATASOL
FORTE HOR
- 00482323 NOVO-GESIC NOP
- 00892505 PMS-ACETAMINOPHEN PMS
- 01962353 TANTAPHEN TAN
- 00863270 TYLENOL MCL
- 00559407 TYLENOL
EXTRA STRENGTH MCL
- 00723908 TYLENOL
EXTRA STRENGTH MCL
FLOCTAFENINE
- 200MG Tablet
- 02244680 APO-FLOCTAFENINE APX
- 400MG Tablet
- 02244681 APO-FLOCTAFENINE APX
28:12.04 ANTICONVULSANTS - BARBITURATES
PHENOBARBITAL
- 5MG/ML Liquid
- 00645575 PMS-PHENOBARBITAL PMS
- 15MG Tablet
- 00178799 PHENOBARBITAL PMS
- 30MG Tablet
- 00178802 PHENOBARBITAL PMS
- 60MG Tablet
- 00178810 PHENOBARBITAL PMS
- 100MG Tablet
- 00178829 PHENOBARBITAL PMS
PRIMIDONE
- 125MG Tablet
- 00399310 APO-PRIMIDONE APX
- 250MG Tablet
- 00396761 APO-PRIMIDONE APX
28:12.08 ANTICONVULSANTS - BENZODIAZEPINES
CLONAZEPAM
- 0.25MG Tablet
- 02179660 PMS-CLONAZEPAM PMS
- 0.5MG Tablet
- 02177889 APO-CLONAZEPAM APX
- 02230366 CLONAPAM VAE
- 02220598 CLONAZEPAM PDL
- 02270641 CO-CLONAZEPAM COB
- 02130998 DOM-CLONAZEPAM DPC
- 02224100 DOM-CLONAZEPAM-R DPC
- 02230950 GEN-CLONAZEPAM GEN
- 02237277 MED-CLONAZEPAM MEC
- 02239024 NOVO-CLONAZEPAM NOP
- 02173344 NU-CLONAZEPAM NXP
- 02145227 PHL-CLONAZEPAM PHH
- 02048701 PMS-CLONAZEPAM PMS
- 02207818 PMS-CLONAZEPAM
R PMS
- 02311593 PRO-CLONAZEPAM PDL
- 02103656 RATIO-CLONAZEPAM RPH
- 02242077 RIVA-CLONAZEPAM RIV
- 00382825 RIVOTRIL HLR
- 02233960 SANDOZ-CLONAZEPAM SDZ
- 02303310 ZYM-CLONAZEPAM ZYM
- 1MG Tablet
- 02230368 CLONAPAM VAE
- 02270668 CO-CLONAZEPAM COB
- 02145235 PHL-CLONAZEPAM PHH
- 02048728 PMS-CLONAZEPAM PMS
- 02311607 PRO-CLONAZEPAM PDL
- 02233982 SANDOZ-CLONAZEPAM SDZ
- 02303329 ZYM-CLONAZEPAM ZYM
- 2MG Tablet
- 02177897 APO-CLONAZEPAM APX
- 02230369 CLONAPAM VAE
- 02220601 CLONAZEPAM PDL
- 02270676 CO-CLONAZEPAM COB
- 02131013 DOM-CLONAZEPAM DPC
- 02230951 GEN-CLONAZEPAM GEN
- 02237278 MED-CLONAZEPAM MEC
- 02239025 NOVO-CLONAZEPAM NOP
- 02173352 NU-CLONAZEPAM NXP
- 02145243 PHL-CLONAZEPAM PHH
- 02048736 PMS-CLONAZEPAM PMS
- 02311615 PRO-CLONAZEPAM PDL
- 02103737 RATIO-CLONAZEPAM RPH
- 02242078 RIVA-CLONAZEPAM RIV
- 00382841 RIVOTRIL HLR
- 02233985 SANDOZ-CLONAZEPAM SDZ
- 02303337 ZYM-CLONAZEPAM ZYM
28:12.12 ANTICONVULSANTS - HYDANTOINS
PHENYTOIN
- 30MG Capsule
- 00022772 DILANTIN PFI
- 100MG Capsule
- 00022780 DILANTIN PFI
- 50MG Chewable Tablet
- 00023698 DILANTIN
INFATABS PFI
- 6MG/ML Suspension
- 00023442 DILANTIN
30 PFI
- 25MG/ML Suspension
- 00023450 DILANTIN
125 PFI
- 02250896 TARO-PHENYTOIN TAR
28:12.20 ANTICONVULSANTS- SUCCINIMIDES
ETHOSUXIMIDE
- 250MG Capsule
- 00022799 ZARONTIN ERF
- 50MG/ML Syrup
- 00023485 ZARONTIN ERF
METHSUXIMIDE
- 300MG Capsule
- 00022802 CELONTIN ERF
28:12.92 MISCELLANEOUS ANTICONVULSANTS
CARBAMAZEPINE
- 100MG Chewable Tablet
- 02231542 PMS-CARBAMAZEPINE PMS
- 02261855 SANDOZ-CARBAMAZEPINE SDZ
- 02244403 TARO-CARBAMAZEPINE TAR
- 00369810 TEGRETOL NVR
- 200MG Chewable Tablet
- 02231540 PMS-CARBAMAZEPINE PMS
- 02261863 SANDOZ-CARBAMAZEPINE SDZ
- 02244404 TARO-CARBAMAZEPINE TAR
- 00665088 TEGRETOL NVR
- 200MG Extended Release Tablet
- 02261839 SANDOZ-CARBAMAZEPINE SDZ
- 400MG Extended Release Tablet
- 02261847 SANDOZ-CARBAMAZEPINE SDZ
- 20MG/ML Suspension
- 02194333 TEGRETOL NVR
- 200MG Sustained Release Tablet
- 02238222 DOM-CARBAMAZEPINE
CR DPC
- 02241882 GEN-CARBAMAZEPINE
CR GEN
- 02231543 PMS-CARBAMAZEPINE
SRT PMS
- 02237907 TARO-CARBAMAZEPINE
CR TAR
- 00773611 TEGRETOL
CR NVR
- 400MG Sustained Release Tablet
- 02238223 DOM-CARBAMAZEPINE
CR DPC
- 02241883 GEN-CARBAMAZEPINE
CR GEN
- 02231544 PMS-CARBAMAZEPINE
SRT PMS
- 02237908 TARO-CARBAMAZEPINE
CR TAR
- 00755583 TEGRETOL
CR NVR
- 200MG Tablet
- 00402699 APO-CARBAMAZEPINE APX
- 00578460 CARBAMAZEPINE PDL
- 00782718 NOVO-CARBAMAZ NOP
- 02042568 NU-CARBAMAZEPINE NXP
- 00010405 TEGRETOL NVR
DIVALPROEX SODIUM
- 125MG Delayed Release Tablet
- 02265133 GEN-DIVALPROEX GEN
- 250MG Delayed Release Tablet
- 02265141 GEN-DIVALPROEX GEN
- 500MG Delayed Release Tablet
- 02265168 GEN-DIVALPROEX GEN
- 125MG Enteric Coated Tablet
- 00596418 EPIVAL ABB
- 250MG Enteric Coated Tablet
- 00596426 EPIVAL ABB
- 500MG Enteric Coated Tablet
- 00596434 EPIVAL ABB
GABAPENTIN
- 100MG Capsule
- 02244304 APO-GABAPENTIN APX
- 02256142 CO-GABAPENTIN COB
- 02243743 DOM-GABAPENTIN DPC
- 02248259 GEN-GABAPENTIN GEN
- 02084260 NEURONTIN PFI
- 02244513 NOVO-GABAPENTIN NOP
- 02243446 PMS-GABAPENTIN PMS
- 02310449 PRO-GABAPENTIN PDL
- 02319055 RAN-GABAPENTIN RBY
- 02260883 RATIO-GABAPENTIN RPH
- 02251167 RIVA-GABAPENTIN RIV
- 02304775 ZYM-GABAPENTIN ZYM
- 300MG Capsule
- 02244305 APO-GABAPENTIN APX
- 02256150 CO-GABAPENTIN COB
- 02243744 DOM-GABAPENTIN DPC
- 02249375 GABAPENTIN PRE
- 02273853 GABAPENTIN GEN
- 02248260 GEN-GABAPENTIN GEN
- 02084279 NEURONTIN PFI
- 02244514 NOVO-GABAPENTIN NOP
- 02243447 PMS-GABAPENTIN PMS
- 02310457 PRO-GABAPENTIN PDL
- 02319063 RAN-GABAPENTIN RBY
- 02260891 RATIO-GABAPENTIN RPH
- 02251175 RIVA-GABAPENTIN RIV
- 02304783 ZYM-GABAPENTIN ZYM
- 400MG Capsule
- 02244306 APO-GABAPENTIN APX
- 02256169 CO-GABAPENTIN COB
- 02243745 DOM-GABAPENTIN DPC
- 02249383 GABAPENTIN PRE
- 02248261 GEN-GABAPENTIN GEN
- 02084287 NEURONTIN PFI
- 02244515 NOVO-GABAPENTIN NOP
- 02243448 PMS-GABAPENTIN PMS
- 02319071 RAN-GABAPENTIN RBY
- 02260905 RATIO-GABAPENTIN RPH
- 02251183 RIVA-GABAPENTIN RIV
- 02304791 ZYM-GABAPENTIN ZYM
- 600MG Tablet
- 02293358 APO-GABAPENTIN APX
- 02239717 NEURONTIN PFI
- 02248457 NOVO-GABAPENTIN NOP
- 02255898 PMS-GABAPENTIN PMS
- 02310481 PRO-GABAPENTIN PDL
- 02310473 PRO-GABAPENTIN PDL
- 02260913 RATIO-GABAPENTIN RPH
- 02259796 RIVA-GABAPENTIN RIV
- 800MG Tablet
- 02293366 APO-GABAPENTIN APX
- 02239718 NEURONTIN PFI
- 02247346 NOVO-GABAPENTIN NOP
- 02255901 PMS-GABAPENTIN PMS
- 02260921 RATIO-GABAPENTIN RPH
- 02259818 RIVA-GABAPENTIN RIV
LAMOTRIGINE
- 2MG Chewable Tablet
- 02243803 LAMICTAL GSK
- 5MG Chewable Tablet
- 02240115 LAMICTAL GSK
- 25MG Tablet
- 02245208 APO-LAMOTRIGINE APX
- 02265494 GEN-LAMOTRIGINE GEN
- 02142082 LAMICTAL GSK
- 02302969 LAMOTRIGINE PDL
- 02248232 NOVO-LAMOTRIGINE NOP
- 02246897 PMS-LAMOTRIGINE PMS
- 02243352 RATIO-LAMOTRIGINE RPH
- 100MG Tablet
- 02245209 APO-LAMOTRIGINE APX
- 02265508 GEN-LAMOTRIGINE GEN
- 02142104 LAMICTAL GSK
- 02302985 LAMOTRIGINE PDL
- 02248233 NOVO-LAMOTRIGINE NOP
- 02246898 PMS-LAMOTRIGINE PMS
- 02243353 RATIO-LAMOTRIGINE RPH
- 150MG Tablet
- 02245210 APO-LAMOTRIGINE APX
- 02265516 GEN-LAMOTRIGINE GEN
- 02142112 LAMICTAL GSK
- 02302993 LAMOTRIGINE PDL
- 02248234 NOVO-LAMOTRIGINE NOP
- 02246899 PMS-LAMOTRIGINE PMS
- 02246963 RATIO-LAMOTRIGINE RPH
LEVETIRACETAM
Limited use benefit (prior approval required).
