Formulario Nacional Lista de Medicamentos Preferidos - Junio

Transcripción

1 Formulario Nacional Lista de Medicamentos Preferidos - Junio La Lista de Medicamentos Preferidos es una guía que identifica medicamentos de marca preferidos dentro de categorías terapéuticas. La Lista de Medicamentos Preferidos no incluye todos los medicamentos cubiertos por el beneficio de medicamentos con receta. Los medicamentos genéricos estándisponibles en muchas de las categorías terapéuticas mencionadas, además de categorías no mencionadas, y debe ser considerada como la primera línea de la prescripción. Para la cubierta de beneficios o restricciones por favor revise su plan de beneficios. Esta lista se revisa periódicamente a medida que los nuevos medicamentos y nueva información de prescripción están disponibles. Se recomienda traer esta lista de medicamentos cuando usted o un miembro de su familia bajo la cubierta visite a un médico o profesional de la salud. Algunos medicamentos cubiertos pueden tener requisitos adicionales o límites en la cubierta. Estos requisitos y límites pueden ser: Pre Autorizaciones: MCS Life requiere que usted o su médico obtengan autorización previa para ciertos medicamentos. Esto significa que necesitará aprobación del plan antes de presentar sus recetas médicas. Si no obtiene aprobación, su plan puede no cubrir el medicamento. Límites de cantidad: Para ciertos medicamentos, MCS Life limita la cantidad de medicamento que cubre. Por ejemplo, MCS Life proveerá cantidad de medicamento máxima según la aprobación de la FDA. Esto puede ser adicional a un suministro estándar de un mes o tres meses. Favor referirse a su póliza para más información sobre despachos de tres meses. ADHD / ANTI-NARCOLEPSIA / ANTI-OBESIDAD / ANORÉXICOS AMFETAMINAS Vyvanse Oral Cap 10 Mg QL Vyvanse Oral Cap 20 Mg QL Vyvanse Oral Cap 30 Mg QL Vyvanse Oral Cap 40 Mg QL Vyvanse Oral Cap 50 Mg QL Vyvanse Oral Cap 60 Mg QL Vyvanse Oral Cap 70 Mg QL Vyvanse Oral Tab Chewable 10 Mg QL Vyvanse Oral Tab Chewable 20 Mg QL Vyvanse Oral Tab Chewable 30 Mg QL Vyvanse Oral Tab Chewable 40 Mg QL Vyvanse Oral Tab Chewable 50 Mg QL Vyvanse Oral Tab Chewable 60 Mg QL ESTIMULANTES - MISC. Daytrana Transdermal Patch QL Quillivant Xr Oral Susp Reconst. 25 Mg/5ml QL AGENTES ANTIANGINALES ANTIANGINALES-OTROS Ranexa Tab 1000mg Ranexa Tab 500mg NITRATOS Isosorbide Dinitrate Er Oral Tab ER 40 Mg Isosorbide Dinitrate Oral Tab 10 Mg Isosorbide Dinitrate Oral Tab 20 Mg Isosorbide Dinitrate Oral Tab 30 Mg Isosorbide Dinitrate Oral Tab 5 Mg Isosorbide Mononitrate Er Oral Tab ER 24Hr 120 Mg Isosorbide Mononitrate Er Oral Tab ER 24Hr 30 Mg Isosorbide Mononitrate Er Oral Tab ER 24Hr 60 Mg Isosorbide Mononitrate Oral Tab 10 Mg Isosorbide Mononitrate Oral Tab 20 Mg Dilatrate-sr Oral Cap ER 40 Mg AGENTES ANTIASMATICOS Y BRONCODILATADORES BRONCODILATADORES - ANTICOLINERGICOS Ipratropium Bromide Inhal Sol 0.02 % Atrovent Hfa Inhal Aerosol QL Spiriva Handihaler Inhal Cap 18 Mcg QL Tudorza Pressair Inhal Aerosol INHALANTES ESTEROIDALES Arnuity Ellipta Inhal Aerosol QL Asmanex 120 Metered Doses Inhal Aerosol QL Asmanex 14 Metered Doses Inhal Aerosol QL Asmanex 30 Metered Doses Inhal Aerosol QL Asmanex 60 Metered Doses Inhal Aerosol QL Asmanex 7 Metered Doses Inhal Aerosol QL Asmanex Hfa Inhal Aerosol QL Flovent Diskus Inhal Aerosol QL Flovent Hfa Inhal Aerosol QL Pulmicort Flexhaler Inhal Aerosol QL Qvar_Inhal Aerosol QL INHIBIDORES SELECTIVOS DE LA FOSFODIESTERASA (PDE4) Daliresp Tab 250mcg PA

2 Daliresp Tab 500mcg PA MODULADORES LEUCOTRIENOS Montelukast Sodium Oral Packet Montelukast Sodium Oral Tab 10 Mg Montelukast Sodium Oral Tab Chewable 4 Mg Montelukast Sodium Oral Tab Chewable 5 Mg Zafirlukast Oral Tab 10 Mg Zafirlukast Oral Tab 20 Mg SIMPATOMIMETICOS Albuterol Sulfate Er Oral Tab ER 12Hr 4 Mg Albuterol Sulfate Er Oral Tab ER 12Hr 8 Mg Albuterol Sulfate Inhal Nebulization Sol (2.5 Mg/3ml) 0.083% Albuterol Sulfate Inhal Nebulization Sol (5 Mg/ml) 0.5% Albuterol Sulfate Inhal Nebulization Sol 0.63 Mg/3ml Albuterol Sulfate Inhal Nebulization Sol 1.25 Mg/3ml Albuterol Sulfate Oral Syrup Albuterol Sulfate Oral Tab 2 Mg Albuterol Sulfate Oral Tab 4 Mg Terbutaline Sulfate Inj Sol 1 Mg/ml Terbutaline Sulfate Oral Tab 2.5 Mg Terbutaline Sulfate Oral Tab 5 Mg Advair Diskus Inhal Aerosol QL Advair Hfa Inhal Aerosol QL Anoro Ellipta Inhal Aerosol QL Arcapta Neohaler Inhal Cap 75 Mcg Breo_Ellipta Inhal Aerosol QL Combivent Respimat Inhal Aerosol Dulera Inhal Aerosol QL Perforomist Inhal Nebulization Sol 20 Mcg/2ml QL Serevent Diskus Inhal Aerosol QL Striverdi Respimat Inhal Aerosol QL Symbicort Inhal Aerosol QL Ventolin Hfa Inhal Aerosol XANTINAS Theophylline Er Oral Tab ER 12Hr 100 Mg Theophylline Er Oral Tab ER 12Hr 200 Mg Theophylline Er Oral Tab ER 12Hr 300 Mg Theophylline Er Oral Tab ER 12Hr 450 Mg Theophylline Er Oral Tab ER 24Hr 400 Mg Theophylline Er Oral Tab ER 24Hr 600 Mg Theophylline Oral Sol 80 Mg/15ml AGENTES ANTIINFECTIVOS - MISC. AGENTES ANTIINFECTIVOS - MISC. Metronidazole Oral Cap 375 Mg Metronidazole Oral Tab 250 Mg Metronidazole Oral Tab 500 Mg Trimethoprim Oral Tab 100 Mg Xifaxan Tab 200mg Xifaxan Tab 550mg Cayston Inhal Sol Reconst. 75 Mg Colistimethate Sodium Inj Sol Reconst. 150 Mg AGENTES ANTIPROTOZOARIOS Alinia Sus 100/5ml Alinia Tab 500mg ANTIINFECTIVOS MISC. - COMBINACIONES Sulfamethoxazole-trimethoprim Oral Susp Mg/5ml Sulfamethoxazole-trimethoprim Oral Tab Mg Sulfamethoxazole-trimethoprim Oral Tab Mg LINCOSAMIDAS Clindamycin Hcl Oral Cap 150 Mg Clindamycin Hcl Oral Cap 300 Mg Clindamycin Hcl Oral Cap 75 Mg Clindamycin Palmitate Hcl Oral Sol Reconst. 75 Mg/5ml AGENTES ANTIMIASTENIA/COLINERGICOS AGENTES ANTIMIASTENIA/COLINERGICOS Mestinon Syp 60mg/5ml AGENTES ANTIMICOBACTERIALES AGENTES ANTIMICOBACTERIALES Rifampin IV Sol Reconst. 600 Mg Rifampin Oral Cap 300 Mg Priftin Tab 150mg AGENTES ANTIPARKINSON ANTICOLINERGICOS ANTIPARKINSON Benztropine Mesylate Inj Sol 1 Mg/ml Benztropine Mesylate Oral Tab 0.5 Mg Benztropine Mesylate Oral Tab 1 Mg Benztropine Mesylate Oral Tab 2 Mg DOPAMINERGICOS ANTIPARKINSON Amantadine Hcl Oral Cap 100 Mg Amantadine Hcl Oral Syrup Carbidopa-levodopa Er Oral Tab ER Mg Carbidopa-levodopa Er Oral Tab ER Mg Carbidopa-levodopa Oral Tab Mg Carbidopa-levodopa Oral Tab Mg Carbidopa-levodopa Oral Tab Mg Carbidopa-levodopa Oral Tab Dispersible Mg Carbidopa-levodopa Oral Tab Dispersible Mg

3 Carbidopa-levodopa Oral Tab Dispersible Mg Ropinirole Hcl Er Oral Tab ER 24Hr 12 Mg Ropinirole Hcl Er Oral Tab ER 24Hr 2 Mg Ropinirole Hcl Er Oral Tab ER 24Hr 4 Mg Ropinirole Hcl Er Oral Tab ER 24Hr 6 Mg Ropinirole Hcl Er Oral Tab ER 24Hr 8 Mg Ropinirole Hcl Oral Tab 0.25 Mg Ropinirole Hcl Oral Tab 0.5 Mg Ropinirole Hcl Oral Tab 1 Mg Ropinirole Hcl Oral Tab 2 Mg Ropinirole Hcl Oral Tab 3 Mg Ropinirole Hcl Oral Tab 4 Mg Ropinirole Hcl Oral Tab 5 Mg Apokyn Subcut. Sol 10 Mg/ml INHIBIDORES DE MONOAMINO-OXIDASA - ANTIPARKINSON Rasagiline Mesylate Oral Tab 0.5 Mg Rasagiline Mesylate Oral Tab 1 Mg AGENTES ANTIPSICOTICOS/ANTIMANIATICOS AGENTES ANTIMANIACOS Lithium Carbonate Er Oral Tab ER 300 Mg Lithium Carbonate Er Oral Tab ER 450 Mg Lithium Carbonate Oral Cap 150 Mg Lithium Carbonate Oral Cap 300 Mg Lithium Carbonate Oral Cap 600 Mg Lithium Carbonate Oral Tab 300 Mg ANTIPSICOTICOS - MISC. Latuda Oral Tab 120 Mg QL Latuda Oral Tab 20 Mg QL Latuda Oral Tab 40 Mg QL Latuda Oral Tab 60 Mg QL Latuda Oral Tab 80 Mg QL BENZOISOXAZOLES Risperidone Oral Sol 1 Mg/ml QL Risperidone Oral Tab 0.25 Mg Risperidone Oral Tab 0.5 Mg QL Risperidone Oral Tab 1 Mg QL Risperidone Oral Tab 2 Mg QL Risperidone Oral Tab 3 Mg QL Risperidone Oral Tab 4 Mg QL Risperidone Oral Tab Dispersible 0.25 Mg Risperidone Oral Tab Dispersible 0.5 Mg QL Risperidone Oral Tab Dispersible 1 Mg QL Risperidone Oral Tab Dispersible 2 Mg QL Risperidone Oral Tab Dispersible 3 Mg QL Risperidone Oral Tab Dispersible 4 Mg QL Risperdal Consta Intramuscular Susp Reconst Mg Risperdal Consta Intramuscular Susp Reconst. 25 Mg Risperdal Consta Intramuscular Susp Reconst Mg Risperdal Consta Intramuscular Susp Reconst. 50 Mg BUTIROFERONAS Haloperidol Oral Tab 0.5 Mg Haloperidol Oral Tab 1 Mg Haloperidol Oral Tab 10 Mg Haloperidol Oral Tab 2 Mg Haloperidol Oral Tab 20 Mg Haloperidol Oral Tab 5 Mg FENOTIAZINAS Chlorpromazine Hcl Oral Tab 10 Mg Chlorpromazine Hcl Oral Tab 100 Mg Chlorpromazine Hcl Oral Tab 200 Mg Chlorpromazine Hcl Oral Tab 25 Mg Chlorpromazine Hcl Oral Tab 50 Mg Fluphenazine Hcl Oral Tab 1 Mg Fluphenazine Hcl Oral Tab 10 Mg Fluphenazine Hcl Oral Tab 2.5 Mg Fluphenazine Hcl Oral Tab 5 Mg Perphenazine Oral Tab 16 Mg Perphenazine Oral Tab 2 Mg Perphenazine Oral Tab 4 Mg Perphenazine Oral Tab 8 Mg Prochlorperazine Maleate Oral Tab 10 Mg Prochlorperazine Maleate Oral Tab 5 Mg Thioridazine Hcl Oral Tab 10 Mg Thioridazine Hcl Oral Tab 100 Mg Thioridazine Hcl Oral Tab 25 Mg Thioridazine Hcl Oral Tab 50 Mg Trifluoperazine Hcl Oral Tab 1 Mg Trifluoperazine Hcl Oral Tab 10 Mg Trifluoperazine Hcl Oral Tab 2 Mg Trifluoperazine Hcl Oral Tab 5 Mg AGENTES CARDIOVASCULARES - MISC. HIPERTENSION PULMONAR - ESTIMULADOR DE CICLASA SOL GUANYLATE Adempas Oral Tab 0.5 Mg PA Adempas Oral Tab 1 Mg PA Adempas Oral Tab 1.5 Mg PA Adempas Oral Tab 2 Mg PA Adempas Oral Tab 2.5 Mg PA HIPERTENSION PULMONAR - INHIBIDORES DE LA FOSFODIESTERASA Adcirca Oral Tab 20 Mg PA Sildenafil Citrate Oral Tab 20 Mg PA