For the use in combination with other anti-epileptic medication(s) in the treatment
of partial seizures in patients who are refractory to adequate trials of three
anti-epileptic medications used either as monotherapy or in combination. This
product must be prescribed by a Neurologist.
- 250MG Tablet
- 02285924 APO-LEVETIRACETAM APX
- 02274183 CO-LEVETIRACETAM COB
- 02247027 KEPPRA UCB
- 02296101 PMS-LEVETIRACETAM PMS
- 500MG Tablet
- 02285932 APO-LEVETIRACETAM APX
- 02274191 CO-LEVETIRACETAM COB
- 02247028 KEPPRA UCB
- 02296128 PMS-LEVETIRACETAM PMS
- 750MG Tablet
- 02285940 APO-LEVETIRACETAM APX
- 02274205 CO-LEVETIRACETAM COB
- 02247029 KEPPRA UCB
- 02296136 PMS-LEVETIRACETAM PMS
TOPIRAMATE
- 15MG Sprinkle Capsule
- 02239907 TOPAMAX
SPRINKLE JNO
- 25MG Sprinkle Capsule
- 02239908 TOPAMAX
SPRINKLE JNO
- 25MG Tablet
- 02279614 APO-TOPIRAMATE APX
- 02287765 CO
TOPIRAMATE CBT
- 02271141 DOM-TOPIRAMATE DPC *
- 02263351 GEN-TOPIRAMATE GEN
- 02315645 MINT-TOPIRAMATE MIN
- 02248860 NOVO-TOPIRAMATE NOP
- 02262991 PMS-TOPIRAMATE PMS
- 02313650 PRO-TOPIRAMATE PDL
- 02256827 RATIO-TOPIRAMATE RPH
- 02260050 SANDOZ-TOPIRAMATE SDZ
- 02230893 TOPAMAX JNO
- 50MG Tablet
- 02312085 PMS-TOPIRAMATE PMS
- 100MG Tablet
- 02279630 APO-TOPIRAMATE APX
- 02287773 CO
TOPIRAMATE CBT
- 02271168 DOM-TOPIRAMATE DPC *
- 02263378 GEN-TOPIRAMATE GEN
- 02315653 MINT-TOPIRAMATE MIN
- 02248861 NOVO-TOPIRAMATE NOP
- 02263009 PMS-TOPIRAMATE PMS
- 02313669 PRO-TOPIRAMATE PDL
- 02256835 RATIO-TOPIRAMATE RPH
- 02260069 SANDOZ-TOPIRAMATE SDZ
- 02230894 TOPAMAX JNO
- 200MG Tablet
- 02279649 APO-TOPIRAMATE APX
- 02287781 CO
TOPIRAMATE CBT
- 02271176 DOM-TOPIRAMATE DPC *
- 02263386 GEN-TOPIRAMATE GEN
- 02315661 MINT-TOPIRAMATE MIN
- 02248862 NOVO-TOPIRAMATE NOP
- 02313677 PDL-TOPIRAMATE PDL
- 02263017 PMS-TOPIRAMATE PMS
- 02256843 RATIO-TOPIRAMATE RPH
- 02267837 SANDOZ-TOPIRAMATE SDZ
- 02230896 TOPAMAX JNO
VALPROATE, SODIUM
- 50MG/ML Syrup
- 02238370 APO-VALPROIC APX
- 00443832 DEPAKENE ABB
- 02238817 DOM-VALPROIC
ACID DPC
- 02236807 PMS-VALPROIC
ACID PMS
- 02140063 RATIO-VALPROIC RPH
VALPROIC ACID
- 250MG Capsule
- 02238048 APO-VALPROIC APX
- 00443840 DEPAKENE ABB
- 02231030 DOM-VALPROIC
ACID DPC
- 02238448 FTP-VALPROIC
ACID FTP
- 02184648 GEN-VALPROIC GEN
- 02230663 MED-VALPROIC
ACID MEC
- 02100630 NOVO-VALPROIC NOP
- 02237830 NU-VALPROIC NXP
- 02238546 PDL-VALPROIC PDL
- 02231248 PENTA-VALPROIC PEN
- 02230768 PMS-VALPROIC
ACID PMS
- 02140047 RATIO-VALPROIC
ACID RPH
- 02239714 SANDOZ-VALPROIC SDZ
- 500MG Enteric Coated Capsule
- 02231031 DOM-VALPROIC
ACID DPC
- 02218321 NOVO-VALPROIC NOP
- 02260662 PHL-VALPROIC
ACID PHH
- 02229628 PMS-VALPROIC
ACID PMS
- 02140055 RATIO-VALPROIC
ACID RPH
- 02239713 SANDOZ-VALPROIC SDZ
- 125MG Enteric Coated Tablet
- 02239698 APO-DIVALPROEX APX
- 02239701 NOVO-DIVALPROEX NOP
- 02239517 NU-DIVALPROEX NXP
- 02244138 PMS-DIVALPROEX PMS
- 250MG Enteric Coated Tablet
- 02239699 APO-DIVALPROEX APX
- 02239702 NOVO-DIVALPROEX NOP
- 02239518 NU-DIVALPROEX NXP
- 02244139 PMS-DIVALPROEX PMS
- 500MG Enteric Coated Tablet
- 02239700 APO-DIVALPROEX APX
- 02240343 DIVALPROEX
EC PDL
- 02239703 NOVO-DIVALPROEX NOP
- 02239519 NU-DIVALPROEX NXP
- 02244140 PMS-DIVALPROEX PMS
VIGABATRIN
- 500MG Powder
- 02068036 SABRIL OVA
- 500MG Tablet
- 02065819 SABRIL OVA
28:16.04 ANTIDEPRESSANTS
AMITRIPTYLINE HCL
- 10MG Tablet
- 00370991 AMITRIPTYLINE PRO
- 00335053 APO-AMITRIPTYLINE APX
- 02248131 DOM-AMITRIPTYLINE DPC
- 00037400 NOVO-TRIPTYN NOP
- 02247302 PMS-AMITRIPTYLINE PMS
- 25MG Tablet
- 00371009 AMITRIPTYLINE PRO
- 00335061 APO-AMITRIPTYLINE APX
- 02248132 DOM-AMITRIPTYLINE DPC
- 00037419 NOVO-TRIPTYN NOP
- 02247303 PMS-AMITRIPTYLINE PMS
- 50MG Tablet
- 00456349 AMITRIPTYLINE PDL
- 00335088 APO-AMITRIPTYLINE APX
- 02248133 DOM-AMITRIPTYLINE DPC
- 00271152 LEVATE ICN
- 00037427 NOVO-TRIPTYN NOP
- 02247304 PMS-AMITRIPTYLINE PMS
- 75MG Tablet
- 00754129 APO-AMITRIPTYLINE APX
- 00354295 ELAVIL FRS
- 00405612 LEVATE VAE
BUPROPION HCL (WELLBUTRIN)
Limited use benefit (prior approval required).
For treatment of depression in patients unresponsive to or intolerant of other
listed antidepressants. (Note: this product will not be approved for coverage
for smoking cessation).
- 100MG Sustained Release Tablet
- 02285657 RATIO-BUPROPION RPH
- 02275074 SANDOZ-BUPROPION
SR SDZ
- 150MG Sustained Release Tablet
- 02260239 NOVO-BUPROPION
SR NOP
- 02313421 PMS-BUPROPION SR PMS
- 02285665 RATIO-BUPROPION RPH
- 02275082 SANDOZ-BUPROPION
SR SDZ
- 02237825 WELLBUTRIN
SR BPC
BUPROPION HCL (ZYBAN)
Limited use benefit with quantity and frequency limits (prior
approval is not required).
For smoking cessation:
Coverage is limited to 180 tablets during a one-year period. The year starts
on the date the first prescription is filled. Once this quantity has been reached,
the client is eligible again for coverage for bupropion HCl when one year has
elapsed from the day the initial prescription was filled.
- 150MG Sustained Release Tablet
- 02238441 ZYBAN
SR BPC
CITALOPRAM
- 10MG Tablet
- 02312336 NOVO-CITALOPRAM NOP
- 02270609 PMS-CITALOPRAM PMS
- 02303256 RIVA-CITALOPRAM RIV
- 02301822 ZYM-CITALOPRAM ZYM
- 20MG Tablet
- 02246056 APO-CITALOPRAM APX
- 02239607 CELEXA LUD
- 02257513 CITALOPRAM-20 PDL
- 02248050 CO-CITALOPRAM COB
- 02248942 DOM-CITALOPRAM DPC
- 02246594 GEN-CITALOPRAM GEN
- 02313405 JAMP-CITALOPRAM JMP
- 02304686 MINT-CITALOPRAM MIN
- 02251558 NOVO-CITALOPRAM NOP
- 02293218 NOVO-CITALOPRAM NOP
- 02248996 NU-CITALOPRAM NXP
- 02248944 PHL-CITALOPRAM PHH
- 02248010 PMS-CITALOPRAM PMS
- 02249227 PREM-CITALOPRAM PRE
- 02285622 RAN-CITALO RBY
- 02268000 RAN-CITALOPRAM RBY
- 02252112 RATIO-CITALOPRAM RPH
- 02249278 RIVA-CITALOPRAM RIV
- 02303264 RIVA-CITALOPRAM RIV
- 02248170 SANDOZ-CITALOPRAM SDZ
- 02301830 ZYM-CITALOPRAM ZYM
- 30MG Tablet
- 02296152 CTP ORY
- 40MG Tablet
- 02246057 APO-CITALOPRAM APX
- 02239608 CELEXA LUD
- 02257521 CITALOPRAM PDL
- 02248051 CO-CITALOPRAM COB
- 02248943 DOM-CITALOPRAM DPC
- 02246595 GEN-CITALOPRAM GEN
- 02313413 JAMP-CITALOPRAM JMP
- 02304694 MINT-CITALOPRAM MIN
- 02251566 NOVO-CITALOPRAM NOP
- 02293226 NOVO-CITALOPRAM NOP
- 02248997 NU-CITALOPRAM NXP
- 02248945 PHL-CITALOPRAM PHH
- 02248011 PMS-CITALOPRAM PMS
- 02249235 PREM-CITALOPRAM PRE
- 02285630 RAN-CITALO RBY
- 02268019 RAN-CITALOPRAM RBY
- 02252120 RATIO-CITALOPRAM RPH
- 02249286 RIVA-CITALOPRAM RIV
- 02303272 RIVA-CITALOPRAM RIV
- 02248171 SANDOZ-CITALOPRAM SDZ
- 02301849 ZYM-CITALOPRAM ZYM
CLOMIPRAMINE HCL
- 10MG Tablet
- 00330566 ANAFRANIL ORY
- 02040786 APO-CLOMIPRAMINE APX
- 02130122 CLOMIPRAMINE PDL
- 02244816 CO-CLOMIPRAMINE COB
- 02188996 MED-CLOMIPRAMINE MEC
- 02230256 NOVO-CLOPAMINE NOP
- 25MG Tablet
- 00324019 ANAFRANIL ORY
- 02040778 APO-CLOMIPRAMINE APX
- 02130130 CLOMIPRAMINE PDL
- 02244817 CO-CLOMIPRAMINE COB
- 02189003 MED-CLOMIPRAMINE MEC
- 02130165 NOVO-CLOPAMINE NOP
- 50MG Tablet
- 00402591 ANAFRANIL ORY
- 02040751 APO-CLOMIPRAMINE APX
- 02130149 CLOMIPRAMINE PDL
- 02244818 CO-CLOMIPRAMINE COB
- 02189011 MED-CLOMIPRAMINE MEC
- 02130173 NOVO-CLOPAMINE NOP
DESIPRAMINE HCL
- 10MG Tablet
- 02216248 APO-DESIPRAMINE APX
- 02222981 DESIPRAMINE PDL
- 02223341 NOVO-DESIPRAMINE NOP
- 02211939 NU-DESIPRAMINE NXP
- 01946250 PMS-DESIPRAMINE PMS
- 25MG Tablet
- 02216256 APO-DESIPRAMINE APX
- 02223007 DESIPRAMINE PDL
- 02130092 DOM-DESIPRAMINE DPC
- 02223325 NOVO-DESIPRAMINE NOP
- 02211947 NU-DESIPRAMINE NXP
- 01946269 PMS-DESIPRAMINE PMS
- 50MG Tablet
- 02216264 APO-DESIPRAMINE APX
- 02223015 DESIPRAMINE PDL
- 02130106 DOM-DESIPRAMINE DPC
- 02223333 NOVO-DESIPRAMINE NOP
- 02211955 NU-DESIPRAMINE NXP
- 01946277 PMS-DESIPRAMINE PMS
- 75MG Tablet
- 02216272 APO-DESIPRAMINE APX
- 02223023 DESIPRAMINE PDL
- 02223368 NOVO-DESIPRAMINE NOP
- 02211963 NU-DESIPRAMINE NXP
- 01946242 PMS-DESIPRAMINE PMS
- 100MG Tablet
- 02216280 APO-DESIPRAMINE APX
- 02223031 DESIPRAMINE PDL
- 02211971 NU-DESIPRAMINE NXP
DOXEPIN HCL
- 10MG Capsule
- 02049996 APO-DOXEPIN APX
- 00024325 SINEQUAN ERF
- 25MG Capsule
- 02050005 APO-DOXEPIN APX
- 01913425 NOVO-DOXEPIN NOP
- 00024333 SINEQUAN ERF
- 50MG Capsule
- 02050013 APO-DOXEPIN APX
- 01913433 NOVO-DOXEPIN NOP
- 00024341 SINEQUAN ERF
- 75MG Capsule
- 02050021 APO-DOXEPIN APX
- 01913441 NOVO-DOXEPIN NOP
- 00400750 SINEQUAN ERF
- 100MG Capsule
- 02050048 APO-DOXEPIN APX
- 01913468 NOVO-DOXEPIN NOP
- 00326925 SINEQUAN ERF
- 150MG Capsule
- 01913476 NOVO-DOXEPIN NOP
- 10MG Tablet
- 02150727 DOXEPINE PDL
- 25MG Tablet
- 02150735 DOXEPINE PDL
- 50MG Tablet
- 02150743 DOXEPINE PDL
- 75MG Tablet
- 02150751 DOXEPINE PDL
- 100MG Tablet
- 02150778 DOXEPINE PDL
- 150MG Tablet
- 02150786 DOXEPINE PDL
FLUOXETINE HCL
- 10MG Capsule
- 02216353 APO-FLUOXETINE APX
- 02242177 CO-FLUOXETINE SCN
- 02177617 DOM-FLUOXETINE DPC
- 02220121 FLUOXETINE PDL
- 02237813 GEN-FLUOXETINE GEN
- 02216582 NOVO-FLUOXETINE NOP
- 02192756 NU-FLUOXETINE NXP
- 02223481 PHL-FLUOXETINE PHH
- 02177579 PMS-FLUOXETINE PMS
- 02314991 PRO-FLUOXETINE PDL
- 02018985 PROZAC LIL
- 02241371 RATIO-FLUOXETINE RPH
- 02242123 RIVA-FLUOXETINE RIV
- 02243486 SANDOZ-FLUOXETINE SDZ
- 02302659 ZYM-FLUOXETINE ZYM
- 20MG Capsule
- 02216361 APO-FLUOXETINE APX
- 02242178 CO-FLUOXETINE SCN
- 02177625 DOM-FLUOXETINE DPC
- 02220148 FLUOXETINE PDL
- 02237814 GEN-FLUOXETINE GEN
- 02216590 NOVO-FLUOXETINE NOP
- 02192764 NU-FLUOXETINE NXP
- 02223503 PHL-FLUOXETINE PHH
- 02177587 PMS-FLUOXETINE PMS
- 02315009 PRO-FLUOXETINE PDL
- 00636622 PROZAC LIL
- 02241374 RATIO-FLUOXETINE RPH
- 02242124 RIVA-FLUOXETINE RIV
- 02243487 SANDOZ-FLUOXETINE SDZ
- 02302667 ZYM-FLUOXETINE ZYM
- 40MG Capsule
- 02245283 FXT ORY
- 4MG/ML Liquid
- 02231328 APO-FLUOXETINE APX
- 02177595 PMS-FLUOXETINE PMS
FLUVOXAMINE MALEATE
- 50MG Tablet
- 02231329 APO-FLUVOXAMINE APX
- 02257661 BCI-FLUVOXAMINE BCI
- 02255529 CO-FLUVOXAMINE COB
- 02241347 DOM-FLUVOXAMINE DPC
- 02236753 FLUVOXAMINE PDL
- 01919342 LUVOX SPH
- 02239953 NOVO-FLUVOXAMINE NOP
- 02231192 NU-FLUVOXAMINE NXP
- 02240682 PMS-FLUVOXAMINE PMS
- 02218453 RATIO-FLUVOXAMINE RPH
- 02240723 RIVA-FLUVOX RIV
- 02303345 RIVA-FLUVOX RIV
- 02247054 SANDOZ-FLUVOXAMINE SDZ
- 100MG Tablet
- 02231330 APO-FLUVOXAMINE APX
- 02257688 BCI-FLUVOXAMINE BCI
- 02255537 CO-FLUVOXAMINE COB
- 02241348 DOM-FLUVOXAMINE DPC
- 02236754 FLUVOXAMINE PDL
- 01919369 LUVOX SPH
- 02239954 NOVO-FLUVOXAMINE NOP
- 02231193 NU-FLUVOXAMINE NXP
- 02240683 PMS-FLUVOXAMINE PMS
- 02218461 RATIO-FLUVOXAMINE RPH
- 02303361 RIVA-FLUVOX RIV
- 02247055 SANDOZ-FLUVOXAMINE SDZ
IMIPRAMINE HCL
- 10MG Tablet
- 00360201 APO-IMIPRAMINE APX
- 00371017 IMIPRAMINE PRO
- 00021504 NOVO-PRAMINE NOP
- 25MG Tablet
- 00312797 APO-IMIPRAMINE APX
- 00371025 IMIPRAMINE PRO
- 00021512 NOVO-PRAMINE NOP
- 50MG Tablet
- 00326852 APO-IMIPRAMINE APX
- 00456357 IMIPRAMINE PDL
- 00021520 NOVO-PRAMINE NOP
- 75MG Tablet
- 00644579 APO-IMIPRAMINE APX
MAPROTILINE HCL