4 AGENTES CONTRA LA ANSIEDAD AGENTES CONTRA LA ANSIEDAD - MISC. Buspirone Hcl Oral Tab 10 Mg Buspirone Hcl Oral Tab 15 Mg Buspirone Hcl Oral Tab 30 Mg Buspirone Hcl Oral Tab 5 Mg Buspirone Hcl Oral Tab 7.5 Mg Hydroxyzine Hcl Intramuscular Sol 50 Mg/ml Hydroxyzine Hcl Oral Syrup Hydroxyzine Hcl Oral Tab 10 Mg Hydroxyzine Hcl Oral Tab 25 Mg Hydroxyzine Hcl Oral Tab 50 Mg Hydroxyzine Pamoate Oral Cap 25 Mg Hydroxyzine Pamoate Oral Cap 50 Mg BENZODIAZEPINAS Alprazolam Oral Tab 0.25 Mg Alprazolam Oral Tab 0.5 Mg Alprazolam Oral Tab 1 Mg Alprazolam Oral Tab Dispersible 0.25 Mg Alprazolam Oral Tab Dispersible 0.5 Mg Alprazolam Oral Tab Dispersible 1 Mg Alprazolam Oral Tab Dispersible 2 Mg Clorazepate Dipotassium Oral Tab 15 Mg Clorazepate Dipotassium Oral Tab 3.75 Mg Clorazepate Dipotassium Oral Tab 7.5 Mg Diazepam Oral Tab 10 Mg Diazepam Oral Tab 2 Mg Diazepam Oral Tab 5 Mg Lorazepam Inj Sol 2 Mg/ml Lorazepam Inj Sol 4 Mg/ml Lorazepam Oral Concentrate 2 Mg/ml Lorazepam Oral Tab 0.5 Mg Lorazepam Oral Tab 1 Mg Lorazepam Oral Tab 2 Mg Oxazepam Oral Cap 10 Mg Oxazepam Oral Cap 15 Mg Oxazepam Oral Cap 30 Mg AGENTES ENDOCRINOS Y METABOLICOS - MISC. AGENTES SOMATOSTATICOS Octreotide Acetate Inj Sol 100 Mcg/ml PA Octreotide Acetate Inj Sol 1000 Mcg/ml PA Octreotide Acetate Inj Sol 200 Mcg/ml PA Octreotide Acetate Inj Sol 50 Mcg/ml PA Octreotide Acetate Inj Sol 500 Mcg/ml PA Somatuline Depot Subcut. Sol 120 Mg/0.5ml Somatuline Depot Subcut. Sol 60 Mg/0.2ml Somatuline Depot Subcut. Sol 90 Mg/0.3ml HORMONAS DE LA PITUITARIA POSTERIOR Desmopressin Acetate Spray Nasal Sol 0.01 % INHIBIDORES DE PROLACTINA Cabergoline Oral Tab 0.5 Mg MODIFICADORES METABOLICOS Calcitriol IV Sol 1 Mcg/ml Calcitriol Oral Cap 0.25 Mcg Calcitriol Oral Cap 0.5 Mcg Calcitriol Oral Sol 1 Mcg/ml Sensipar Tab 30mg Sensipar Tab 60mg Sensipar Tab 90mg Buphenyl Oral Tab 500 Mg REGULADORES DE LA DENSIDAD OSEA Alendronate Sodium Oral Tab 10 Mg Alendronate Sodium Oral Tab 35 Mg Alendronate Sodium Oral Tab 5 Mg Alendronate Sodium Oral Tab 70 Mg Miacalcin Inj 200/ml Forteo Subcut. Sol 600 Mcg/2.4ml PA AGENTES GASTROINTESTINALES - MISC. ACIDIFICADORES INTESTINALES Lactulose Encephalopathy Oral Sol 10 Gm/15ml ACTIVADORES DEL CANAL DE CLORO GASTROINTESTINAL Amitiza Cap 24mcg Amitiza Cap 8mcg AGENTES PARA EL SINDROME DE INTESTINO INFLAMADO Sulfasalazine Oral Tab 500 Mg Sulfasalazine Oral Tab Delayed Rel 500 Mg Asacol Hd Tab 800mg Delzicol Cap 400mg Pentasa Cap 250mg Cr Pentasa Cap 500mg Cr AGENTES PARA EL SINDROME DE INTESTINO IRRITABLE Linzess Cap 145mcg Linzess Cap 290mcg ESTIMULANTES GASTROINTESTINALES Metoclopramide Hcl Inj Sol 5 Mg/ml

5 Metoclopramide Hcl Oral Sol 10 Mg/10ml Metoclopramide Hcl Oral Sol 5 Mg/5ml Metoclopramide Hcl Oral Tab 10 Mg Metoclopramide Hcl Oral Tab 5 Mg Metoclopramide Hcl Oral Tab Dispersible 5 Mg IANTAGONISTAS DE RECEPTORES OPIODES PERIFERALES Relistor Inj 12/0.6ml Relistor Inj 8/0.4ml AGENTES GENITOURINARIOS - MISC. AGENTES PARA LA HIPERTROFIA PROSTATICA Alfuzosin Hcl Er Oral Tab ER 24Hr 10 Mg Dutasteride Oral Cap 0.5 Mg Finasteride Oral Tab 5 Mg Tamsulosin Hcl Oral Cap 0.4 Mg PA QL Cialis Oral Tab 2.5 Mg PA QL Cialis Oral Tab 5 Mg Rapaflo Oral Cap 4 Mg Rapaflo Oral Cap 8 Mg AGENTES PARA LA CISTITIS INTERSTICIAL Elmiron Cap 100mg ALKALINIZADORES Citric Acid-sodium Citrate Oral Sol Mg/5ml ANALGESICOS URINARIOS Phenazopyridine Hcl Oral Tab 100 Mg Phenazopyridine Hcl Oral Tab 200 Mg AGENTES HEMATOLOGICOS - MISC. AGENTES HEMATOREOLÓGICOS Pentoxifylline Er Oral Tab ER 400 Mg INHIBIDORES DE AGREGACION DE PLAQUETAS Cilostazol Oral Tab 100 Mg Cilostazol Oral Tab 50 Mg Clopidogrel Bisulfate Oral Tab 300 Mg Clopidogrel Bisulfate Oral Tab 75 Mg Dipyridamole Oral Tab 25 Mg Dipyridamole Oral Tab 50 Mg Dipyridamole Oral Tab 75 Mg Brilinta Oral Tab 60 Mg Brilinta Oral Tab 90 Mg AGENTES HEMATOPOYETICOS ACIDO FOLICO / FOLATOS Folic Acid Oral Tab 1 Mg AGENTES PARA LA ANEMIA FALCIFORME Droxia Cap 200mg Droxia Cap 300mg Droxia Cap 400mg AGENTES PARA LA ENFERMEDAD DE GAUCHER Cerdelga Oral Cap 84 Mg FACTORES HEMATOPOYETICOS DE CRECIMIENTO Procrit Inj Sol Unit/ml PA Procrit Inj Sol 2000 Unit/ml PA Procrit Inj Sol Unit/ml PA Procrit Inj Sol 3000 Unit/ml PA Procrit Inj Sol 4000 Unit/ml PA Procrit Inj Sol Unit/ml PA Zarxio Inj Sol Prefilled Syringe PA AGENTES NASALES - SISTEMICOS Y TOPICOS ANTIALERGICOS NASALES Azelastine Hcl Nasal Sol 0.1 % Azelastine Hcl Nasal Sol 0.15 % ANTICOLINERGICOS NASALES Ipratropium Bromide Nasal Sol 0.03 % Ipratropium Bromide Nasal Sol 0.06 % ESTEROIDES NASALES Fluticasone Propionate Nasal Susp 50 Mcg/act QL AGENTES OFTALMICOS AGENTES ADRENERGICOS OFTALMICOS Brimonidine Tartrate Ophthalmic Sol 0.15 % Brimonidine Tartrate Ophthalmic Sol 0.2 % ANESTESIA LOCAL OFTALMICA Tetracaine Hcl Ophthalmic Sol 0.5 % ANTIINFECTIVOS OFTALMICOS Bacitracin-polymyxin B Ophthalmic Ointment Ciprofloxacin Hcl Ophthalmic Sol 0.3 % Erythromycin Ophthalmic Ointment Gentamicin Sulfate Ophthalmic Sol 0.3 % Ofloxacin Ophthalmic Sol 0.3 % Polymyxin B-trimethoprim Ophthalmic Sol Unit/ml-% Tobramycin Ophthalmic Sol 0.3 % Trifluridine Ophthalmic Sol 1 % Besivance Ophthalmic Susp 0.6 % Moxeza Ophthalmic Sol 0.5 % BLOQUEADORES BETA - OFTALMICOS

6 Dorzolamide Hcl-timolol Mal Ophthalmic Sol Mg/ml Levobunolol Hcl Ophthalmic Sol 0.5 % Timolol Maleate Ophthalmic Gel Timolol Maleate Ophthalmic Sol 0.25 % Timolol Maleate Ophthalmic Sol 0.5 % Combigan Ophthalmic Sol % ESTEROIDES OFTALMICOS Dexamethasone Sodium Phosphate Ophthalmic Sol 0.1 % Tobramycin-dexamethasone Ophthalmic Susp % Zylet Ophthalmic Susp % INMUNOMODULADORES OFTALMICOS Restasis Multidose Ophthalmic Emulsion Restasis Ophthalmic Emulsion MIDRIÁTICOS CICLOPLÉJICOS Atropine Sulfate Ophthalmic Sol 1 % OFTALMICOS - MISC. Cromolyn Sodium Ophthalmic Sol 4 % Diclofenac Sodium Ophthalmic Sol 0.1 % Dorzolamide Hcl Ophthalmic Sol 2 % Ketotifen Fumarate Ophthalmic Sol % Bepreve Ophthalmic Sol 1.5 % Prolensa Ophthalmic Sol 0.07 % Cystaran Ophthalmic Sol 0.44 % PROSTAGLANDINAS OFTALMICAS Latanoprost Ophthalmic Sol % AGENTES OTICOS AGENTES OTICOS - MISC. Acetic Acid Otic Sol 2 % ANTIINFECTIVOS OTICOS Ofloxacin Otic Sol 0.3 % ESTEROIDES OTICOS Hydrocortisone-acetic Acid Otic Sol 1-2 % AGENTES PARA LA BOCA/GARGANTA/DENTALES ANESTESICOS ORALES TOPICOS Lidocaine Viscous Mouth/throat Sol 2 % ANTIINFECTIVOS GARGANTA Clotrimazole Mouth/throat Lozenge Clotrimazole Mouth/throat Troche 10 Mg Nystatin Mouth/throat Susp Unit/ml ANTISEPTICOS - BOCA Y GARGANTA Chlorhexidine Gluconate Mouth/throat Sol 0.12 % AGENTES PARA LA TIROIDES AGENTES ANTITIROIDEO Methimazole Oral Tab 10 Mg Methimazole Oral Tab 5 Mg HORMONAS PARA LA TIROIDES Levothyroxine Sodium Oral Tab 100 Mcg Levothyroxine Sodium Oral Tab 112 Mcg Levothyroxine Sodium Oral Tab 125 Mcg Levothyroxine Sodium Oral Tab 137 Mcg Levothyroxine Sodium Oral Tab 150 Mcg Levothyroxine Sodium Oral Tab 175 Mcg Levothyroxine Sodium Oral Tab 200 Mcg Levothyroxine Sodium Oral Tab 25 Mcg Levothyroxine Sodium Oral Tab 300 Mcg Levothyroxine Sodium Oral Tab 50 Mcg Levothyroxine Sodium Oral Tab 75 Mcg Levothyroxine Sodium Oral Tab 88 Mcg Liothyronine Sodium IV Sol 10 Mcg/ml PA Liothyronine Sodium Oral Tab 25 Mcg PA Liothyronine Sodium Oral Tab 5 Mcg PA Liothyronine Sodium Oral Tab 50 Mcg PA Synthroid Oral Tab 100 Mcg Synthroid Oral Tab 112 Mcg Synthroid Oral Tab 125 Mcg Synthroid Oral Tab 137 Mcg Synthroid Oral Tab 150 Mcg Synthroid Oral Tab 175 Mcg Synthroid Oral Tab 200 Mcg Synthroid Oral Tab 25 Mcg Synthroid Oral Tab 300 Mcg Synthroid Oral Tab 50 Mcg Synthroid Oral Tab 75 Mcg Synthroid Oral Tab 88 Mcg AGENTES PARA TERAPIA MUSCULOESQUELETAL RELAJANTES DEL SISTEMA MUSCULAR Baclofen Oral Tab 10 Mg Baclofen Oral Tab 20 Mg Carisoprodol Oral Tab 350 Mg Chlorzoxazone Oral Tab 500 Mg Cyclobenzaprine Hcl Oral Tab 10 Mg Cyclobenzaprine Hcl Oral Tab 5 Mg