- 25MG Tablet
- 02158612 NOVO-MAPROTILINE NOP
- 50MG Tablet
- 02158620 NOVO-MAPROTILINE NOP
- 75MG Tablet
- 02158639 NOVO-MAPROTILINE NOP
MIRTAZAPINE
- 15MG Orally Disintegrating Tablet
- 02279894 NOVO-MIRTAZAPINE
OD NOP
- 02248542 REMERON
RD ORG
- 30MG Orally Disintegrating Tablet
- 02279908 NOVO-MIRTAZAPINE
OD NOP
- 02248543 REMERON
RD ORG
- 45MG Orally Disintegrating Tablet
- 02279916 NOVO-MIRTAZAPINE
OD NOP
- 02248544 REMERON
RD ORG
- 15MG Tablet
- 02286610 APO-MIRTAZAPINE APX
- 02256096 GEN-MIRTAZAPINE GEN
- 02273942 PMS-MIRTAZAPINE PMS
- 02312778 PRO-MIRTAZAPINE PDL
- 02250594 RHOXAL-MIRTAZAPINE RHO
- 30MG Tablet
- 02286629 APO-MIRTAZAPINE APX
- 02274361 CO-MIRTAZAPINE COB
- 02252287 DOM-MIRTAZAPINE DPC
- 02256118 GEN-MIRTAZAPINE GEN
- 02259354 NOVO-MIRTAZAPINE NOP
- 02252279 PHL-MIRTAZAPINE PHH
- 02248762 PMS-MIRTAZAPINE PMS
- 02312786 PRO-MIRTAZAPINE PDL
- 02270927 RATIO-MIRTAZAPINE RPH
- 02243910 REMERON ORG
- 02265265 RIVA-MIRTAZAPINE RIV
- 02250608 SANDOZ-MIRTAZAPINE SDZ
- 02267292 SANDOZ-MIRTAZAPINE
FC SDZ
- 45MG Tablet
- 02286637 APO-MIRTAZAPINE APX
- 02256126 GEN-MIRTAZAPINE GEN
MOCLOBEMIDE
- 100MG Tablet
- 02232148 APO-MOCLOBEMIDE APX
- 02236928 MOCLOBEMIDE PDL
- 02239746 NOVO-MOCLOBEMIDE NOP
- 02237111 NU-MOCLOBEMIDE NXP
- 150MG Tablet
- 02232150 APO-MOCLOBEMIDE APX
- 00899356 MANERIX HLR
- 02239747 NOVO-MOCLOBEMIDE NOP
- 02237112 NU-MOCLOBEMIDE NXP
- 02243218 PMS-MOCLOBEMIDE PMS
- 02218410 RATIO-MOCLOBEMIDE RPH
- 300MG Tablet
- 02240456 APO-MOCLOBEMIDE APX
- 02166747 MANERIX HLR
- 02239748 NOVO-MOCLOBEMIDE NOP
- 02243219 PMS-MOCLOBEMIDE PMS
NORTRIPTYLINE HCL
- 10MG Capsule
- 02223511 APO-NORTRIPTYLINE APX
- 00015229 AVENTYL PHH
- 02178729 DOM-NORTRIPTYLINE DPC
- 02231686 GEN-NORTRIPTYLINE GEN
- 02231781 NOVO-NORTRIPTYLINE NOP
- 02223139 NU-NORTRIPTYLINE NXP
- 02177692 PMS-NORTRIPTYLINE PMS
- 02240789 RATIO-NORTRIPTYLINE RPH
- 25MG Capsule
- 02223538 APO-NORTRIPTYLINE APX
- 00015237 AVENTYL PHH
- 02178737 DOM-NORTRIPTYLINE DPC
- 02231687 GEN-NORTRIPTYLINE GEN
- 02231782 NOVO-NORTRIPTYLINE NOP
- 02223147 NU-NORTRIPTYLINE NXP
- 02177706 PMS-NORTRIPTYLINE PMS
- 02240790 RATIO-NORTRIPTYLINE RPH
PAROXETINE HCL
- 10MG Tablet
- 02240907 APO-PAROXETINE APX
- 02262746 CO-PAROXETINE COB
- 02248447 DOM-PAROXETINE DPC
- 02248012 GEN-PAROXETINE GEN
- 02248556 NOVO-PAROXETINE NOP
- 02248719 NU-PAROXETINE NXP
- 02248913 PAROXETINE PDL
- 02027887 PAXIL GSK
- 02248450 PHL-PAROXETINE PHH
- 02247750 PMS-PAROXETINE PMS
- 02247810 RATIO-PAROXETINE RPH
- 02254743 RHOXAL-PAROXETINE RHO
- 02248559 RIVA-PAROXETINE RIV
- 02269422 SANDOZ-PAROXETINE SDZ
- 02302012 ZYM-PAROXETINE ZYM
- 20MG Tablet
- 02240908 APO-PAROXETINE APX
- 02262754 CO-PAROXETINE COB
- 02248448 DOM-PAROXETINE DPC
- 02248013 GEN-PAROXETINE GEN
- 02248557 NOVO-PAROXETINE NOP
- 02248720 NU-PAROXETINE NXP
- 02248914 PAROXETINE PDL
- 01940481 PAXIL GSK
- 02248451 PHL-PAROXETINE PHH
- 02247751 PMS-PAROXETINE PMS
- 02247811 RATIO-PAROXETINE RPH
- 02248560 RIVA-PAROXETINE RIV
- 02254751 SANDOZ-PAROXETINE SDZ
- 02269430 SANDOZ-PAROXETINE SDZ
- 02302020 ZYM-PAROXETINE ZYM
- 30MG Tablet
- 02240909 APO-PAROXETINE APX
- 02262762 CO-PAROXETINE COB
- 02248449 DOM-PAROXETINE DPC
- 02248014 GEN-PAROXETINE GEN
- 02248558 NOVO-PAROXETINE NOP
- 02248721 NU-PAROXETINE NXP
- 02248915 PAROXETINE PDL
- 01940473 PAXIL GSK
- 02248452 PHL-PAROXETINE PHH
- 02247752 PMS-PAROXETINE PMS
- 02251361 PREM-PAROXETINE PRE
- 02247812 RATIO-PAROXETINE RPH
- 02248561 RIVA-PAROXETINE RIV
- 02254778 SANDOZ-PAROXETINE SDZ
- 02269449 SANDOZ-PAROXETINE SDZ
- 02302039 ZYM-PAROXETINE ZYM
- 40MG Tablet
- 02293749 PMS-PAROXETINE PMS
PHENELZINE SULFATE
- 15MG Tablet
- 00476552 NARDIL PFI
SERTRALINE
- 25MG Capsule
- 02238280 APO-SERTRALINE APX
- 02287390 CO
SERTRALINE CBT
- 02245748 DOM-SERTRALINE DPC
- 02242519 GEN-SERTRALINE GEN
- 09857435 GEN-SERTRALINE
(ONT) GEN
- 02240485 NOVO-SERTRALINE NOP
- 02247047 NU-SERTRALINE NXP
- 02245824 PHL-SERTRALINE PHH
- 02244838 PMS-SERTRALINE PMS
- 02245787 RATIO-SERTRALINE RPH
- 09857460 RHOXAL-SERTRALINE
(ONT) RHO
- 02248496 RIVA-SERTRALINE RIV
- 02245159 SANDOZ-SERTRALINE SDZ
- 02241302 SERTRALINE-25 PDL
- 02132702 ZOLOFT PFI
- 50MG Capsule
- 02238281 APO-SERTRALINE APX
- 02287404 CO
SERTRALINE CBT
- 02245749 DOM-SERTRALINE DPC
- 02242520 GEN-SERTRALINE GEN
- 09857443 GEN-SERTRALINE
(ONT) GEN
- 02240484 NOVO-SERTRALINE NOP
- 02247048 NU-SERTRALINE NXP
- 02245825 PHL-SERTRALINE PHH
- 02244839 PMS-SERTRALINE PMS
- 02245788 RATIO-SERTRALINE RPH
- 09857478 RHOXAL-SERTRALINE
(ONT) RHO
- 02248497 RIVA-SERTRALINE RIV
- 02245160 SANDOZ-SERTRALINE SDZ
- 02241303 SERTRALINE-50 PDL
- 01962817 ZOLOFT PFI
- 100MG Capsule
- 02238282 APO-SERTRALINE APX
- 02287412 CO
SERTRALINE CBT
- 02245750 DOM-SERTRALINE DPC
- 02242521 GEN-SERTRALINE GEN
- 09857451 GEN-SERTRALINE
(ONT) GEN
- 02240481 NOVO-SERTRALINE NOP
- 02247050 NU-SERTRALINE NXP
- 02245826 PHL-SERTRALINE PHH
- 02244840 PMS-SERTRALINE PMS
- 02245789 RATIO-SERTRALINE RPH
- 09857486 RHOXAL-SERTRALINE
(ONT) RHO
- 02248498 RIVA-SERTRALINE RIV
- 02245161 SANDOZ-SERTRALINE SDZ
- 02241304 SERTRALINE-100 PDL
- 01962779 ZOLOFT PFI
TRANYLCYPROMINE SULFATE
- 10MG Tablet
- 01919598 PARNATE GSK
TRAZODONE HCL
- 50MG Tablet
- 02147637 APO-TRAZODONE APX
- 00579351 DESYREL BMS
- 02128950 DOM-TRAZODONE DPC
- 02231683 GEN-TRAZODONE GEN
- 02144263 NOVO-TRAZODONE NOP
- 02165384 NU-TRAZODONE NXP
- 02232543 PENTA-TRAZODONE PEN
- 02236941 PHL-TRAZODONE PHH
- 01937227 PMS-TRAZODONE PMS
- 02277344 RATIO-TRAZODONE RPH
- 02053187 RATIO-TRAZODONE RPH
- 02164353 TRAZODONE PDL
- 02230284 TRAZOREL VAE
- 75MG Tablet
- 02237339 PMS-TRAZODONE PMS
- 100MG Tablet
- 02147645 APO-TRAZODONE APX
- 00579378 DESYREL BMS
- 02128969 DOM-TRAZODONE DPC
- 02231684 GEN-TRAZODONE GEN
- 02144271 NOVO-TRAZODONE NOP
- 02165392 NU-TRAZODONE NXP
- 02232544 PENTA-TRAZODONE PEN
- 02236942 PHL-TRAZODONE PHH
- 01937235 PMS-TRAZODONE PMS