7 Cyclobenzaprine Hcl Oral Tab 7.5 Mg Methocarbamol Inj Sol 1000 Mg/10ml Methocarbamol Oral Tab 500 Mg Methocarbamol Oral Tab 750 Mg Orphenadrine Citrate Er Oral Tab ER 12Hr 100 Mg Orphenadrine Citrate Inj Sol 30 Mg/ml Tizanidine Hcl Oral Cap 2 Mg Tizanidine Hcl Oral Cap 4 Mg Tizanidine Hcl Oral Cap 6 Mg Tizanidine Hcl Oral Tab 2 Mg Tizanidine Hcl Oral Tab 4 Mg AGENTES PSICOTERAPEUTICOS Y NEUROLOGICOS - MISC. AGENTES CONTRA LA DEMENCIA Galantamine Hydrobromide Er Oral Cap ER 24Hr 16 Mg Galantamine Hydrobromide Er Oral Cap ER 24Hr 24 Mg Galantamine Hydrobromide Er Oral Cap ER 24Hr 8 Mg Galantamine Hydrobromide Oral Tab 12 Mg Galantamine Hydrobromide Oral Tab 4 Mg Galantamine Hydrobromide Oral Tab 8 Mg Namenda Xr Titration Pack Oral Cap ER 24Hr 7 & 14 & 21 &28 M AGENTES PARA FIBROMIALGIA Savella Tab 100mg Savella Tab 12.5mg Savella Tab 25mg Savella Tab 50mg AGENTES PARA LA ESCLEROSIS MULTIPLE Ampyra Oral Tab ER 12Hr 10 Mg PA Avonex Intramuscular Kit PA Avonex Pen Intramuscular Auto-injector Kit PA Avonex Prefilled Intramuscular Prefilled Syringe PA Betaseron Subcut. Kit PA Glatiramer Acetate Subcut. Sol Prefilled Syringe PA Glatopa Subcut. Sol Prefilled Syringe PA AGENTES PSICOTERAPEUTICOS Y NEUROLOGICOS - MISC. Pimozide Oral Tab 1 Mg Pimozide Oral Tab 2 Mg AGENTES PARA LA NEURALGIA POST-HERPÉTICA (PHN) Gralise Star Mis 300/600 Gralise Tab 300mg Gralise Tab 600mg TERAPIA PARA DESÓRDENES DEL MOVIMIENTO Tetrabenazine Oral Tab 12.5 Mg Tetrabenazine Oral Tab 25 Mg AGENTES RESPIRATORIOS - MISC. AGENTES PARA LA FIBROSIS PULMONAR Ofev_Oral Cap 100 Mg Ofev_Oral Cap 150 Mg AGENTES PARA LA GOTA AGENTES PARA LA GOTA Allopurinol Oral Tab 100 Mg Allopurinol Oral Tab 300 Mg Uloric Tab 40mg Uloric Tab 80mg AMINOGLICOSIDOS AMINOGLICOSIDOS Bethkis Inhal Nebulization Sol 300 Mg/4ml Kitabis Pak Inhal Nebulization Sol 300 Mg/5ml Tobramycin Inhal Nebulization Sol 300 Mg/5ml ANALGESICOS - ANTIINFLAMATORIOS AGENTES ANTIINFLAMATORIOS NO ESTEROIDALES Celecoxib Oral Cap 100 Mg QL Celecoxib Oral Cap 200 Mg QL Celecoxib Oral Cap 400 Mg QL Celecoxib Oral Cap 50 Mg QL Diclofenac Potassium Oral Tab 50 Mg Diclofenac Sodium Er Oral Tab ER 24Hr 100 Mg Diclofenac Sodium Oral Tab Delayed Rel 25 Mg Diclofenac Sodium Oral Tab Delayed Rel 50 Mg Diclofenac Sodium Oral Tab Delayed Rel 75 Mg Etodolac Er Oral Tab ER 24Hr 400 Mg Etodolac Er Oral Tab ER 24Hr 500 Mg Etodolac Er Oral Tab ER 24Hr 600 Mg Etodolac Oral Cap 200 Mg Etodolac Oral Cap 300 Mg Etodolac Oral Tab 400 Mg Etodolac Oral Tab 500 Mg Flurbiprofen Oral Tab 100 Mg Flurbiprofen Oral Tab 50 Mg Ibuprofen Oral Susp 100 Mg/5ml Ibuprofen Oral Tab 400 Mg Ibuprofen Oral Tab 600 Mg Ibuprofen Oral Tab 800 Mg Indomethacin Er Oral Cap ER 75 Mg Indomethacin Oral Cap 25 Mg Indomethacin Oral Cap 50 Mg Meloxicam Oral Tab 15 Mg Meloxicam Oral Tab 7.5 Mg Nabumetone Oral Tab 500 Mg Nabumetone Oral Tab 750 Mg Naproxen Oral Susp 125 Mg/5ml

8 Naproxen Oral Tab 250 Mg Naproxen Oral Tab 375 Mg Naproxen Oral Tab 500 Mg Naproxen Sodium Er Oral Tab ER 24Hr 375 Mg Naproxen Sodium Er Oral Tab ER 24Hr 500 Mg Naproxen Sodium Oral Tab 275 Mg Naproxen Sodium Oral Tab 550 Mg Oxaprozin Oral Tab 600 Mg Piroxicam Oral Cap 10 Mg Piroxicam Oral Cap 20 Mg Sulindac Oral Tab 150 Mg Sulindac Oral Tab 200 Mg Zorvolex Oral Cap 18 Mg Zorvolex Oral Cap 35 Mg ANTIMETABOLITOS ANTIREUMATICOS Otrexup Subcut. Sol Auto-injector 10 Mg/0.4ml Otrexup Subcut. Sol Auto-injector 12.5 Mg/0.4ml Otrexup Subcut. Sol Auto-injector 15 Mg/0.4ml Otrexup Subcut. Sol Auto-injector 17.5 Mg/0.4ml Otrexup Subcut. Sol Auto-injector 20 Mg/0.4ml Otrexup Subcut. Sol Auto-injector 22.5 Mg/0.4ml Otrexup Subcut. Sol Auto-injector 25 Mg/0.4ml Rasuvo Subcut. Sol Auto-injector 10 Mg/0.2ml Rasuvo Subcut. Sol Auto-injector 12.5 Mg/0.25ml Rasuvo Subcut. Sol Auto-injector 15 Mg/0.3ml Rasuvo Subcut. Sol Auto-injector 17.5 Mg/0.35ml Rasuvo Subcut. Sol Auto-injector 20 Mg/0.4ml Rasuvo Subcut. Sol Auto-injector 22.5 Mg/0.45ml Rasuvo Subcut. Sol Auto-injector 25 Mg/0.5ml Rasuvo Subcut. Sol Auto-injector 30 Mg/0.6ml Rasuvo Subcut. Sol Auto-injector 7.5 Mg/0.15ml ANTIREUMATICOS - INHIBIDORES DE ENZIMAS Xeljanz Oral Tab 5 Mg PA Xeljanz Xr Oral Tab ER 24Hr 11 Mg PA COMPUESTOS DE ORO Ridaura Cap 3mg INHIBIDORES DE RECEPTORS INTERLEUKINA 6 Actemra Subcut. Sol Prefilled Syringe PA ANALGESICOS - NO NARCOTICOS SALICILATOS Diflunisal Oral Tab 500 Mg Salsalate Oral Tab 500 Mg Salsalate Oral Tab 750 Mg ANALGESICOS - OPIOIDES AGONISTAS OPIOIDES Fentanyl Citrate (pf) Inj Sol 100 Mcg/2ml Fentanyl Citrate (pf) Inj Sol 1000 Mcg/20ml Fentanyl Citrate (pf) Inj Sol 250 Mcg/5ml Fentanyl Citrate (pf) Inj Sol 2500 Mcg/50ml Fentanyl Citrate (pf) Inj Sol 500 Mcg/10ml Fentanyl Citrate (pf) Inj Sol Cartridge Fentanyl Citrate Buccal Lozenge QL Meperidine Hcl Inj Sol 100 Mg/ml Meperidine Hcl Inj Sol 25 Mg/ml Meperidine Hcl Inj Sol 50 Mg/ml Meperidine Hcl Oral Tab 100 Mg Meperidine Hcl Oral Tab 50 Mg Morphine Sulfate (concentrate) Oral Sol 100 Mg/5ml Morphine Sulfate (concentrate) Oral Sol 20 Mg/ml Morphine Sulfate (pf) Inj Sol 0.5 Mg/ml Morphine Sulfate (pf) Inj Sol 1 Mg/ml Morphine Sulfate Er Oral Cap ER 24Hr 10 Mg QL Morphine Sulfate Er Oral Cap ER 24Hr 100 Mg QL Morphine Sulfate Er Oral Cap ER 24Hr 20 Mg QL Morphine Sulfate Er Oral Cap ER 24Hr 30 Mg QL Morphine Sulfate Er Oral Cap ER 24Hr 50 Mg QL Morphine Sulfate Er Oral Cap ER 24Hr 60 Mg QL Morphine Sulfate Er Oral Cap ER 24Hr 80 Mg QL Morphine Sulfate Er Oral Tab ER 100 Mg QL Morphine Sulfate Er Oral Tab ER 15 Mg QL Morphine Sulfate Er Oral Tab ER 200 Mg QL Morphine Sulfate Er Oral Tab ER 30 Mg QL Morphine Sulfate Er Oral Tab ER 60 Mg QL Morphine Sulfate IV Sol 1 Mg/ml Morphine Sulfate Inj Sol 10 Mg/ml Morphine Sulfate Inj Sol 8 Mg/ml Morphine Sulfate Oral Sol 10 Mg/5ml Morphine Sulfate Oral Sol 20 Mg/5ml Tramadol Hcl Er (biphasic) Oral Tab ER 24Hr 100 Mg Tramadol Hcl Er (biphasic) Oral Tab ER 24Hr 200 Mg Tramadol Hcl Er (biphasic) Oral Tab ER 24Hr 300 Mg Tramadol Hcl Er Oral Tab ER 24Hr 100 Mg Tramadol Hcl Er Oral Tab ER 24Hr 200 Mg Tramadol Hcl Er Oral Tab ER 24Hr 300 Mg Tramadol Hcl Oral Tab 50 Mg Lazanda Nasal Sol 100 Mcg/act Lazanda Nasal Sol 300 Mcg/act Lazanda Nasal Sol 400 Mcg/act Oxycontin Oral Tab Er 12Hr Abuse-deterrent 10 Mg QL Oxycontin Oral Tab Er 12Hr Abuse-deterrent 15 Mg QL Oxycontin Oral Tab Er 12Hr Abuse-deterrent 20 Mg QL Oxycontin Oral Tab Er 12Hr Abuse-deterrent 30 Mg QL Oxycontin Oral Tab Er 12Hr Abuse-deterrent 40 Mg QL Oxycontin Oral Tab Er 12Hr Abuse-deterrent 60 Mg QL

9 Oxycontin Oral Tab Er 12Hr Abuse-deterrent 80 Mg QL AGONISTAS PARCIALES DE OPIOIDES Nalbuphine Hcl Inj Sol 10 Mg/ml Nalbuphine Hcl Inj Sol 20 Mg/ml COMBINACIONES DE OPIOIDES Acetaminophen-codeine #2 Oral Tab Mg Acetaminophen-codeine #4 Oral Tab Mg Acetaminophen-codeine Oral Sol Mg/5ml Acetaminophen-codeine Oral Tab Mg Acetaminophen-codeine Oral Tab Mg Acetaminophen-codeine Oral Tab Mg Hydrocodone-acetaminophen Oral Sol Mg/5ml Hydrocodone-acetaminophen Oral Sol Mg/10ml Hydrocodone-acetaminophen Oral Sol Mg/15ml Hydrocodone-acetaminophen Oral Tab Mg Hydrocodone-acetaminophen Oral Tab Mg Hydrocodone-acetaminophen Oral Tab Mg Hydrocodone-acetaminophen Oral Tab Mg Hydrocodone-acetaminophen Oral Tab Mg Hydrocodone-acetaminophen Oral Tab Mg Hydrocodone-acetaminophen Oral Tab Mg Hydrocodone-ibuprofen Oral Tab Mg Hydrocodone-ibuprofen Oral Tab Mg Hydrocodone-ibuprofen Oral Tab Mg Oxycodone-acetaminophen Oral Sol Mg/5ml Oxycodone-acetaminophen Oral Tab Mg Oxycodone-acetaminophen Oral Tab Mg Oxycodone-acetaminophen Oral Tab Mg Oxycodone-acetaminophen Oral Tab Mg Tramadol-acetaminophen Oral Tab Mg ANESTESIA LOCAL - PARENTERAL ANESTESIA LOCAL - AMIDAS Lidocaine Hcl (pf) Inj Sol 0.5 % Lidocaine Hcl (pf) Inj Sol 1 % Lidocaine Hcl (pf) Inj Sol 2 % Lidocaine Hcl (pf) Inj Sol 4 % Lidocaine Hcl Inj Sol 0.5 % Lidocaine Hcl Inj Sol 1 % Lidocaine Hcl Inj Sol 2 % ANTIARRITMICOS ANTIARRITMICOS TIPO I-C Flecainide Acetate Oral Tab 100 Mg Flecainide Acetate Oral Tab 150 Mg Flecainide Acetate Oral Tab 50 Mg ANTICOAGULANTES ANTICOAGULANTES DE CUMARINA Warfarin Sodium Oral Tab 1 Mg Warfarin Sodium Oral Tab 10 Mg Warfarin Sodium Oral Tab 2 Mg Warfarin Sodium Oral Tab 2.5 Mg Warfarin Sodium Oral Tab 3 Mg Warfarin Sodium Oral Tab 4 Mg Warfarin Sodium Oral Tab 5 Mg Warfarin Sodium Oral Tab 6 Mg Warfarin Sodium Oral Tab 7.5 Mg HEPARINAS Y AGENTES SIMILARES A HEPARINOIDES Enoxaparin Sodium Inj Sol 300 Mg/3ml PA Enoxaparin Sodium Subcut. Sol 100 Mg/ml PA Enoxaparin Sodium Subcut. Sol 120 Mg/0.8ml PA Enoxaparin Sodium Subcut. Sol 150 Mg/ml PA Enoxaparin Sodium Subcut. Sol 30 Mg/0.3ml PA Enoxaparin Sodium Subcut. Sol 40 Mg/0.4ml PA Enoxaparin Sodium Subcut. Sol 60 Mg/0.6ml PA Enoxaparin Sodium Subcut. Sol 80 Mg/0.8ml PA Fondaparinux Sodium Subcut. Sol 10 Mg/0.8ml Fondaparinux Sodium Subcut. Sol 2.5 Mg/0.5ml Fondaparinux Sodium Subcut. Sol 5 Mg/0.4ml Fondaparinux Sodium Subcut. Sol 7.5 Mg/0.6ml Fragmin Subcut. Sol 7500 Unit/0.3ml Fragmin Subcut. Sol Unit/3.8ml INHIBIDORES DE FACTOR DIRECTO XA Eliquis Oral Tab 2.5 Mg QL Eliquis Oral Tab 5 Mg QL Xarelto Oral Tab 10 Mg QL Xarelto Oral Tab 15 Mg Xarelto Oral Tab 20 Mg QL Xarelto Starter Pack Oral Tab Therapy QL INHIBIDORES DE TROMBINA Pradaxa Oral Cap 110 Mg QL Pradaxa Oral Cap 150 Mg QL Pradaxa Oral Cap 75 Mg QL ANTICONVULSIVOS ACIDO VALPROICO Divalproex Sodium Er Oral Tab ER 24Hr 250 Mg Divalproex Sodium Er Oral Tab ER 24Hr 500 Mg Divalproex Sodium Oral Cap Delayed Rel Sprinkle 125 Mg Divalproex Sodium Oral Tab Delayed Rel 125 Mg Divalproex Sodium Oral Tab Delayed Rel 250 Mg Divalproex Sodium Oral Tab Delayed Rel 500 Mg Valproate Sodium IV Sol 100 Mg/ml Valproate Sodium IV Sol 500 Mg/5ml Valproic Acid Oral Cap 250 Mg Valproic Acid Oral Sol 250 Mg/5ml