- 02277352 RATIO-TRAZODONE RPH
- 02053195 RATIO-TRAZODONE RPH
- 02164361 TRAZODONE PDL
- 02230285 TRAZOREL VAE
- 150MG Tablet
- 02147653 APO-TRAZODONE
D APX
- 00702277 DESYREL
DIVIDOSE BMS
- 02231685 GEN-TRAZODONE GEN
- 02144298 NOVO-TRAZODONE NOP
- 02165406 NU-TRAZODONE
D NXP
- 02277360 RATIO-TRAZODONE RPH
- 02053209 RATIO-TRAZODONE RPH
- 02164388 TRAZODONE PDL
TRIMIPRAMINE MALEATE
- 75MG Capsule
- 02070987 APO-TRIMIP APX
- 02147599 TRIMIPRAMINE PDL
- 12.5MG Tablet
- 00740799 APO-TRIMIPRAMINE APX
- 02020599 NU-TRIMIPRAMINE NXP
- 00761702 TRIMIPRAMINE PRO
- 25MG Tablet
- 00740802 APO-TRIMIPRAMINE APX
- 01940430 NOVO-TRIPRAMINE NOP
- 02020602 NU-TRIMIPRAMINE NXP
- 01926322 SURMONTIL SAC
- 00761710 TRIMIPRAMINE PDL
- 50MG Tablet
- 00740810 APO-TRIMIPRAMINE APX
- 01940449 NOVO-TRIPRAMINE NOP
- 02020610 NU-TRIMIPRAMINE NXP
- 00761729 TRIMIPRAMINE PDL
- 100MG Tablet
- 00740829 APO-TRIMIPRAMINE APX
- 01940457 NOVO-TRIPRAMINE NOP
- 02020629 NU-TRIMIPRAMINE NXP
- 00761737 TRIMIPRAMINE PDL
VENLAFAXINE HCL
- 37.5MG Sustained Release Capsule
- 02304317 CO VENLAFAXINE XR COB
- 02237279 EFFEXOR
XR WAY
- 02310279 GEN-VENLAFAXINE XR GEN
- 02275023 NOVO-VENLAFAXINE
XR NOP
- 02278545 PMS-VENLAFAXINE
XR PMS
- 02273969 RATIO-VENLAFAXINE
XR RPH
- 02307774 RIVA-VENLAFAXINE XR RIV
- 02310317 SANDOZ VENLAFAXINE XR SDZ
- 75MG Sustained Release Capsule
- 02304325 CO VENLAFAXINE XR COB
- 02237280 EFFEXOR
XR WAY
- 02310287 GEN-VENLAFAXINE XR GEN
- 02275031 NOVO-VENLAFAXINE
XR NOP
- 02278553 PMS-VENLAFAXINE
XR PMS
- 02273977 RATIO-VENLAFAXINE
SR RPH
- 02307782 RIVA-VENLAFAXINE XR RIV
- 02310325 SANDOZ VENLAFAXINE XR SDZ
- 150MG Sustained Release Capsule
- 02304333 CO VENLAFAXINE XR COB
- 02237282 EFFEXOR
XR WAY
- 02310295 GEN-VENLAFAXINE XR GEN
- 02275058 NOVO-VENLAFAXINE
XR NOP
- 02278561 PMS-VENLAFAXINE
XR PMS
- 02273985 RATIO-VENLAFAXINE
XR RPH
- 02307790 RIVA-VENLAFAXINE XR RIV
- 02310333 SANDOZ VENLAFAXINE XR SDZ
28:16.08 ANTIPSYCHOTIC AGENTS
CHLORPROMAZINE
- 25MG/ML Injection
- 00743518 CHLORPROMAZINE
HCL SDZ
- 25MG Tablet
- 00232823 NOVO-CHLORPROMAZINE NOP
- 50MG Tablet
- 00232807 NOVO-CHLORPROMAZINE NOP
- 100MG Tablet
- 00232831 NOVO-CHLORPROMAZINE NOP
CLOZAPINE
- 25MG Tablet
- 02248034 APO-CLOZAPINE APX
- 00894737 CLOZARIL NVR
- 02247243 GEN-CLOZAPINE GEN
- 50MG Tablet
- 02305003 GEN-CLOZAPINE GEN
- 100MG Tablet
- 02248035 APO-CLOZAPINE APX
- 00894745 CLOZARIL NVR
- 02247244 GEN-CLOZAPINE GEN
- 200MG Tablet
- 02305011 GEN-CLOZAPINE GEN
FLUPENTHIXOL DECANOATE
- 20MG/ML Injection
- 02156032 FLUANXOL
DEPOT LUD
- 100MG/ML Injection
- 02156040 FLUANXOL
DEPOT LUD
FLUPENTHIXOL DIHYDROCHLORIDE
- 0.5MG Tablet
- 02156008 FLUANXOL LUD
- 3MG Tablet
- 02156016 FLUANXOL LUD
FLUPHENAZINE DECANOATE
- 25MG/ML Injection
- 02239636 FLUPHENAZINE
OMEGA OMG
- 02091275 PMS-FLUPHENAZINE PMS
- 100MG/ML Injection
- 02242570 FLUPHENAZINE
OMEGA OMG
- 00755575 MODECATE BMS
- 02241928 PMS-FLUPHENAZINE PMS
FLUPHENAZINE HCL
- 0.5MG/ML Elixir
- 00893420 PMS-FLUPHENAZINE PMS
- 1MG Tablet
- 00405345 APO-FLUPHENAZINE APX
- 00563846 FLUPHENAZINE PDL
- 2MG Tablet
- 00410632 APO-FLUPHENAZINE APX
- 00563838 FLUPHENAZINE PDL
- 5MG Tablet
- 00405361 APO-FLUPHENAZINE APX
HALOPERIDOL
- 5MG/ML Injection
- 00808652 HALOPERIDOL SDZ
- 2MG/ML Solution
- 00759503 PMS-HALOPERIDOL PMS
- 00552429 RATIO-HALOPERIDOL RPH
- 0.5MG Tablet
- 00396796 APO-HALOPERIDOL APX
- 00587796 HALOPERIDOL PDL
- 00363685 NOVO-PERIDOL NOP
- 00552135 RATIO-HALOPERIDOL RPH
- 1MG Tablet
- 00396818 APO-HALOPERIDOL APX
- 00587788 HALOPERIDOL PDL
- 00363677 NOVO-PERIDOL NOP
- 00552143 RATIO-HALOPERIDOL RPH
- 2MG Tablet
- 00396826 APO-HALOPERIDOL APX
- 00761745 HALOPERIDOL PDL
- 00363669 NOVO-PERIDOL NOP
- 00728292 RATIO-HALOPERIDOL RPH
- 5MG Tablet
- 00396834 APO-HALOPERIDOL APX
- 00761753 HALOPERIDOL PDL
- 00363650 NOVO-PERIDOL NOP
- 00647969 RATIO-HALOPERIDOL RPH
- 10MG Tablet
- 00463698 APO-HALOPERIDOL APX
- 00761761 HALOPERIDOL PDL
- 00713449 NOVO-PERIDOL NOP
- 00728306 RATIO-HALOPERIDOL RPH
- 20MG Tablet
- 00768820 NOVO-PERIDOL NOP
HALOPERIDOL DECANOATE
- 50MG/ML Injection
- 02130297 HALOPERIDOL
LA SDZ
- 02236866 HALOPERIDOL
LA NOP
- 02230707 PMS-HALOPERIDOL
LA PMS
- 100MG/ML Injection
- 02242362 APO-HALOPERIDOL
LA APX
- 02130300 HALOPERIDOL
LA SDZ
- 02239640 HALOPERIDOL
LA OMG
- 02242631 HALOPERIDOL
LA NOP
- 02230708 PMS-HALOPERIDOL
LA PMS
LOXAPINE HCL
- 25MG/ML Oral Liquid
- 02239101 PMS-LOXAPINE PMS
LOXAPINE SUCCINATE
- 2.5MG Tablet
- 02242868 PMS-LOXAPINE PMS
- 5MG Tablet
- 02237651 APO-LOXAPINE APX
- 02239918 DOM-LOXAPINE DPC
- 02237534 NU-LOXAPINE NXP
- 02238196 PDL-LOXAPINE PDL
- 02236943 PHL-LOXAPINE PHH
- 02230837 PMS-LOXAPINE PMS
- 10MG Tablet
- 02237652 APO-LOXAPINE APX
- 02239919 DOM-LOXAPINE DPC
- 02237535 NU-LOXAPINE NXP
- 02238197 PDL-LOXAPINE PDL
- 02236944 PHL-LOXAPINE PHH
- 02230838 PMS-LOXAPINE PMS
- 25MG Tablet
- 02237653 APO-LOXAPINE APX
- 02239920 DOM-LOXAPINE DPC
- 02237536 NU-LOXAPINE NXP
- 02236945 PDL-LOXAPINE PHH
- 02238198 PDL-LOXAPINE PDL
- 02230839 PMS-LOXAPINE PMS
- 50MG Tablet
- 02237654 APO-LOXAPINE APX
- 02239921 DOM-LOXAPINE DPC
- 02237537 NU-LOXAPINE NXP
- 02236946 PDL-LOXAPINE PHH
- 02238199 PDL-LOXAPINE PDL
- 02230840 PMS-LOXAPINE PMS
METHOTRIMEPRAZINE
- 2MG Tablet
- 02238403 APO-METHOPRAZINE APX
- 02239632 METHOTRIMEPRAZINE PDL
- 5MG Tablet
- 02238404 APO-METHOPRAZINE APX
- 02239633 METHOTRIMEPRAZINE PDL
- 02232903 PMS-METHOTRIMEPRAZINE PMS
- 25MG Tablet
- 02238405 APO-METHOPRAZINE APX
- 02239634 METHOTRIMEPRAZINE PDL
- 01964925 NOVO-MEPRAZINE NOP
- 02232904 PMS-METHOTRIMEPRAZINE PMS
- 50MG Tablet
- 02238406 APO-METHOPRAZINE APX
- 02239635 METHOTRIMEPRAZINE PDL
- 02232905 PMS-METHOTRIMEPRAZINE PMS
OLANZAPINE
- 5MG Orally Disintegrating Tablet
- 02243086 ZYPREXA
ZYDIS LIL
- 10MG Orally Disintegrating Tablet
- 02243087 ZYPREXA
ZYDIS LIL
- 15MG Orally Disintegrating Tablet
- 02243088 ZYPREXA
ZYDIS LIL
- 2.5MG Tablet
- 02276712 NOVO-OLANZAPINE NOP