10 ANTAGONISTAS DEL RECEPTOR AMPA GLUTAMATO Fycompa Oral Susp 0.5 Mg/ml Fycompa Oral Tab 10 Mg Fycompa Oral Tab 12 Mg Fycompa Oral Tab 2 Mg Fycompa Oral Tab 4 Mg Fycompa Oral Tab 6 Mg Fycompa Oral Tab 8 Mg ANTICONVULSIVOS - BENZODIACEPINAS Clonazepam Oral Tab 0.5 Mg Clonazepam Oral Tab 1 Mg Clonazepam Oral Tab 2 Mg Clonazepam Oral Tab Dispersible Mg Clonazepam Oral Tab Dispersible 0.25 Mg Clonazepam Oral Tab Dispersible 0.5 Mg Clonazepam Oral Tab Dispersible 1 Mg Clonazepam Oral Tab Dispersible 2 Mg Onfi_Oral Susp 2.5 Mg/ml Onfi_Oral Tab 10 Mg Onfi_Oral Tab 20 Mg ANTICONVULSIVOS - MISC. Gabapentin Oral Cap 100 Mg Gabapentin Oral Cap 300 Mg Gabapentin Oral Cap 400 Mg Gabapentin Oral Sol 250 Mg/5ml Gabapentin Oral Tab 600 Mg Gabapentin Oral Tab 800 Mg Primidone Oral Tab 250 Mg Primidone Oral Tab 50 Mg Topiramate Oral Cap Sprinkle 15 Mg Topiramate Oral Cap Sprinkle 25 Mg Topiramate Oral Tab 100 Mg Topiramate Oral Tab 200 Mg Topiramate Oral Tab 25 Mg Topiramate Oral Tab 50 Mg Zonisamide Oral Cap 100 Mg Zonisamide Oral Cap 25 Mg Zonisamide Oral Cap 50 Mg Banzel Oral Susp 40 Mg/ml Banzel Oral Tab 200 Mg Banzel Oral Tab 400 Mg Lyrica Oral Cap 100 Mg Lyrica Oral Cap 150 Mg Lyrica Oral Cap 200 Mg Lyrica Oral Cap 225 Mg Lyrica Oral Cap 25 Mg Lyrica Oral Cap 300 Mg Lyrica Oral Cap 50 Mg Lyrica Oral Cap 75 Mg Lyrica Oral Sol 20 Mg/ml Vimpat Oral Sol 10 Mg/ml Vimpat Oral Tab 100 Mg Vimpat Oral Tab 150 Mg Vimpat Oral Tab 200 Mg Vimpat Oral Tab 50 Mg HIDANTOINAS Phenytoin Oral Susp 125 Mg/5ml Phenytoin Oral Tab Chewable 50 Mg Phenytoin Sodium Ext Oral Cap 100 Mg Dilantin Oral Cap 100 Mg Dilantin Oral Cap 30 Mg Dilantin Oral Susp 125 Mg/5ml Peganone Oral Tab 250 Mg SUCCINIMIDAS Celontin Oral Cap 300 Mg ANTIDEPRESIVOS AGENTES TRICICLICOS Amitriptyline Hcl Oral Tab 10 Mg Amitriptyline Hcl Oral Tab 100 Mg Amitriptyline Hcl Oral Tab 150 Mg Amitriptyline Hcl Oral Tab 25 Mg Amitriptyline Hcl Oral Tab 50 Mg Amitriptyline Hcl Oral Tab 75 Mg Doxepin Hcl Oral Cap 10 Mg Doxepin Hcl Oral Cap 100 Mg Doxepin Hcl Oral Cap 150 Mg Doxepin Hcl Oral Cap 25 Mg Doxepin Hcl Oral Cap 50 Mg Doxepin Hcl Oral Concentrate 10 Mg/ml Imipramine Hcl Oral Tab 10 Mg Imipramine Hcl Oral Tab 25 Mg Imipramine Hcl Oral Tab 50 Mg Nortriptyline Hcl Oral Cap 10 Mg Nortriptyline Hcl Oral Cap 25 Mg Nortriptyline Hcl Oral Cap 50 Mg Nortriptyline Hcl Oral Cap 75 Mg ANTAGONISTAS DE RECEPTORES ALFA-2 (TETRACICLICOS) Mirtazapine Oral Tab 15 Mg Mirtazapine Oral Tab 30 Mg Mirtazapine Oral Tab 45 Mg Mirtazapine Oral Tab 7.5 Mg Mirtazapine Oral Tab Dispersible 15 Mg

11 Mirtazapine Oral Tab Dispersible 30 Mg Mirtazapine Oral Tab Dispersible 45 Mg ANTIDEPRESIVOS - MISC. Bupropion Hcl Er (sr) Oral Tab ER 12Hr 100 Mg QL Bupropion Hcl Er (sr) Oral Tab ER 12Hr 150 Mg QL Bupropion Hcl Er (sr) Oral Tab ER 12Hr 200 Mg QL Bupropion Hcl Er (xl) Oral Tab ER 24Hr 150 Mg QL Bupropion Hcl Er (xl) Oral Tab ER 24Hr 300 Mg QL Bupropion Hcl Oral Tab 100 Mg Bupropion Hcl Oral Tab 75 Mg INHIBIDORES DE MONOAMINA OXIDASA (IMAO) Emsam Transdermal Patch INHIBIDORES SELECTIVOS DE LA RECAPTACION DE SEROTONINA Y NOREPINEFRINA (SNRIS) Duloxetine Hcl Oral Cap Delayed Rel Particles 20 Mg QL Duloxetine Hcl Oral Cap Delayed Rel Particles 30 Mg QL Duloxetine Hcl Oral Cap Delayed Rel Particles 60 Mg QL Venlafaxine Hcl Er Oral Cap ER 24Hr 150 Mg QL Venlafaxine Hcl Er Oral Cap ER 24Hr 37.5 Mg QL Venlafaxine Hcl Er Oral Cap ER 24Hr 75 Mg QL Venlafaxine Hcl Oral Tab 100 Mg QL Venlafaxine Hcl Oral Tab 25 Mg QL Venlafaxine Hcl Oral Tab 37.5 Mg QL Venlafaxine Hcl Oral Tab 50 Mg QL Venlafaxine Hcl Oral Tab 75 Mg QL INHIBIDORES SELECTIVOS DE LA RECAPTACIÓN DE SEROTONINA (SSRIS ) Citalopram Hydrobromide Oral Sol 10 Mg/5ml QL Citalopram Hydrobromide Oral Tab 10 Mg QL Citalopram Hydrobromide Oral Tab 20 Mg QL Citalopram Hydrobromide Oral Tab 40 Mg QL Escitalopram Oxalate Oral Sol 5 Mg/5ml QL Escitalopram Oxalate Oral Tab 10 Mg QL Escitalopram Oxalate Oral Tab 20 Mg QL Escitalopram Oxalate Oral Tab 5 Mg QL Fluoxetine Hcl Oral Cap 10 Mg QL Fluoxetine Hcl Oral Cap 20 Mg QL Fluoxetine Hcl Oral Cap 40 Mg QL Fluoxetine Hcl Oral Cap Delayed Rel 90 Mg QL Fluoxetine Hcl Oral Sol 20 Mg/5ml QL Fluoxetine Hcl Oral Tab 10 Mg QL Fluoxetine Hcl Oral Tab 20 Mg QL Fluvoxamine Maleate Er Oral Cap ER 24Hr 100 Mg QL Fluvoxamine Maleate Er Oral Cap ER 24Hr 150 Mg QL Fluvoxamine Maleate Oral Tab 100 Mg QL Fluvoxamine Maleate Oral Tab 25 Mg QL Fluvoxamine Maleate Oral Tab 50 Mg QL Paroxetine Hcl Er Oral Tab ER 24Hr 12.5 Mg QL Paroxetine Hcl Er Oral Tab ER 24Hr 25 Mg QL Paroxetine Hcl Er Oral Tab ER 24Hr 37.5 Mg QL Paroxetine Hcl Oral Tab 10 Mg QL Paroxetine Hcl Oral Tab 20 Mg QL Paroxetine Hcl Oral Tab 30 Mg QL Paroxetine Hcl Oral Tab 40 Mg QL Sertraline Hcl Oral Concentrate 20 Mg/ml Sertraline Hcl Oral Tab 100 Mg QL Sertraline Hcl Oral Tab 25 Mg QL Sertraline Hcl Oral Tab 50 Mg QL MODULADORES DE SEROTONINA Trazodone Hcl Oral Tab 100 Mg Trazodone Hcl Oral Tab 150 Mg Trazodone Hcl Oral Tab 300 Mg Trazodone Hcl Oral Tab 50 Mg ANTIDIABETICOS AGENTES MIMÉTICOS DE INCRETINA (AGONISTAS DEL RECEPTOR GLP-1) Bydureon Bcise Subcut. Auto-injector 2 Mg/0.85ml Bydureon Subcut. Pen-injector 2 Mg Bydureon Subcut. Susp Reconst. Er 2 Mg Byetta 10 Mcg Pen Subcut. Sol Pen-injector 10 Mcg/0.04ml Byetta 5 Mcg Pen Subcut. Sol Pen-injector 5 Mcg/0.02ml Victoza Inj 18mg/3ml QL AGENTES SENSIBILIZADORES DE INSULINA Pioglitazone Hcl Oral Tab 15 Mg Pioglitazone Hcl Oral Tab 30 Mg Pioglitazone Hcl Oral Tab 45 Mg ANTIDIABETICOS - ANALOGOS DE AMILINA Symlinpen 120 Subcut. Sol Pen-injector 2700 Mcg/2.7ml Symlinpen 60 Subcut. Sol Pen-injector 1500 Mcg/1.5ml BIGUANIDAS Metformin Hcl Er (mod) Oral Tab ER 24Hr 1000 Mg Metformin Hcl Er (mod) Oral Tab ER 24Hr 500 Mg Metformin Hcl Er (osm) Oral Tab ER 24Hr 1000 Mg Metformin Hcl Er (osm) Oral Tab ER 24Hr 500 Mg Metformin Hcl Er Oral Tab ER 24Hr 500 Mg Metformin Hcl Er Oral Tab ER 24Hr 750 Mg Metformin Hcl Oral Tab 1000 Mg Metformin Hcl Oral Tab 500 Mg Metformin Hcl Oral Tab 850 Mg COMBINACIONES CONTRA LA DIABETES Glipizide-metformin Hcl Oral Tab Mg Glipizide-metformin Hcl Oral Tab Mg