- 02303116 PMS-OLANZAPINE PMS
- 02229250 ZYPREXA LIL
- 5MG Tablet
- 02276720 NOVO-OLANZAPINE NOP
- 02303159 PMS-OLANZAPINE PMS
- 02229269 ZYPREXA LIL
- 7.5MG Tablet
- 02276739 NOVO-OLANZAPINE NOP
- 02303167 PMS-OLANZAPINE PMS
- 02229277 ZYPREXA LIL
- 10MG Tablet
- 02276747 NOVO-OLANZAPINE NOP
- 02303175 PMS-OLANZAPINE PMS
- 02229285 ZYPREXA LIL
- 15MG Tablet
- 02276755 NOVO-OLANZAPINE NOP
- 02303183 PMS-OLANZAPINE PMS
- 02238850 ZYPREXA LIL
PERICYAZINE
- 5MG Capsule
- 01926780 NEULEPTIL ERF
- 10MG Capsule
- 01926772 NEULEPTIL ERF
- 20MG Capsule
- 01926764 NEULEPTIL ERF
- 10MG/ML Drop
- 01926756 NEULEPTIL ERF
PERPHENAZINE
- 3.2MG/ML Liquid
- 00751898 PMS-PERPHENAZINE PMS
- 2MG Tablet
- 00335134 APO-PERPHENAZINE APX
- 00563757 PERPHENAZINE PDL
- 4MG Tablet
- 00335126 APO-PERPHENAZINE APX
- 00563749 PERPHENAZINE PDL
- 8MG Tablet
- 00335118 APO-PERPHENAZINE APX
- 00563730 PERPHENAZINE PDL
- 16MG Tablet
- 00335096 APO-PERPHENAZINE APX
- 00563722 PERPHENAZINE PDL
PIMOZIDE
- 2MG Tablet
- 02245432 APO-PIMOZIDE APX
- 00313815 ORAP PHH
- 4MG Tablet
- 02245433 APO-PIMOZIDE APX
- 00313823 ORAP PHH
PIPOTIAZINE PALMITATE
- 25MG/ML Injection
- 01926667 PIPORTIL
L4 SAC
- 50MG/ML Injection
- 00894672 PIPORTIL
L4 RHO *
PROCHLORPERAZINE
- 5MG/ML Injection
- 00789747 PROCHLORPERAZINE SDZ
- 10MG Suppository
- 00753688 PMS-PROCHLORPERAZINE PMS
- 00789720 PROCHLORPERAZINE SIL
- 5MG Tablet
- 00886440 APO-PROCHLORAZINE APX
- 01964399 NU-PROCHLOR NXP
- 00753661 PMS-PROCHLORPERAZINE PMS
- 10MG Tablet
- 00886432 APO-PROCHLORAZINE APX
- 01964402 NU-PROCHLOR NXP
- 00753637 PMS-PROCHLORPERAZINE PMS
QUETIAPINE FUMARATE
- 25MG Tablet
- 02313901 APO-QUETIAPINE APX
- 02316080 CO QUETIAPINE COB
- 02307804 GEN-QUETIAPINE GEN
- 02284235 NOVO-QUETIAPINE NOP
- 02296551 PMS-QUETIAPINE PMS
- 02317346 PRO-QUETIAPINE PDL
- 02311704 RATIO-QUETIAPINE RPH
- 02316692 RIVA-QUETIAPINE RIV
- 02313995 SANDOZ-QUETIAPINE SDZ
- 02236951 SEROQUEL AZC
- 02317893 ZYM-QUETIAPINE ZYM
- 100MG Tablet
- 02313928 APO-QUETIAPINE APX
- 02316099 CO QUETIAPINE COB
- 02307812 GEN-QUETIAPINE GEN
- 02284243 NOVO-QUETIAPINE NOP
- 02296578 PMS-QUETIAPINE PMS
- 02317354 PRO-QUETIAPINE PDL
- 02311712 RATIO-QUETIAPINE RPH
- 02316706 RIVA-QUETIAPINE RIV
- 02314002 SANDOZ-QUETIAPINE SDZ
- 02236952 SEROQUEL AZC
- 02317907 ZYM-QUETIAPINE ZYM
- 150MG Tablet
- 02284251 NOVO-QUETIAPINE NOP
- 200MG Tablet
- 02313936 APO-QUETIAPINE APX
- 02316110 CO QUETIAPINE COB
- 02307839 GEN-QUETIAPINE GEN
- 02284278 NOVO-QUETIAPINE NOP
- 02296594 PMS-QUETIAPINE PMS
- 02317362 PRO-QUETIAPINE PDL
- 02311747 RATIO-QUETIAPINE RPH
- 02316722 RIVA-QUETIAPINE RIV
- 02314010 SANDOZ-QUETIAPINE SDZ
- 02236953 SEROQUEL AZC
- 02317923 ZYM-QUETIAPINE ZYM
- 300MG Tablet
- 02313944 APO-QUETIAPINE APX
- 02316129 CO QUETIAPINE COB
- 02307847 GEN-QUETIAPINE GEN
- 02284286 NOVO-QUETIAPINE NOP
- 02296608 PMS-QUETIAPINE PMS
- 02317370 PRO-QUETIAPINE PDL
- 02311755 RATIO-QUETIAPINE RPH
- 02316730 RIVA-QUETIAPINE RIV
- 02314029 SANDOZ-QUETIAPINE SDZ
- 02244107 SEROQUEL AZC
- 02317931 ZYM-QUETIAPINE ZYM
RISPERIDONE
- 0.5MG Orally Disintegrating Tablet
- 02247704 RISPERDAL-M JNO
- 1MG Orally Disintegrating Tablet
- 02247705 RISPERDAL-M JNO
- 2MG Orally Disintegrating Tablet
- 02247706 RISPERDAL-M JNO
- 3MG Orally Disintegrating Tablet
- 02268086 RISPERDAL-M JNO
- 4MG Orally Disintegrating Tablet
- 02268094 RISPERDAL-M JNO
- 1MG/ML Solution
- 02280396 APO-RISPERIDONE APX
- 02279266 PMS-RISPERIDONE PMS
- 02236950 RISPERDAL JNO
- 0.25MG Tablet
- 02282119 APO-RISPERIDONE APX
- 02282585 CO-RISPERIDONE COB
- 02282240 GEN-RISPERIDONE GEN
- 02282690 NOVO-RISPERIDONE NOP
- 02252007 PMS-RISPERIDONE PMS
- 02312700 PRO-RISPERIDONE PDL
- 02280906 RAN-RISPERIDONE RBY
- 02264757 RATIO-RISPERIDONE RPH
- 02240551 RISPERDAL JNO
- 02283565 RIVA-RISPERIDONE RIV
- 02303655 SANDOZ RISPERIDONE SDZ
- 02279509 SANDOZ-RISPERIDONE SDZ
- 02292807 SANDOZ-RISPERIDONE SDZ
- 02303485 ZYM-RISPERIDONE ZYM
- 0.5MG Tablet
- 02282127 APO-RISPERIDONE APX
- 02282593 CO-RISPERIDONE COB
- 02282259 GEN-RISPERIDONE GEN
- 02264188 NOVO-RISPERIDONE NOP
- 02252015 PMS-RISPERIDONE PMS
- 02312719 PRO-RISPERIDONE PDL
- 02280914 RAN-RISPERIDONE RBY
- 02264765 RATIO-RISPERIDONE RPH
- 02240552 RISPERDAL JNO
- 02283573 RIVA-RISPERIDONE RIV
- 02303663 SANDOZ RISPERIDONE SDZ
- 02279495 SANDOZ-RISPERIDONE SDZ
- 02303493 ZYM-RISPERIDONE ZYM
- 1MG Tablet
- 02282135 APO-RISPERIDONE APX
- 02282607 CO-RISPERIDONE COB
- 02282267 GEN-RISPERIDONE GEN
- 02264196 NOVO-RISPERIDONE NOP
- 02252023 PMS-RISPERIDONE PMS
- 02312727 PRO-RISPERIDONE PDL
- 02280922 RAN-RISPERIDONE RBY
- 02264773 RATIO-RISPERIDONE RPH
- 02025280 RISPERDAL JNO
- 02283581 RIVA-RISPERIDONE RIV
- 02279800 SANDOZ-RISPERIDONE SDZ
- 02303507 ZYM-RISPERIDONE ZYM
- 2MG Tablet
- 02282143 APO-RISPERIDONE APX
- 02282615 CO-RISPERIDONE COB
- 02282275 GEN-RISPERIDONE GEN
- 02264218 NOVO-RISPERIDONE NOP
- 02252031 PMS-RISPERIDONE PMS
- 02312735 PRO-RISPERIDONE PDL
- 02280930 RAN-RISPERIDONE RBY
- 02264781 RATIO-RISPERIDONE RPH
- 02025299 RISPERDAL JNO
- 02283603 RIVA-RISPERIDONE RIV
- 02279819 SANDOZ-RISPERIDONE SDZ
- 02303515 ZYM-RISPERIDONE ZYM
- 3MG Tablet
- 02282151 APO-RISPERIDONE APX
- 02282623 CO-RISPERIDONE COB
- 02282283 GEN-RISPERIDONE GEN
- 02264226 NOVO-RISPERIDONE NOP
- 02252058 PMS-RISPERIDONE PMS
- 02312743 PRO-RISPERIDONE PDL
- 02280949 RAN-RISPERIDONE RBY
- 02264803 RATIO-RISPERIDONE RPH
- 02025302 RISPERDAL JNO
- 02283611 RIVA-RISPERIDONE RIV
- 02279827 SANDOZ-RISPERIDONE SDZ
- 02303523 ZYM-RISPERIDONE ZYM
- 4MG Tablet
- 02282178 APO-RISPERIDONE APX
- 02282631 CO-RISPERIDONE COB
- 02282291 GEN-RISPERIDONE GEN
- 02264234 NOVO-RISPERIDONE NOP
- 02252066 PMS-RISPERIDONE PMS
- 02312751 PRO-RISPERIDONE PDL
- 02280957 RAN-RISPERIDONE RBY
- 02264811 RATIO-RISPERIDONE RPH
- 02025310 RISPERDAL JNO
- 02283638 RIVA-RISPERIDONE RIV
- 02279835 SANDOZ-RISPERIDONE SDZ
- 02303531 ZYM-RISPERIDONE ZYM