12 Glipizide-metformin Hcl Oral Tab Mg Glyburide-metformin Oral Tab Mg Glyburide-metformin Oral Tab Mg Glyburide-metformin Oral Tab Mg Actoplus Met Xr Oral Tab ER 24Hr Mg Actoplus Met Xr Oral Tab ER 24Hr Mg PA QL Invokamet Oral Tab Mg PA QL Invokamet Oral Tab Mg PA QL Invokamet Oral Tab Mg PA QL Invokamet Oral Tab Mg PA QL Invokamet Xr Oral Tab ER 24Hr Mg PA QL Invokamet Xr Oral Tab ER 24Hr Mg PA QL Invokamet Xr Oral Tab ER 24Hr Mg PA QL Invokamet Xr Oral Tab ER 24Hr Mg Janumet Oral Tab Mg Janumet Oral Tab Mg Janumet Xr Oral Tab ER 24Hr Mg Janumet Xr Oral Tab ER 24Hr Mg Janumet Xr Oral Tab ER 24Hr Mg Jentadueto Oral Tab Mg Jentadueto Oral Tab Mg Jentadueto Oral Tab Mg Xigduo Xr Oral Tab ER 24Hr Mg QL Xigduo Xr Oral Tab ER 24Hr Mg QL Xigduo Xr Oral Tab ER 24Hr Mg QL Xigduo Xr Oral Tab ER 24Hr Mg QL Xigduo Xr Oral Tab ER 24Hr Mg QL DIABETES - OTROS Glucagen Hypokit Inj Sol Reconst. 1 Mg Glucagon Emergency Inj Kit Proglycem Oral Susp 50 Mg/ml INHIBIDORES DE DIPEPTIDIL PEPTIDASA-4 (DPP-4) Januvia Oral Tab 100 Mg Januvia Oral Tab 25 Mg Januvia Oral Tab 50 Mg Tradjenta Oral Tab 5 Mg INHIBIDORES DE SGLT2 Farxiga Oral Tab 10 Mg QL Farxiga Oral Tab 5 Mg QL PA QL Invokana Oral Tab 100 Mg PA QL Invokana Oral Tab 300 Mg Jardiance Oral Tab 10 Mg QL Jardiance Oral Tab 25 Mg QL INSULINA Humulin 70/30 Subcut. Susp (70-30) 100 Unit/ml Humulin N Subcut. Susp 100 Unit/ml Humulin R Inj Sol 100 Unit/ml Lantus Subcut. Sol 100 Unit/ml Levemir Subcut. Sol 100 Unit/ml Novolin 70/30 Subcut. Susp (70-30) 100 Unit/ml Novolin N Subcut. Susp 100 Unit/ml Novolin R Inj Sol 100 Unit/ml Novolog Mix 70/30 Subcut. Susp (70-30) 100 Unit/ml Novolog Subcut. Sol 100 Unit/ml SULFONILUREAS Glimepiride Oral Tab 1 Mg Glimepiride Oral Tab 2 Mg Glimepiride Oral Tab 4 Mg Glipizide Er Oral Tab ER 24Hr 10 Mg Glipizide Er Oral Tab ER 24Hr 2.5 Mg Glipizide Er Oral Tab ER 24Hr 5 Mg Glipizide Oral Tab 10 Mg Glipizide Oral Tab 5 Mg Glyburide Micronized Oral Tab 1.5 Mg Glyburide Micronized Oral Tab 3 Mg Glyburide Micronized Oral Tab 6 Mg Glyburide Oral Tab 1.25 Mg Glyburide Oral Tab 2.5 Mg Glyburide Oral Tab 5 Mg ANTIDIARREICOS AGENTES ANTIPERISTALTICOS Diphenoxylate-atropine Oral Tab Mg Loperamide Hcl Oral Cap 2 Mg ANTIDOTOS Y ANTAGONISTAS ESPECIFICOS ANTAGONISTAS DE BENZODIAZEPINA Flumazenil IV Sol 0.5 Mg/5ml Flumazenil IV Sol 1 Mg/10ml ANTAGONISTAS OPIOIDES Naltrexone Hcl Oral Tab 50 Mg ANTIDOTOS - AGENTES QUELANTES Chemet Cap 100mg ANTIEMETICOS ANTAGONISTAS DE RECEPTORES 5-HT3 Ondansetron Oral Tab Dispersible 4 Mg QL Ondansetron Oral Tab Dispersible 8 Mg QL Granisetron Hcl IV Sol 0.1 Mg/ml Granisetron Hcl IV Sol 1 Mg/ml Granisetron Hcl IV Sol 4 Mg/4ml Ondansetron Hcl Inj Sol 4 Mg/2ml Ondansetron Hcl Inj Sol 40 Mg/20ml

13 ANTIEMETICOS - ANTICOLINERGICOS Meclizine Hcl Oral Tab 12.5 Mg Meclizine Hcl Oral Tab 25 Mg Trimethobenzamide Hcl Oral Cap 300 Mg ANTIEMETICOS - MISCELANEOS Akynzeo Oral Cap Mg ANTIESPASMODICOS URINARIOS ANTIESPASMODICOS URINARIOS - AGONISTAS ADRENERGICOS BETA-3 Myrbetriq Oral Tab ER 24Hr 25 Mg Myrbetriq Oral Tab ER 24Hr 50 Mg ANTIESPASMODICOS URINARIOS AGONISTAS COLINERGICOS Bethanechol Chloride Oral Tab 10 Mg Bethanechol Chloride Oral Tab 25 Mg Bethanechol Chloride Oral Tab 5 Mg Bethanechol Chloride Oral Tab 50 Mg ANTIESPASMÓDICOS URINARIOS - ANTIMUSCARINICOS (ANTICOLINERGICOS) Oxybutynin Chloride Er Oral Tab ER 24Hr 10 Mg Oxybutynin Chloride Er Oral Tab ER 24Hr 15 Mg Oxybutynin Chloride Er Oral Tab ER 24Hr 5 Mg Oxybutynin Chloride Oral Syrup Oxybutynin Chloride Oral Tab 5 Mg Toviaz Oral Tab ER 24Hr 4 Mg Toviaz Oral Tab ER 24Hr 8 Mg Vesicare Oral Tab 10 Mg Vesicare Oral Tab 5 Mg ANTIFUNGALES ANTIFUNGALES Griseofulvin Microsize Oral Susp 125 Mg/5ml Griseofulvin Microsize Oral Tab 500 Mg Terbinafine Hcl Oral Tab 250 Mg ANTIFUNGALES RELACIONADOS AL IMIDAZOLE Fluconazole Oral Susp Reconst. 10 Mg/ml Fluconazole Oral Susp Reconst. 40 Mg/ml Fluconazole Oral Tab 100 Mg Fluconazole Oral Tab 150 Mg Fluconazole Oral Tab 200 Mg Fluconazole Oral Tab 50 Mg Ketoconazole Oral Tab 200 Mg PA Noxafil Oral Susp 40 Mg/ml Noxafil Oral Tab Delayed Rel 100 Mg Sporanox Oral Sol 10 Mg/ml ANTIHELMINTICOS ANTIHELMINTICOS Ivermectin Oral Tab 3 Mg Albenza Tab 200mg Biltricide Tab 600mg ANTIHIPERLIPIDEMICOS ANTIHIPERLIPIDEMICOS - MISC. Vascepa Oral Cap 1 Gm DERIVADOS DE ACIDO FIBRICO Gemfibrozil Oral Tab 600 Mg INHIBIDORES DE LA ABSORCION INTESTINAL DEL COLESTEROL Ezetimibe Oral Tab 10 Mg QL INHIBIDORES DE LA REDUCTASA HNG COA Atorvastatin Calcium Oral Tab 10 Mg QL * Atorvastatin Calcium Oral Tab 20 Mg QL * Atorvastatin Calcium Oral Tab 40 Mg QL Atorvastatin Calcium Oral Tab 80 Mg QL Lovastatin Oral Tab 10 Mg QL * Lovastatin Oral Tab 20 Mg QL * Lovastatin Oral Tab 40 Mg QL * Pravastatin Sodium Oral Tab 10 Mg QL * Pravastatin Sodium Oral Tab 20 Mg QL * Pravastatin Sodium Oral Tab 40 Mg QL * Pravastatin Sodium Oral Tab 80 Mg QL * Simvastatin Oral Tab 10 Mg QL * Simvastatin Oral Tab 20 Mg QL * Simvastatin Oral Tab 40 Mg QL * Simvastatin Oral Tab 5 Mg QL * Simvastatin Oral Tab 80 Mg QL Livalo Oral Tab 1 Mg QL * Livalo Oral Tab 2 Mg QL * Livalo Oral Tab 4 Mg QL * SECUESTRANTES DEL ACIDO BILIAR Cholestyramine Light Oral Packet Cholestyramine Light Oral Powder Cholestyramine Oral Packet Cholestyramine Oral Powder Colestipol Hcl Oral Granules 5 Gm Colestipol Hcl Oral Packet Colestipol Hcl Oral Tab 1 Gm

14 Welchol Oral Packet Welchol Oral Tab 625 Mg ANTIHIPERTENSIVOS ANTAGONISTAS PARA RECEPTORES DE ANGIOTENSINA II Irbesartan Oral Tab 150 Mg QL Irbesartan Oral Tab 300 Mg QL Irbesartan Oral Tab 75 Mg QL Losartan Potassium Oral Tab 100 Mg QL Losartan Potassium Oral Tab 25 Mg QL Losartan Potassium Oral Tab 50 Mg QL Telmisartan Oral Tab 20 Mg QL Telmisartan Oral Tab 40 Mg QL Telmisartan Oral Tab 80 Mg QL Valsartan Oral Tab 160 Mg QL Valsartan Oral Tab 320 Mg QL Valsartan Oral Tab 40 Mg QL Valsartan Oral Tab 80 Mg QL ANTIHIPERTENSIVOS ANTIADRENERGICOS Clonidine Hcl Oral Tab 0.1 Mg Clonidine Hcl Oral Tab 0.2 Mg Clonidine Hcl Oral Tab 0.3 Mg Clonidine Hcl Transdermal Patch Doxazosin Mesylate Oral Tab 1 Mg Doxazosin Mesylate Oral Tab 2 Mg Doxazosin Mesylate Oral Tab 4 Mg Doxazosin Mesylate Oral Tab 8 Mg Guanfacine Hcl Oral Tab 1 Mg Guanfacine Hcl Oral Tab 2 Mg Methyldopa Oral Tab 250 Mg Methyldopa Oral Tab 500 Mg Prazosin Hcl Oral Cap 1 Mg Prazosin Hcl Oral Cap 2 Mg Prazosin Hcl Oral Cap 5 Mg Terazosin Hcl Oral Cap 1 Mg Terazosin Hcl Oral Cap 10 Mg Terazosin Hcl Oral Cap 2 Mg Terazosin Hcl Oral Cap 5 Mg COMBINACIONES DE ANTIHIPERTENSIVOS Amlodipine Besy-benazepril Hcl Oral Cap Mg Amlodipine Besy-benazepril Hcl Oral Cap Mg Amlodipine Besy-benazepril Hcl Oral Cap Mg Amlodipine Besy-benazepril Hcl Oral Cap 5-10 Mg Amlodipine Besy-benazepril Hcl Oral Cap 5-20 Mg Amlodipine Besy-benazepril Hcl Oral Cap 5-40 Mg Amlodipine-olmesartan Oral Tab Mg QL Amlodipine-olmesartan Oral Tab Mg QL Amlodipine-olmesartan Oral Tab 5-20 Mg QL Amlodipine-olmesartan Oral Tab 5-40 Mg QL Atenolol-chlorthalidone Oral Tab Mg Atenolol-chlorthalidone Oral Tab Mg Benazepril-hydrochlorothiazide Oral Tab Mg Benazepril-hydrochlorothiazide Oral Tab Mg Benazepril-hydrochlorothiazide Oral Tab Mg Benazepril-hydrochlorothiazide Oral Tab Mg Bisoprolol-hydrochlorothiazide Oral Tab Mg Bisoprolol-hydrochlorothiazide Oral Tab Mg Bisoprolol-hydrochlorothiazide Oral Tab Mg Enalapril-hydrochlorothiazide Oral Tab Mg Enalapril-hydrochlorothiazide Oral Tab Mg Irbesartan-hydrochlorothiazide Oral Tab Mg QL Irbesartan-hydrochlorothiazide Oral Tab Mg QL Lisinopril-hydrochlorothiazide Oral Tab Mg Lisinopril-hydrochlorothiazide Oral Tab Mg Lisinopril-hydrochlorothiazide Oral Tab Mg Losartan Potassium-hctz Oral Tab Mg QL Losartan Potassium-hctz Oral Tab Mg QL Losartan Potassium-hctz Oral Tab Mg QL Quinapril-hydrochlorothiazide Oral Tab Mg Quinapril-hydrochlorothiazide Oral Tab Mg Quinapril-hydrochlorothiazide Oral Tab Mg Valsartan-hydrochlorothiazide Oral Tab Mg QL Valsartan-hydrochlorothiazide Oral Tab Mg QL Valsartan-hydrochlorothiazide Oral Tab Mg QL Valsartan-hydrochlorothiazide Oral Tab Mg QL Valsartan-hydrochlorothiazide Oral Tab Mg QL Tekturna Hct Oral Tab Mg Tekturna Hct Oral Tab Mg Tekturna Hct Oral Tab Mg Tekturna Hct Oral Tab Mg INHIBIDORES ACE Benazepril Hcl Oral Tab 10 Mg Benazepril Hcl Oral Tab 20 Mg Benazepril Hcl Oral Tab 40 Mg Benazepril Hcl Oral Tab 5 Mg Captopril Oral Tab 100 Mg Captopril Oral Tab 12.5 Mg Captopril Oral Tab 25 Mg Captopril Oral Tab 50 Mg Enalapril Maleate Oral Tab 10 Mg Enalapril Maleate Oral Tab 2.5 Mg Enalapril Maleate Oral Tab 20 Mg Enalapril Maleate Oral Tab 5 Mg Fosinopril Sodium Oral Tab 10 Mg Fosinopril Sodium Oral Tab 20 Mg Fosinopril Sodium Oral Tab 40 Mg Lisinopril Oral Tab 10 Mg Lisinopril Oral Tab 2.5 Mg

15 Lisinopril Oral Tab 20 Mg Lisinopril Oral Tab 30 Mg Lisinopril Oral Tab 40 Mg Lisinopril Oral Tab 5 Mg Perindopril Erbumine Oral Tab 2 Mg Perindopril Erbumine Oral Tab 4 Mg Perindopril Erbumine Oral Tab 8 Mg Quinapril Hcl Oral Tab 10 Mg Quinapril Hcl Oral Tab 20 Mg Quinapril Hcl Oral Tab 40 Mg Quinapril Hcl Oral Tab 5 Mg Ramipril Oral Cap 1.25 Mg Ramipril Oral Cap 10 Mg Ramipril Oral Cap 2.5 Mg Ramipril Oral Cap 5 Mg Trandolapril Oral Tab 1 Mg Trandolapril Oral Tab 2 Mg Trandolapril Oral Tab 4 Mg INHIBIDORES DIRECTOS DE LA RENINA Tekturna Oral Tab 150 Mg Tekturna Oral Tab 300 Mg VASODILATADORES Hydralazine Hcl Inj Sol 20 Mg/ml Hydralazine Hcl Oral Tab 10 Mg Hydralazine Hcl Oral Tab 100 Mg Hydralazine Hcl Oral Tab 25 Mg Hydralazine Hcl Oral Tab 50 Mg Minoxidil Oral Tab 10 Mg Minoxidil Oral Tab 2.5 Mg ANTIHISTAMINICOS ANTIHISTAMINICOS - ETANOLAMINAS Diphenhydramine Hcl Inj Sol 50 Mg/ml Diphenhydramine Hcl Oral Elixir ANTIHISTAMINICOS - FENOTIAZINAS Promethazine Hcl Inj Sol 25 Mg/ml Promethazine Hcl Inj Sol 50 Mg/ml Promethazine Hcl Oral Sol 6.25 Mg/5ml Promethazine Hcl Oral Syrup Promethazine Hcl Oral Tab 12.5 Mg Promethazine Hcl Oral Tab 25 Mg Promethazine Hcl Oral Tab 50 Mg Promethazine Hcl Rectal Suppository ANTIHISTAMINICOS - NO SEDANTES Cetirizine Hcl Oral Sol 1 Mg/ml Cetirizine Hcl Oral Syrup Desloratadine Oral Tab 5 Mg Levocetirizine Dihydrochloride Oral Sol 2.5 Mg/5ml Levocetirizine Dihydrochloride Oral Tab 5 Mg ANTIHISTAMINICOS - PIPERIDINAS Cyproheptadine Hcl Oral Syrup Cyproheptadine Hcl Oral Tab 4 Mg ANTIMALARIALES ANTIMALARIALES Hydroxychloroquine Sulfate Oral Tab 200 Mg Mefloquine Hcl Oral Tab 250 Mg ANTINEOPLASICOS Y TERAPIAS ADYUVANTES AGENTES ALQUILANTES Leukeran Tab 2mg Temozolomide Oral Cap 100 Mg PA Temozolomide Oral Cap 140 Mg PA Temozolomide Oral Cap 180 Mg PA Temozolomide Oral Cap 20 Mg PA Temozolomide Oral Cap 250 Mg PA Temozolomide Oral Cap 5 Mg PA Thiotepa Inj Sol Reconst. 15 Mg AGENTES PARA EL RESCATE/ANTÍDOTO DE QUIMIOTERAPIA Leucovorin Calcium Oral Tab 25 Mg Leucovorin Calcium Oral Tab 5 Mg ANTIMETABOLITOS Mercaptopurine Oral Tab 50 Mg Methotrexate Oral Tab 2.5 Mg Methotrexate Sodium (pf) Inj Sol 1 Gm/40ml Methotrexate Sodium (pf) Inj Sol 100 Mg/4ml Methotrexate Sodium (pf) Inj Sol 250 Mg/10ml Methotrexate Sodium (pf) Inj Sol 50 Mg/2ml Methotrexate Sodium Inj Sol 250 Mg/10ml Methotrexate Sodium Inj Sol 50 Mg/2ml Methotrexate Sodium Inj Sol Reconst. 1 Gm Methotrexate Sodium Oral Tab 2.5 Mg Capecitabine Oral Tab 150 Mg PA Capecitabine Oral Tab 500 Mg PA ANTINEOPLASICOS MISC. Hydroxyurea Oral Cap 500 Mg Bexarotene Oral Cap 75 Mg Tretinoin Oral Cap 10 Mg ANTINEOPLASTICOS - AGENTES HORMONALES Y RELACIONADOS

16 Megestrol Acetate Oral Susp 40 Mg/ml Megestrol Acetate Oral Susp 400 Mg/10ml Megestrol Acetate Oral Tab 20 Mg Megestrol Acetate Oral Tab 40 Mg Tamoxifen Citrate Oral Tab 10 Mg Tamoxifen Citrate Oral Tab 20 Mg Depo-provera Inj 400/ml PA Emcyt Cap 140mg Eligard Subcut. Kit PA Hydroxyprogesterone Caproate Intramuscular Sol 1.25 Gm/5ml Leuprolide Acetate Inj Kit PA Zoladex Subcut. Implant ANTINEOPLÁSICOS - INHIBIDORES DEL TRAYECTO DE "HEDGEHOG" Erivedge Oral Cap 150 Mg INHIBIDORES DE LAS ENZIMAS ANTINEOPLASTICAS Afinitor Disperz Oral Tab Soluble 2 Mg Afinitor Disperz Oral Tab Soluble 3 Mg Afinitor Disperz Oral Tab Soluble 5 Mg Afinitor Oral Tab 10 Mg PA Afinitor Oral Tab 2.5 Mg PA Afinitor Oral Tab 5 Mg PA Afinitor Oral Tab 7.5 Mg PA Bosulif Oral Tab 100 Mg PA Bosulif Oral Tab 400 Mg PA Bosulif Oral Tab 500 Mg PA Imatinib Mesylate Oral Tab 100 Mg PA Imatinib Mesylate Oral Tab 400 Mg PA Sprycel Oral Tab 100 Mg PA Sprycel Oral Tab 140 Mg PA Sprycel Oral Tab 20 Mg PA Sprycel Oral Tab 50 Mg PA Sprycel Oral Tab 70 Mg PA Sprycel Oral Tab 80 Mg PA INHIBIDORES MITOTICOS Teniposide IV Sol 10 Mg/ml ANTINFECTIVOS URINARIOS ANTINFECTIVOS URINARIOS Nitrofurantoin Macrocrystal Oral Cap 100 Mg Nitrofurantoin Macrocrystal Oral Cap 25 Mg Nitrofurantoin Macrocrystal Oral Cap 50 Mg Nitrofurantoin Monohyd Macro Oral Cap 100 Mg ANTIVIRALES AGENTES CMV Valganciclovir Hcl Oral Tab 450 Mg AGENTES PARA EL HERPES Acyclovir Oral Cap 200 Mg Acyclovir Oral Susp 200 Mg/5ml Acyclovir Oral Tab 400 Mg Acyclovir Oral Tab 800 Mg Famciclovir Oral Tab 125 Mg Famciclovir Oral Tab 250 Mg Famciclovir Oral Tab 500 Mg AGENTES PARA LA HEPATITIS Adefovir Dipivoxil Oral Tab 10 Mg Baraclude Oral Sol 0.05 Mg/ml Baraclude Oral Tab 0.5 Mg Baraclude Oral Tab 1 Mg Daklinza Oral Tab 30 Mg PA Daklinza Oral Tab 60 Mg PA Daklinza Oral Tab 90 Mg PA Entecavir Oral Tab 0.5 Mg Entecavir Oral Tab 1 Mg Epivir Hbv Oral Sol 5 Mg/ml Lamivudine Oral Tab 100 Mg Moderiba 1200 Dose Pack Oral Tab 600 Mg Moderiba 800 Dose Pack Oral Tab 400 Mg Moderiba Oral Misc. 200 & 400 Mg Moderiba Oral Misc. 400 & 600 Mg Moderiba Oral Tab 200 Mg Olysio Oral Cap 150 Mg PA Ribasphere Oral Cap 200 Mg Ribasphere Oral Tab 200 Mg Ribavirin Oral Cap 200 Mg Ribavirin Oral Tab 200 Mg AGENTES PARA LA INFLUENZA Rimantadine Hcl Oral Tab 100 Mg Relenza Mis Diskhale QL ANTIRETROVIRALES Abacavir Sulfate Oral Tab 300 Mg Abacavir Sulfate-lamivudine Oral Tab Mg Abacavir-lamivudine-zidovudine Oral Tab Mg Aptivus Oral Cap 250 Mg Aptivus Oral Sol 100 Mg/ml Atripla Oral Tab Mg Complera Oral Tab Mg Crixivan Oral Cap 200 Mg Crixivan Oral Cap 400 Mg Didanosine Oral Cap Delayed Rel 125 Mg

17 Didanosine Oral Cap Delayed Rel 200 Mg Didanosine Oral Cap Delayed Rel 250 Mg Didanosine Oral Cap Delayed Rel 400 Mg Edurant Oral Tab 25 Mg Emtriva Oral Cap 200 Mg Emtriva Oral Sol 10 Mg/ml Isentress Oral Packet Isentress Oral Tab 400 Mg Isentress Oral Tab Chewable 100 Mg Isentress Oral Tab Chewable 25 Mg Kaletra Oral Tab Mg Kaletra Oral Tab Mg Lamivudine Oral Sol 10 Mg/ml Lamivudine Oral Tab 150 Mg Lamivudine Oral Tab 300 Mg Lamivudine-zidovudine Oral Tab Mg Lexiva Oral Susp 50 Mg/ml Lexiva Oral Tab 700 Mg Lopinavir-ritonavir Oral Sol Mg/ml Nevirapine Er Oral Tab ER 24Hr 100 Mg Nevirapine Er Oral Tab ER 24Hr 400 Mg Nevirapine Oral Tab 200 Mg Norvir Oral Cap 100 Mg Norvir Oral Sol 80 Mg/ml Prezista Oral Susp 100 Mg/ml Prezista Oral Tab 150 Mg Prezista Oral Tab 600 Mg Prezista Oral Tab 75 Mg Prezista Oral Tab 800 Mg Reyataz Oral Packet Stavudine Oral Cap 15 Mg Stavudine Oral Cap 20 Mg Stavudine Oral Cap 30 Mg Stavudine Oral Cap 40 Mg Viread Oral Powder Viread Oral Tab 150 Mg Viread Oral Tab 200 Mg Viread Oral Tab 250 Mg Zidovudine Oral Cap 100 Mg Zidovudine Oral Syrup Zidovudine Oral Tab 300 Mg BLOQUEADORES BETA BLOQUEADORES ALFA-BETA Carvedilol Oral Tab 12.5 Mg Carvedilol Oral Tab 25 Mg Carvedilol Oral Tab Mg Carvedilol Oral Tab 6.25 Mg Labetalol Hcl IV Sol 5 Mg/ml Labetalol Hcl Oral Tab 100 Mg Labetalol Hcl Oral Tab 200 Mg Labetalol Hcl Oral Tab 300 Mg BLOQUEADORES BETA CARDIOSELECTIVOS Acebutolol Hcl Oral Cap 200 Mg Acebutolol Hcl Oral Cap 400 Mg Atenolol Oral Tab 100 Mg Atenolol Oral Tab 25 Mg Atenolol Oral Tab 50 Mg Betaxolol Hcl Oral Tab 10 Mg Betaxolol Hcl Oral Tab 20 Mg Bisoprolol Fumarate Oral Tab 10 Mg Bisoprolol Fumarate Oral Tab 5 Mg Metoprolol Succinate Er Oral Tab ER 24Hr 100 Mg Metoprolol Succinate Er Oral Tab ER 24Hr 200 Mg Metoprolol Succinate Er Oral Tab ER 24Hr 25 Mg Metoprolol Succinate Er Oral Tab ER 24Hr 50 Mg Metoprolol Tartrate IV Sol 5 Mg/5ml Metoprolol Tartrate Oral Tab 100 Mg Metoprolol Tartrate Oral Tab 25 Mg Metoprolol Tartrate Oral Tab 50 Mg Bystolic Oral Tab 10 Mg Bystolic Oral Tab 2.5 Mg Bystolic Oral Tab 20 Mg Bystolic Oral Tab 5 Mg BLOQUEADORES BETA NO SELECTIVOS Pindolol Oral Tab 10 Mg Pindolol Oral Tab 5 Mg Sotalol Hcl Oral Tab 120 Mg Sotalol Hcl Oral Tab 160 Mg Sotalol Hcl Oral Tab 240 Mg Sotalol Hcl Oral Tab 80 Mg BLOQUEADORES DE CANAL DE CALCIO BLOQUEADORES DE CANAL DE CALCIO Amlodipine Besylate Oral Tab 10 Mg Amlodipine Besylate Oral Tab 2.5 Mg Amlodipine Besylate Oral Tab 5 Mg Diltiazem Hcl Er Beads Oral Cap ER 24Hr 120 Mg Diltiazem Hcl Er Beads Oral Cap ER 24Hr 180 Mg Diltiazem Hcl Er Beads Oral Cap ER 24Hr 240 Mg Diltiazem Hcl Er Beads Oral Cap ER 24Hr 300 Mg Diltiazem Hcl Er Beads Oral Cap ER 24Hr 360 Mg Diltiazem Hcl Er Beads Oral Cap ER 24Hr 420 Mg Diltiazem Hcl Er Coated Beads Oral Cap ER 24Hr 120 Mg Diltiazem Hcl Er Coated Beads Oral Cap ER 24Hr 180 Mg Diltiazem Hcl Er Coated Beads Oral Cap ER 24Hr 240 Mg Diltiazem Hcl Er Coated Beads Oral Cap ER 24Hr 300 Mg Diltiazem Hcl Er Coated Beads Oral Cap ER 24Hr 360 Mg Diltiazem Hcl Er Coated Beads Oral Tab ER 24Hr 180 Mg