THIOPROPERAZINE MESYLATE
- 10MG Tablet
- 01927639 MAJEPTIL ERF
THIOTHIXENE
- 2MG Capsule
- 00024430 NAVANE ERF
- 5MG Capsule
- 00024449 NAVANE ERF
- 10MG Capsule
- 00024457 NAVANE ERF
TRIFLUOPERAZINE HCL
- 10MG/ML Liquid
- 00751871 PMS-TRIFLUOPERAZINE PMS
- 1MG Tablet
- 00345539 APO-TRIFLUOPERAZINE APX
- 00386529 TRIFLUOPERAZINE PRO
- 2MG Tablet
- 00312754 APO-TRIFLUOPERAZINE APX
- 00386510 TRIFLUOPERAZINE PRO
- 5MG Tablet
- 00312746 APO-TRIFLUOPERAZINE APX
- 00386502 TRIFLUOPERAZINE PRO
- 10MG Tablet
- 00326836 APO-TRIFLUOPERAZINE APX
- 00389943 TRIFLUOPERAZINE PDL
- 20MG Tablet
- 00595942 APO-TRIFLUOPERAZINE APX
28:20.04 AMPHETAMINES
DEXTROAMPHETAMINE SULFATE
- 10MG Sustained Release Capsule
- 01924559 DEXEDRINE
SPANSULE GSK
- 15MG Sustained Release Capsule
- 01924567 DEXEDRINE
SPANSULE GSK
- 5MG Tablet
- 01924516 DEXEDRINE GSK
28:20.92 MISC ANOREXIGENIC AGENTS & RESPIRATORY & CEREBRAL
STIMULANT
METHYLPHENIDATE HCL
- 20MG Extended Release Tablet
- 02266687 APO-METHYLPHENIDATE APX
- 20MG Sustained Release Tablet
- 00632775 RITALIN
SR NVR
- 5MG Tablet
- 02273950 APO-METHYLPHENIDATE APX
- 02234749 PMS-METHYLPHENIDATE PMS
- 10MG Tablet
- 02249324 APO-METHYLPHENIDATE APX
- 00584991 PMS-METHYLPHENIDATE PMS
- 00005606 RITALIN NVR
- 20MG Tablet
- 02249332 APO-METHYLPHENIDATE APX
- 00585009 PMS-METHYLPHENIDATE PMS
- 00005614 RITALIN NVR
MODAFINIL
- 100MG Tablet
- 02239665 ALERTEC DPY
- 02285398 APO-MODAFINIL APX
28:24.08 ANXIOLYTICS, SEDATIVES AND HYPNOTICS - BENZODIAZEPINES
ALPRAZOLAM
- 0.25MG Tablet
- 01908189 ALPRAZOLAM PDL
- 00865397 APO-ALPRAZ APX
- 02137534 GEN-ALPRAZOLAM GEN
- 02237264 MED-ALPRAZOLAM MEC
- 01913484 NOVO-ALPRAZOL NOP
- 01913239 NU-ALPRAZ NXP
- 00548359 XANAX PFI
- 0.5MG Tablet
- 01908170 ALPRAZOLAM PDL
- 00865400 APO-ALPRAZ APX
- 02137542 GEN-ALPRAZOLAM GEN
- 02237265 MED-ALPRAZOLAM MEC
- 01913492 NOVO-ALPRAZOL NOP
- 01913247 NU-ALPRAZ NXP
- 00548367 XANAX PFI
- 1MG Tablet
- 02248706 ALPRAZOLAM PDL
- 02243611 APO-ALPRAZ APX
- 02229813 GEN-ALPRAZOLAM GEN
- 00723770 XANAX PFI
- 2MG Tablet
- 02243612 APO-ALPRAZ APX
- 02229814 GEN-ALPRAZOLAM GEN
- 00813958 XANAX
TS PFI
BROMAZEPAM
- 1.5MG Tablet
- 02177153 APO-BROMAZEPAM APX
- 02220512 BROMAZEPAM PDL
- 02192705 GEN-BROMAZEPAM GEN
- 02230666 MED-BROMAZEPAM MEC
- 02171856 NU-BROMAZEPAM NXP
- 3MG Tablet
- 02177161 APO-BROMAZEPAM APX
- 02220520 BROMAZEPAM PDL
- 02192713 GEN-BROMAZEPAM GEN
- 00518123 LECTOPAM HLR
- 02230667 MED-BROMAZEPAM MEC
- 02230584 NOVO-BROMAZEPAM NOP
- 02171864 NU-BROMAZEPAM NXP
- 02232556 PENTA-BROMAZEPAM PEN
- 6MG Tablet
- 02177188 APO-BROMAZEPAM APX
- 02220539 BROMAZEPAM PDL
- 02192721 GEN-BROMAZEPAM GEN
- 00518131 LECTOPAM HLR
- 02230668 MED-BROMAZEPAM MEC
- 02230585 NOVO-BROMAZEPAM NOP
- 02171872 NU-BROMAZEPAM NXP
CLOBAZAM
- 10MG Tablet
- 02244638 APO-CLOBAZAM APX
- 02248454 CLOBAZAM PDL
- 02247230 DOM-CLOBAZAM DPC
- 02221799 FRISIUM PED
- 02238334 NOVO-CLOBAZAM NOP
- 02244474 PMS-CLOBAZAM PMS
- 02238797 RATIO-CLOBAZAM RPH
DIAZEPAM
- 1MG/ML Oral Solution
- 00891797 PMS-DIAZEPAM PMS
- 2MG Tablet
- 00405329 APO-DIAZEPAM APX
- 00434396 DIAZEPAM PDL
- 02247490 PMS-DIAZEPAM PMS
- 5MG Tablet
- 00362158 APO-DIAZEPAM APX
- 00313580 DIAZEPAM PRO
- 02247491 PMS-DIAZEPAM PMS
- 00013285 VALIUM HLR
- 10MG Tablet
- 00405337 APO-DIAZEPAM APX
- 00434388 DIAZEPAM PDL
- 02247492 PMS-DIAZEPAM PMS
- 00013773 VIVOL AXX
LORAZEPAM
- 0.5MG Tablet
- 00655740 APO-LORAZEPAM APX
- 02041413 ATIVAN WAY
- 02041456 ATIVAN
SUBLINGUAL WAY
- 02245784 DOM-LORAZEPAM DPC
- 00711101 NOVO-LORAZEM NOP
- 00865672 NU-LORAZ NXP
- 00655643 PRO-LORAZEPAM PDL
- 1MG Tablet
- 00655759 APO-LORAZEPAM APX
- 02041421 ATIVAN WAY
- 02041464 ATIVAN
SUBLINGUAL WAY
- 02245785 DOM-LORAZEPAM DPC
- 00637742 NOVO-LORAZEM NOP
- 00865680 NU-LORAZ NXP
- 00655651 PRO-LORAZEPAM PDL
- 2MG Tablet
- 00655767 APO-LORAZEPAM APX
- 02041448 ATIVAN WAY
- 02041472 ATIVAN
SUBLINGUAL WAY
- 02245786 DOM-LORAZEPAM DPC
- 00637750 NOVO-LORAZEM NOP
- 00865699 NU-LORAZ NXP
- 00655678 PRO-LORAZEPAM PDL
NITRAZEPAM
- 5MG Tablet
- 02245230 APO-NITRAZEPAM APX
- 00511528 MOGADON ICN
- 02229654 NITRAZADON VAE
- 02234003 SANDOZ-NITRAZEPAM SDZ
- 10MG Tablet
- 02245231 APO-NITRAZEPAM APX
- 00511536 MOGADON ICN
- 02229655 NITRAZADON VAE
- 02234007 SANDOZ-NITRAZEPAM SDZ
OXAZEPAM
- 10MG Tablet
- 00402680 APO-OXAZEPAM APX
- 00497754 OXAZEPAM PDL
- 00568392 ZAPEX RIV
- 15MG Tablet
- 00402745 APO-OXAZEPAM APX
- 00497762 OXAZEPAM PDL
- 00568406 ZAPEX RIV
- 30MG Tablet
- 00402737 APO-OXAZEPAM APX
- 00497770 OXAZEPAM PDL
- 00568414 ZAPEX RIV
TEMAZEPAM
- 15MG Capsule
- 02225964 APO-TEMAZEPAM APX
- 02244814 CO-TEMAZEPAM COB
- 02229756 DOM-TEMAZEPAM DPC
- 02231615 GEN-TEMAZEPAM GEN
- 02237294 MED-TEMAZEPAM MEC
- 02230095 NOVO-TEMAZEPAM NOP
- 02223570 NU-TEMAZEPAM NXP
- 02239071 PENTA-TEMAZEPAM PEN
- 02229455 PMS-TEMAZEPAM PMS
- 02273039 PMS-TEMAZEPAM PMS
- 02243023 RATIO-TEMAZEPAM RPH
- 00604453 RESTORIL ORY
- 02229760 TEMAZEPAM PDL
- 30MG Capsule
- 02225972 APO-TEMAZEPAM APX
- 02244815 CO-TEMAZEPAM COB
- 02229758 DOM-TEMAZEPAM DPC
- 02231616 GEN-TEMAZEPAM GEN
- 02237295 MED-TEMAZEPAM MEC
- 02230102 NOVO-TEMAZEPAM NOP
- 02223589 NU-TEMAZEPAM NXP
- 02239072 PENTA-TEMAZEPAM PEN
- 02229456 PMS-TEMAZEPAM PMS
- 02273047 PMS-TEMAZEPAM PMS
- 02243024 RATIO-TEMAZEPAM RPH
- 00604461 RESTORIL ORY
- 02229761 TEMAZEPAM PDL
TRIAZOLAM
- 0.125MG Tablet
- 00808563 APO-TRIAZO APX
- 01995227 GEN-TRIAZOLAM GEN
- 00886084 NU-TRIAZO NUP
- 0.25MG Tablet
- 00808571 APO-TRIAZO APX
- 01913506 GEN-TRIAZOLAM GEN
- 00886092 NU-TRIAZO NUP
- 00860824 TRIAZOLAM PDL
28:24.92 MISCELLANEOUS ANXIOLYTICS, SEDATIVES, AND HYPNOTICS
HYDROXYZINE HCL
- 10MG Capsule
- 00739618 HYDROXYZINE PDL
- 00738824 NOVO-HYDROXYZIN NOP
- 02241192 RIVA-HYDROXYZIN RIV
- 25MG Capsule
- 00739626 HYDROXYZINE PDL
- 00738832 NOVO-HYDROXYZIN NOP
- 02241193 RIVA-HYDROXYZIN RIV
- 50MG Capsule
- 00739634 HYDROXYZINE PDL
- 00738840 NOVO-HYDROXYZIN NOP