18 Diltiazem Hcl Er Coated Beads Oral Tab ER 24Hr 240 Mg Diltiazem Hcl Er Coated Beads Oral Tab ER 24Hr 300 Mg Diltiazem Hcl Er Coated Beads Oral Tab ER 24Hr 360 Mg Diltiazem Hcl Er Coated Beads Oral Tab ER 24Hr 420 Mg Diltiazem Hcl Er Oral Cap ER 12Hr 120 Mg Diltiazem Hcl Er Oral Cap ER 12Hr 60 Mg Diltiazem Hcl Er Oral Cap ER 12Hr 90 Mg Diltiazem Hcl Er Oral Cap ER 24Hr 120 Mg Diltiazem Hcl Er Oral Cap ER 24Hr 180 Mg Diltiazem Hcl Er Oral Cap ER 24Hr 240 Mg Diltiazem Hcl IV Sol 125 Mg/25ml Diltiazem Hcl IV Sol 25 Mg/5ml Diltiazem Hcl IV Sol 50 Mg/10ml Diltiazem Hcl Oral Tab 120 Mg Diltiazem Hcl Oral Tab 30 Mg Diltiazem Hcl Oral Tab 60 Mg Diltiazem Hcl Oral Tab 90 Mg Felodipine Er Oral Tab ER 24Hr 10 Mg Felodipine Er Oral Tab ER 24Hr 2.5 Mg Felodipine Er Oral Tab ER 24Hr 5 Mg Nifedipine Er Oral Tab ER 24Hr 30 Mg Nifedipine Er Oral Tab ER 24Hr 60 Mg Nifedipine Er Oral Tab ER 24Hr 90 Mg Nifedipine Er Osmotic Rel Oral Tab ER 24Hr 30 Mg Nifedipine Er Osmotic Rel Oral Tab ER 24Hr 60 Mg Nifedipine Er Osmotic Rel Oral Tab ER 24Hr 90 Mg Nifedipine Oral Cap 10 Mg Nifedipine Oral Cap 20 Mg Verapamil Hcl Er Oral Cap ER 24Hr 100 Mg Verapamil Hcl Er Oral Cap ER 24Hr 120 Mg Verapamil Hcl Er Oral Cap ER 24Hr 180 Mg Verapamil Hcl Er Oral Cap ER 24Hr 200 Mg Verapamil Hcl Er Oral Cap ER 24Hr 240 Mg Verapamil Hcl Er Oral Cap ER 24Hr 300 Mg Verapamil Hcl Er Oral Cap ER 24Hr 360 Mg Verapamil Hcl Er Oral Tab ER 120 Mg Verapamil Hcl Er Oral Tab ER 180 Mg Verapamil Hcl Er Oral Tab ER 240 Mg Verapamil Hcl IV Sol 2.5 Mg/ml Verapamil Hcl Oral Tab 120 Mg Verapamil Hcl Oral Tab 80 Mg CARDIOTONICOS GLUCOSIDOS CARDIACOS Digoxin Inj Sol 0.25 Mg/ml Digoxin Oral Tab 125 Mcg Digoxin Oral Tab 250 Mcg CEFALOSPORINAS CEFALOSPORINAS DE 1RA GENERACION Cefadroxil Oral Cap 500 Mg Cefadroxil Oral Susp Reconst. 250 Mg/5ml Cefadroxil Oral Susp Reconst. 500 Mg/5ml Cefadroxil Oral Tab 1 Gm Cephalexin Oral Cap 250 Mg Cephalexin Oral Cap 500 Mg Cephalexin Oral Cap 750 Mg Cephalexin Oral Susp Reconst. 125 Mg/5ml Cephalexin Oral Susp Reconst. 250 Mg/5ml CEFALOSPORINAS DE 2DA GENERACION Cefprozil Oral Susp Reconst. 125 Mg/5ml Cefprozil Oral Susp Reconst. 250 Mg/5ml Cefprozil Oral Tab 250 Mg Cefprozil Oral Tab 500 Mg Cefuroxime Axetil Oral Tab 250 Mg Cefuroxime Axetil Oral Tab 500 Mg CEFALOSPORINAS DE 3RA GENERACION Cefdinir Oral Cap 300 Mg Cefdinir Oral Susp Reconst. 125 Mg/5ml Cefdinir Oral Susp Reconst. 250 Mg/5ml Ceftriaxone Sodium Inj Sol Reconst. 1 Gm Ceftriaxone Sodium Inj Sol Reconst. 2 Gm Ceftriaxone Sodium Inj Sol Reconst. 250 Mg Ceftriaxone Sodium Inj Sol Reconst. 500 Mg CLASES DIVERSAS AGENTES INMUNOSUPRESORES Azathioprine Oral Tab 50 Mg Astagraf Xl Oral Cap ER 24Hr 0.5 Mg Astagraf Xl Oral Cap ER 24Hr 1 Mg Astagraf Xl Oral Cap ER 24Hr 5 Mg Azasan Oral Tab 100 Mg Azasan Oral Tab 75 Mg Cyclosporine IV Sol 50 Mg/ml Cyclosporine Modified Oral Cap 100 Mg Cyclosporine Modified Oral Cap 25 Mg Cyclosporine Modified Oral Cap 50 Mg Cyclosporine Modified Oral Sol 100 Mg/ml Cyclosporine Oral Cap 100 Mg Cyclosporine Oral Cap 25 Mg Gengraf Oral Cap 100 Mg Gengraf Oral Cap 25 Mg Gengraf Oral Cap 50 Mg Gengraf Oral Sol 100 Mg/ml Mycophenolate Mofetil Oral Susp Reconst. 200 Mg/ml Mycophenolate Mofetil Oral Tab 500 Mg Mycophenolate Sodium Oral Tab Delayed Rel 180 Mg Mycophenolate Sodium Oral Tab Delayed Rel 360 Mg Prograf IV Sol 5 Mg/ml

19 Sirolimus Oral Tab 0.5 Mg Sirolimus Oral Tab 1 Mg Sirolimus Oral Tab 2 Mg Tacrolimus Oral Cap 0.5 Mg Tacrolimus Oral Cap 1 Mg Tacrolimus Oral Cap 5 Mg CORTICOSTEROIDES GLUCOCORTICOSTEROIDES Dexamethasone Oral Elixir Dexamethasone Oral Tab 0.5 Mg Dexamethasone Oral Tab 0.75 Mg Dexamethasone Oral Tab 1.5 Mg Dexamethasone Oral Tab 4 Mg Dexamethasone Oral Tab 6 Mg Dexamethasone Sodium Phosphate Inj Sol 10 Mg/ml Dexamethasone Sodium Phosphate Inj Sol 100 Mg/10ml Dexamethasone Sodium Phosphate Inj Sol 120 Mg/30ml Dexamethasone Sodium Phosphate Inj Sol 20 Mg/5ml Dexamethasone Sodium Phosphate Inj Sol 4 Mg/ml Hydrocortisone Oral Tab 10 Mg Hydrocortisone Oral Tab 20 Mg Hydrocortisone Oral Tab 5 Mg Methylprednisolone Acetate Inj Susp 40 Mg/ml Methylprednisolone Acetate Inj Susp 80 Mg/ml Methylprednisolone Oral Tab 16 Mg Methylprednisolone Oral Tab 32 Mg Methylprednisolone Oral Tab 4 Mg Methylprednisolone Oral Tab 8 Mg Methylprednisolone Oral Tab Therapy Methylprednisolone Sodium Succ Inj Sol Reconst Mg Methylprednisolone Sodium Succ Inj Sol Reconst. 125 Mg Methylprednisolone Sodium Succ Inj Sol Reconst. 40 Mg Prednisolone Oral Sol 15 Mg/5ml Prednisolone Oral Syrup Prednisone Oral Tab 1 Mg Prednisone Oral Tab 10 Mg Prednisone Oral Tab 2.5 Mg Prednisone Oral Tab 20 Mg Prednisone Oral Tab 5 Mg Solu-cortef Inj 1000mg Solu-cortef Inj Sol Reconst. 100 Mg Solu-cortef Inj Sol Reconst. 250 Mg Solu-cortef Inj Sol Reconst. 500 Mg MINERALOCORTICOIDES Fludrocortisone Acetate Oral Tab 0.1 Mg DERMATOLOGICOS AGENTES ANTIINFLAMATORIOS - TOPICOS Diclofenac Sodium Transdermal Gel Diclofenac Sodium Transdermal Sol 1.5 % AGENTES INMUNOMODULARES - TOPICOS Imiquimod External Cream AGENTES INMUNOSUPRESORES - TOPICOS Elidel Cre 1% AGENTES KERATOLITICOS / ANTIMITOTICOS Salicylic Acid Er External Sol 28.5 % Salicylic Acid External Cream Salicylic Acid External Foam Salicylic Acid External Gel Salicylic Acid External Lotion Salicylic Acid External Shampoo Condylox Gel AGENTES ROSACEA Finacea External Foam Finacea External Gel Mirvaso External Gel Soolantra External Cream AGENTES TÓPICOS - ANTINEOPLÁSICOS O LESIONES PRE- MALIGNAS Picato Gel PA ANESTESIA LOCAL - TOPICA Lidocaine Hcl External Cream Lidocaine Hcl External Gel Lidocaine Hcl External Sol 4 % Lidocaine-prilocaine External Cream Lidocaine-prilocaine External Kit ANTIBIOTICOS TOPICOS Mupirocin External Ointment ANTIFUNGALES - TOPICOS Ciclopirox External Gel Ciclopirox External Shampoo Ciclopirox External Sol 8 % Ciclopirox Olamine External Cream Ciclopirox Olamine External Susp 0.77 % Clotrimazole External Cream Clotrimazole External Sol 1 % Econazole Nitrate External Cream Nystatin External Cream Nystatin External Ointment Nystatin External Powder

20 Nystatin-triamcinolone External Cream Nystatin-triamcinolone External Ointment ANTISORIASICOS Cosentyx 300 Dose Subcut. Sol Prefilled Syringe PA Cosentyx Sensoready 300 Dose Subcut. Sol Auto-injector 150 M PA Cosentyx Sensoready Pen Subcut. Sol Auto-injector 150 Mg/ml PA Cosentyx Subcut. Sol Prefilled Syringe PA ANTIVIRALES - TOPICOS Zovirax Cre 5% CORTICOSTEROIDES TOPICOS Fluticasone Propionate External Cream Fluticasone Propionate External Lotion Fluticasone Propionate External Ointment Halobetasol Propionate External Cream Halobetasol Propionate External Ointment Hydrocortisone External Cream Hydrocortisone External Lotion Hydrocortisone External Ointment Hydrocortisone Valerate External Cream Hydrocortisone Valerate External Ointment Mometasone Furoate External Cream Mometasone Furoate External Ointment Mometasone Furoate External Sol 0.1 % Triamcinolone Acetonide External Aerosol Triamcinolone Acetonide External Cream Triamcinolone Acetonide External Lotion Triamcinolone Acetonide External Ointment Taclonex Sus EMOLIENTES Ammonium Lactate External Cream Ammonium Lactate External Lotion Lactic Acid External Lotion PRODUCTOS ANTISEBORREICOS Selenium Sulfide External Lotion PRODUCTOS PARA CURAR HERIDAS Regranex Gel PRODUCTOS PARA QUEMADAS Silver Sulfadiazine External Cream PRODUCTOS PARA EL ACNE Acanya External Gel Epiduo External Gel Epiduo Forte External Gel DIGESTIVOS ENZIMAS DIGESTIVAS Creon Cap 12000unt Creon Cap 24000unt Creon Cap 3000unit Creon Cap 36000unt Creon Cap 6000unit Zenpep Oral Cap Delayed Rel Particles Unit Zenpep Oral Cap Delayed Rel Particles Unit Zenpep Oral Cap Delayed Rel Particles Unit Zenpep Oral Cap Delayed Rel Particles Unit Zenpep Oral Cap Delayed Rel Particles Unit Zenpep Oral Cap Delayed Rel Particles Unit Zenpep Oral Cap Delayed Rel Particles 5000 Unit Zenpep Oral Cap Delayed Rel Particles Unit DIURETICOS COMBINACIONES DIURETICAS Amiloride-hydrochlorothiazide Oral Tab 5-50 Mg Spironolactone-hctz Oral Tab Mg Triamterene-hctz Oral Cap Mg Triamterene-hctz Oral Tab Mg Triamterene-hctz Oral Tab Mg DIURETICOS DE ASA Bumetanide Inj Sol 0.25 Mg/ml Bumetanide Oral Tab 0.5 Mg Bumetanide Oral Tab 1 Mg Bumetanide Oral Tab 2 Mg Furosemide Inj Sol 10 Mg/ml Furosemide Oral Sol 10 Mg/ml Furosemide Oral Tab 20 Mg Furosemide Oral Tab 40 Mg Furosemide Oral Tab 80 Mg Torsemide Oral Tab 10 Mg Torsemide Oral Tab 100 Mg Torsemide Oral Tab 20 Mg Torsemide Oral Tab 5 Mg DIURETICOS DE TIAZIDAS/PARECIDOS A TIAZIDAS Chlorothiazide Oral Tab 250 Mg Chlorothiazide Oral Tab 500 Mg Hydrochlorothiazide Oral Cap 12.5 Mg Hydrochlorothiazide Oral Tab 12.5 Mg Hydrochlorothiazide Oral Tab 25 Mg Hydrochlorothiazide Oral Tab 50 Mg Indapamide Oral Tab 1.25 Mg Indapamide Oral Tab 2.5 Mg Metolazone Oral Tab 10 Mg Metolazone Oral Tab 2.5 Mg