- 02241194 RIVA-HYDROXYZIN RIV
- 2MG/ML Syrup
- 00024694 ATARAX ERF
- 00741817 PMS-HYDROXYZINE PMS
- 10MG Tablet
- 00646059 APO-HYDROXYZINE APX
- 25MG Tablet
- 00646024 APO-HYDROXYZINE APX
- 50MG Tablet
- 00646016 APO-HYDROXYZINE APX
28:28.00 ANTIMANIC AGENTS
LITHIUM CARBONATE
- 150MG Capsule
- 02242837 APO-LITHIUM
CARB APX
- 09857532 APO-LITHIUM
CARBONATE APX
- 02013231 LITHANE ERF
- 02216132 PMS-LITHIUM
CARBONATE PMS
- 300MG Capsule
- 02242838 APO-LITHIUM
CARB APX
- 09857540 APO-LITHIUM
CARBONATE APX
- 00236683 CARBOLITH VAE
- 00406775 LITHANE ERF
- 02216140 PMS-LITHIUM
CARBONATE PMS
- 600MG Capsule
- 02011239 CARBOLITH VAE
- 02216159 PMS-LITHIUM
CARBONATE PMS
- 300MG Sustained Release Tablet
- 02266695 APO-LITHIUM
CARBONATE APX
LITHIUM CITRATE
- 60MG/ML Syrup
- 02074834 PMS-LITHIUM
CITRATE PMS
28:32.28 SELECTIVE SEROTONIN AGONISTS
ALMOTRIPTAN MALATE
- 6.25MG Tablet
- 02248128 AXERT MCL
- 12.5MG Tablet
- 02248129 AXERT MCL
NARATRIPTAN HCL
- 1MG Tablet
- 02237820 AMERGE GSK
- 2.5MG Tablet
- 02237821 AMERGE GSK
RIZATRIPTAN
- 5MG Tablet
- 02240520 MAXALT FRS
- 10MG Tablet
- 02240521 MAXALT FRS
- 5MG Wafer
- 02240518 MAXALT
RPD FRS
- 10MG Wafer
- 02240519 MAXALT
RPD FRS
SUMATRIPTAN HEMISULFATE
- 5MG Nasal Spray
- 02230418 IMITREX GSK
- 20MG Nasal Spray
- 02230420 IMITREX GSK
SUMATRIPTAN SUCCINATE
- 12MG/ML Injection
- 02212188 IMITREX GSK
- 99000598 IMITREX GSK *
- 25MG Tablet
- 02257882 CO-SUMATRIPTAN COB
- 02270749 DOM-SUMATRIPTAN DPC
- 02268906 GEN-SUMATRIPTAN GEN
- 02239738 IMITREX
DF GSK
- 02286815 NOVO-SUMATRIPTAN
DF NOP
- 02256428 PMS-SUMATRIPTAN PMS
- 50MG Tablet
- 02268388 APO-SUMATRIPTAN APX
- 02257890 CO-SUMATRIPTAN COB
- 02270757 DOM-SUMATRIPTAN DPC
- 02268914 GEN-SUMATRIPTAN GEN
- 02212153 IMITREX
DF GSK
- 02286823 NOVO-SUMATRIPTAN
DF NOP
- 02256436 PMS-SUMATRIPTAN PMS
- 02271583 RATIO-SUMATRIPTAN RPH
- 02263025 SANDOZ-SUMATRIPTAN SDZ
- 100MG Tablet
- 02268396 APO-SUMATRIPTAN APX
- 02257904 CO-SUMATRIPTAN COB
- 02270765 DOM-SUMATRIPTAN DPC
- 02268922 GEN-SUMATRIPTAN GEN
- 02212161 IMITREX
DF GSK
- 02239367 NOVO-SUMATRIPTAN NOP
- 02286831 NOVO-SUMATRIPTAN
DF NOP
- 02256444 PMS-SUMATRIPTAN PMS
- 02271591 RATIO-SUMATRIPTAN RPH
- 02263033 SANDOZ-SUMATRIPTAN SDZ
ZOLMITRIPTAN
- 2.5MG Tablet
- 02238660 ZOMIG AZC
- 02243045 ZOMIG
RAPIMELT AZC
28:32.92 MISCELLANEOUS ANTIMIGRANE AGENTS
PIZOTYLINE HYDROGEN MALATE
- 0.5MG Tablet
- 00329320 SANDOMIGRAN PED
- 1MG Tablet
- 00511552 SANDOMIGRAN DS PED
28:36.08 ANTIPARKINSONIAN AGENTS - ANTICHOLINERGIC AGENTS
BENZTROPINE MESYLATE
- 1MG/ML Injection
- 02238903 BENZTROPINE OMEGA OMG
- 1MG Tablet
- 00706531 PMS-BENZTROPINE PMS
- 2MG Tablet
- 00426857 APO-BENZTROPINE APX
- 00563862 BENZTROPINE PDL
- 00587265 PMS-BENZTROPINE PMS
ETHOPROPAZINE HCL
- 50MG Tablet
- 01927744 PARSITAN ERF
PROCYCLIDINE HCL
- 0.5MG/ML Elixir
- 00587362 PMS-PROCYCLIDINE PMS
- 2.5MG Tablet
- 00649392 PMS-PROCYCLIDINE PMS
- 5MG Tablet
- 00587354 PMS-PROCYCLIDINE PMS
TRIHEXYPHENIDYL HCL
- 0.4MG/ML Liquid
- 00885398 PMS-TRIHEXYPHENIDYL PMS
- 2MG Tablet
- 00545058 APO-TRIHEX APX
- 00572802 TRIHEXYPHEN PRO
- 5MG Tablet
- 00545074 APO-TRIHEX APX
- 00572799 TRIHEXYPHEN PDL
28:36.12 ANTIPARKINSONIAN AGENTS - CATECHOL-O-METHYLTRANSFERASE (COMT) INHIBITORS
ENTACAPONE
- 200MG Tablet
- 02243763 COMTAN NVR
28:36.16 ANTIPARKINSONIAN AGENTS - DOPAMINE PRECURSORS
LEVODOPA, BENZERAZIDE
- 50MG & 12.5MG Capsule
- 00522597 PROLOPA HLR
- 100MG & 25MG Capsule
- 00386464 PROLOPA HLR
- 200MG & 50MG Capsule
- 00386472 PROLOPA HLR
LEVODOPA, CARBIDOPA
- 100MG & 25MG Controlled Release Tablet
- 02272873 APO-LEVOCARB CR APX
- 02028786 SINEMET CR BMS
- 200MG & 50MG Controlled Release Tablet
- 02245211 APO-LEVOCARB CR APX
- 00870935 SINEMET CR BMS
- 100MG & 10MG Tablet
- 02195933 APO-LEVOCARB APX
- 02244494 NOVO-LEVOCARBIDOPA NOP
- 02182831 NU-LEVOCARB NXP
- 02126176 RATIO-LEVODOPA/CARBIDOPA RPH
- 00355658 SINEMET BMS
- 100MG & 25MG Tablet
- 02195941 APO-LEVOCARB APX
- 02244495 NOVO-LEVOCARBIDOPA NOP
- 02182823 NU-LEVOCARB NXP
- 02311178 PRO-LEVOCARB PDL
- 02126168 RATIO-LEVODOPA/CARBIDOPA RPH
- 00513997 SINEMET BMS
- 250MG & 25MG Tablet
- 02195968 APO-LEVOCARB APX
- 02244496 NOVO-LEVOCARBIDOPA NOP
- 02182858 NU-LEVOCARB NXP
- 02126184 RATIO-LEVODOPA/CARBIDOPA RPH
- 00328219 SINEMET BMS
28:36.20 ANTIPARKINSONIAN AGENTS - DOPAMINE RECEPTOR AGONISTS
BROMOCRIPTINE MESYLATE
- 5MG Capsule
- 02230454 APO-BROMOCRIPTINE APX
- 02230719 BROMOCRIPTINE PRO
- 02238637 DOM-BROMOCRIPTINE DPC
- 02236949 PMS-BROMOCRIPTINE PMS
- 2.5MG Tablet
- 02087324 APO-BROMOCRIPTINE APX
- 02153378 BROMOCRIPTINE PRO
- 02238636 DOM-BROMOCRIPTINE DPC
- 02231702 PMS-BROMOCRIPTINE PMS
PRAMIPEXOLE DIHYDROCHLORIDE
- 0.25MG Tablet
- 02292378 APO-PRAMIPEXOLE APX
- 02237145 MIRAPEX BOE
- 09857268 MIRAPEX (ONT) BOE *
- 02269309 NOVO-PRAMIPEXOLE NOP
- 02290111 PMS-PRAMIPREXOLE PMS
- 02315262 SANDOZ-PRAMIPEXOLE SDZ
- 0.5MG Tablet
- 02292386 APO-PRAMIPEXOLE APX
- 02241594 MIRAPEX BOE
- 02269317 NOVO-PRAMIPEXOLE NOP
- 02290138 PMS-PRAMIPREXOLE PMS
- 02315270 SANDOZ-PRAMIPEXOLE SDZ
- 1MG Tablet
- 02292394 APO-PRAMIPEXOLE APX
- 02237146 MIRAPEX BOE
- 09857269 MIRAPEX (ONT) BOE *
- 02269325 NOVO-PRAMIPEXOLE NOP
- 02290146 PMS-PRAMIPREXOLE PMS
- 02315289 SANDOZ-PRAMIPEXOLE SDZ
- 1.5MG Tablet
- 02292408 APO-PRAMIPEXOLE APX
- 02237147 MIRAPEX BOE
- 09857270 MIRAPEX (ONT) BOE *
- 02269333 NOVO-PRAMIPEXOLE NOP
- 02290154 PMS-PRAMIPREXOLE PMS
- 02315297 SANDOZ-PRAMIPEXOLE SDZ
ROPINIROLE HCL
- 0.25MG Tablet
- 02232565 REQUIP GSK
- 1MG Tablet
- 02232567 REQUIP GSK
- 2MG Tablet
- 02232568 REQUIP GSK
- 5MG Tablet
- 02232569 REQUIP GSK
28:36.32 ANTIPARKINSONIAN AGENTS - MONOAMINE OXIDASE B INHIBITORS
SELEGILINE HCL
- 5MG Tablet
- 02230641 APO-SELEGILINE APX
- 02238340 DOM-SELEGILINE DPC
- 02231036 GEN-SELEGILINE GEN
- 02237289 MED-SELEGILINE MEC
- 02068087 NOVO-SELEGILINE NOP
- 02230717 NU-SELEGILINE NXP
- 02238102 PMS-SELEGILINE PMS
- 02231479 SELEGILINE PDL