21 Metolazone Oral Tab 5 Mg DIURÉTICOS CONSERVADORES DE POTASIO Amiloride Hcl Oral Tab 5 Mg Spironolactone Oral Tab 100 Mg Spironolactone Oral Tab 25 Mg Spironolactone Oral Tab 50 Mg INHIBIDORES DE LA ANHIDRASA CARBONICA Acetazolamide Er Oral Cap ER 12Hr 500 Mg Acetazolamide Oral Tab 250 Mg EQUIPO MEDICO Y SUPLIDOS SUPLIDOS PARA TERAPIA PARENTERAL Freestyle Precision Ins Syr Misc. 30g X 5/16" 0.5 Ml Freestyle Precision Ins Syr Misc. 30g X 5/16" 1 Ml Freestyle Precision Ins Syr Misc. 31g X 5/16" 0.5 Ml Freestyle Precision Ins Syr Misc. 31g X 5/16" 1 Ml ESTROGENOS COMBINACIONES DE ESTROGENOS Duavee Oral Tab Mg Premphase Oral Tab Mg Prempro Oral Tab Mg Prempro Oral Tab Mg Prempro Oral Tab Mg Prempro Oral Tab Mg ESTROGENOS Estradiol Oral Tab 0.5 Mg Estradiol Oral Tab 1 Mg Estradiol Oral Tab 2 Mg Estradiol Transdermal Patch Estropipate Oral Tab 0.75 Mg Estropipate Oral Tab 1.5 Mg Premarin Oral Tab 0.3 Mg Premarin Oral Tab 0.45 Mg Premarin Oral Tab Mg Premarin Oral Tab 0.9 Mg Premarin Oral Tab 1.25 Mg FLUOROQUINOLONAS FLUOROQUINOLONAS Ciprofloxacin Hcl Oral Tab 100 Mg Ciprofloxacin Hcl Oral Tab 250 Mg Ciprofloxacin Hcl Oral Tab 500 Mg Ciprofloxacin Hcl Oral Tab 750 Mg Ciprofloxacin-ciproflox Hcl Er Oral Tab ER 24Hr 1000 Mg Ciprofloxacin-ciproflox Hcl Er Oral Tab ER 24Hr 500 Mg Levofloxacin Oral Sol 25 Mg/ml Levofloxacin Oral Tab 250 Mg Levofloxacin Oral Tab 500 Mg Levofloxacin Oral Tab 750 Mg Moxifloxacin Hcl Oral Tab 400 Mg HIPNOTICOS/SENDATES/AGENTES PARA PROBLEMAS DE SUEÑO AGONISTAS SELECTIVOS DE RECEPTORES DE MELATONINA Rozerem Tab 8mg QL HIPNOTICOS BARBITURICOS Phenobarbital Oral Elixir Phenobarbital Oral Sol 20 Mg/5ml Phenobarbital Oral Tab 100 Mg Phenobarbital Oral Tab 15 Mg Phenobarbital Oral Tab 16.2 Mg Phenobarbital Oral Tab 30 Mg Phenobarbital Oral Tab 32.4 Mg Phenobarbital Oral Tab 60 Mg Phenobarbital Oral Tab 64.8 Mg Phenobarbital Oral Tab 97.2 Mg HIPNOTICOS NO BARBITURICOS Estazolam Oral Tab 1 Mg Estazolam Oral Tab 2 Mg Eszopiclone Oral Tab 1 Mg QL Eszopiclone Oral Tab 2 Mg QL Eszopiclone Oral Tab 3 Mg QL Flurazepam Hcl Oral Cap 15 Mg Flurazepam Hcl Oral Cap 30 Mg Midazolam Hcl Inj Sol 10 Mg/10ml Midazolam Hcl Inj Sol 10 Mg/2ml Midazolam Hcl Inj Sol 2 Mg/2ml Midazolam Hcl Inj Sol 25 Mg/5ml Midazolam Hcl Inj Sol 5 Mg/5ml Midazolam Hcl Inj Sol 5 Mg/ml Midazolam Hcl Inj Sol 50 Mg/10ml Midazolam Hcl Oral Syrup Temazepam Oral Cap 15 Mg Temazepam Oral Cap 22.5 Mg Temazepam Oral Cap 30 Mg Temazepam Oral Cap 7.5 Mg Triazolam Oral Tab Mg Triazolam Oral Tab 0.25 Mg Zaleplon Oral Cap 10 Mg QL Zaleplon Oral Cap 5 Mg QL Zolpidem Tartrate Oral Tab 10 Mg QL Zolpidem Tartrate Oral Tab 5 Mg LAXANTES COMBINACIONES LAXANTES

22 Peg_3350-kcl-na Bicarb-nacl Oral Sol Reconst. 420 Gm Peg_3350/electrolytes Oral Sol Reconst. 240 Gm Peg-3350/electrolytes Oral Sol Reconst. 236 Gm Prepopik Oral Packet Suprep Bowel Sol Prep LAXANTES - MISCELANEOS Lactulose Oral Sol 10 Gm/15ml Lactulose Oral Sol 20 Gm/30ml Polyethylene Glycol 3350 Oral Packet Polyethylene Glycol 3350 Oral Powder MACROLIDOS ACITROMICINA Azithromycin Oral Susp Reconst. 100 Mg/5ml Azithromycin Oral Susp Reconst. 200 Mg/5ml Azithromycin Oral Tab 250 Mg Azithromycin Oral Tab 500 Mg Azithromycin Oral Tab 600 Mg CLARITROMICINA Clarithromycin Er Oral Tab ER 24Hr 500 Mg Clarithromycin Oral Susp Reconst. 125 Mg/5ml Clarithromycin Oral Susp Reconst. 250 Mg/5ml Clarithromycin Oral Tab 250 Mg Clarithromycin Oral Tab 500 Mg MEDICAMENTOS PARA LA ULCERA ANTAGONISTAS H-2 Cimetidine Hcl Oral Sol 300 Mg/5ml Cimetidine Oral Tab 200 Mg Cimetidine Oral Tab 300 Mg Cimetidine Oral Tab 400 Mg Cimetidine Oral Tab 800 Mg Famotidine IV Sol 20 Mg/2ml Famotidine IV Sol 200 Mg/20ml Famotidine IV Sol 40 Mg/4ml Famotidine Oral Susp Reconst. 40 Mg/5ml Famotidine Oral Tab 20 Mg Famotidine Oral Tab 40 Mg Nizatidine Oral Cap 150 Mg Nizatidine Oral Cap 300 Mg Nizatidine Oral Sol 15 Mg/ml Ranitidine Hcl Oral Cap 150 Mg Ranitidine Hcl Oral Cap 300 Mg Ranitidine Hcl Oral Syrup Ranitidine Hcl Oral Tab 150 Mg Ranitidine Hcl Oral Tab 300 Mg ANTIESPASMODICOS Dicyclomine Hcl Intramuscular Sol 10 Mg/ml Dicyclomine Hcl Oral Cap 10 Mg Dicyclomine Hcl Oral Sol 10 Mg/5ml Dicyclomine Hcl Oral Tab 20 Mg Hyoscyamine Sulfate Er Oral Tab ER 12Hr Mg Hyoscyamine Sulfate Oral Elixir Hyoscyamine Sulfate Oral Sol Mg/ml Hyoscyamine Sulfate Oral Tab Mg Hyoscyamine Sulfate Oral Tab Dispersible Mg Hyoscyamine Sulfate Sl Sublingual Hyoscyamine Sulfate Sublingual COMBINACIONES PARA TERAPIA DE ULCERA Pylera Cap INHIBIDORES DE BOMBA DE PROTONES Lansoprazole Oral Cap Delayed Rel 15 Mg QL Lansoprazole Oral Cap Delayed Rel 30 Mg QL Omeprazole Oral Cap Delayed Rel 10 Mg QL Omeprazole Oral Cap Delayed Rel 20 Mg QL Omeprazole Oral Cap Delayed Rel 40 Mg QL Pantoprazole Sodium Oral Tab Delayed Rel 20 Mg QL Pantoprazole Sodium Oral Tab Delayed Rel 40 Mg QL Rabeprazole Sodium Oral Tab Delayed Rel 20 Mg QL MEDICAMENTOS PARA LA ULCERA - MISC. Sucralfate Oral Tab 1 Gm Carafate Sus 1gm/10ml MEDICAMENTOS PARA LA ULCERA - PROTAGLANDINAS Misoprostol Oral Tab 100 Mcg Misoprostol Oral Tab 200 Mcg MEDICAMENTOS PREVENTIVOS ACA CONTRACEPTIVOS PREVENTIVO Ella_Oral Tab 30 Mg Gianvi Tab Mg Gildess Fe 1.5/30 Tab Mg-mcg Jolivette Oral Tab 0.35 Mg Junel Fe 24 Tab 1-20 Mg-mcg(24) Larin 24 Fe Tab 1-20 Mg-mcg(24) Levonorg-eth Estrad Triphasic Tab Lomedia 24 Fe Tab 1-20 Mg-mcg(24) Lutera Tab Mg-mcg Necon 1/35 (28) Tab 1-35 Mg-mcg Next_Choice One Dose Oral Tab 1.5 Mg Norethin Ace-eth Estrad-fe Tab 1-20 Mg-mcg(24) Nuvaring Vaginal Ring Sprintec 28 Tab Mg-mcg Trinessa (28)tab 0.18/0.215/0.25 Mg-35 Mcg

23 Trivora (28) Tab Vienva Tab Mg-mcg Xulane Transdermal Patch OXITÓCICOS OXITÓCICOS Methylergonovine Maleate Inj Sol 0.2 Mg/ml PENICILINAS AMINOPENICILINAS Amoxicillin Oral Cap 250 Mg Amoxicillin Oral Cap 500 Mg Amoxicillin Oral Susp Reconst. 125 Mg/5ml Amoxicillin Oral Susp Reconst. 200 Mg/5ml Amoxicillin Oral Susp Reconst. 250 Mg/5ml Amoxicillin Oral Susp Reconst. 400 Mg/5ml Amoxicillin Oral Tab 500 Mg Amoxicillin Oral Tab 875 Mg Ampicillin Oral Cap 500 Mg COMBINACIONES DE PENICILINA Amoxicillin-pot Clavulanate Er Oral Tab ER 12Hr Mg Amoxicillin-pot Clavulanate Oral Susp Reconst Mg/5 Amoxicillin-pot Clavulanate Oral Susp Reconst Mg/5 Amoxicillin-pot Clavulanate Oral Susp Reconst Mg/5ml Amoxicillin-pot Clavulanate Oral Susp Reconst Mg/5 Amoxicillin-pot Clavulanate Oral Tab Mg Amoxicillin-pot Clavulanate Oral Tab Mg Amoxicillin-pot Clavulanate Oral Tab Mg Amoxicillin-pot Clavulanate Oral Tab Chewable Mg Amoxicillin-pot Clavulanate Oral Tab Chewable Mg Augmentin Sus 125/5ml Bicillin C-r Inj PENICILINAS NATURALES Penicillin V Potassium Oral Sol Reconst. 125 Mg/5ml Penicillin V Potassium Oral Sol Reconst. 250 Mg/5ml Penicillin V Potassium Oral Tab 250 Mg Penicillin V Potassium Oral Tab 500 Mg Bicillin L-a Inj Bicillin L-a Inj Bicillin L-a Inj PRODUCTOS PARA LA MIGRAÑA AGONISTAS DE SEROTONINA Naratriptan Hcl Oral Tab 1 Mg QL Naratriptan Hcl Oral Tab 2.5 Mg QL Rizatriptan Benzoate Oral Tab 10 Mg QL Rizatriptan Benzoate Oral Tab 5 Mg QL Rizatriptan Benzoate Oral Tab Dispersible 10 Mg QL Rizatriptan Benzoate Oral Tab Dispersible 5 Mg QL Sumatriptan Succinate Oral Tab 100 Mg QL Sumatriptan Succinate Oral Tab 25 Mg QL Sumatriptan Succinate Oral Tab 50 Mg QL Sumatriptan Succinate Refill Subcut. Sol Cartridge QL Sumatriptan Succinate Subcut. Sol 6 Mg/0.5ml QL Sumatriptan Succinate Subcut. Sol Auto-injector 4 Mg/0.5ml QL Sumatriptan Succinate Subcut. Sol Auto-injector 6 Mg/0.5ml QL PRODUCTOS VAGINALES ANTIINFECTIVOS VAGINALES Clotrimazole Vaginal Cream Metronidazole Vaginal Gel Terconazole Vaginal Cream Terconazole Vaginal Suppository ESTROGENOS VAGINALES Yuvafem Vaginal Tab 10 Mcg Premarin Vaginal Cream PROGESTINAS VAGINALES Crinone Vaginal Gel PA PROGESTINAS PROGESTINAS Medroxyprogesterone Acetate Oral Tab 10 Mg Medroxyprogesterone Acetate Oral Tab 2.5 Mg Medroxyprogesterone Acetate Oral Tab 5 Mg Norethindrone Acetate Oral Tab 5 Mg TETRACICLINAS TETRACICLINAS Minocycline Hcl Er Oral Tab ER 24Hr 115 Mg Minocycline Hcl Er Oral Tab ER 24Hr 135 Mg Minocycline Hcl Er Oral Tab ER 24Hr 45 Mg Minocycline Hcl Er Oral Tab ER 24Hr 65 Mg Minocycline Hcl Er Oral Tab ER 24Hr 90 Mg Minocycline Hcl Oral Cap 100 Mg Minocycline Hcl Oral Cap 50 Mg Minocycline Hcl Oral Cap 75 Mg Minocycline Hcl Oral Tab 100 Mg Minocycline Hcl Oral Tab 50 Mg Minocycline Hcl Oral Tab 75 Mg TOS/CATARRO/ALERGIA ANTITUSIVOS Benzonatate Oral Cap 100 Mg

24 Benzonatate Oral Cap 200 Mg COMBINACIONES PARA TOS/CATARRO/ALERGIA Hydrocod Polst-cpm Polst Er Oral Susp ER 10-8 Mg/5ml Promethazine-codeine Oral Syrup Promethazine-dm Oral Syrup Promethazine-phenylephrine Oral Syrup INHALANTES RESPIRATORIOS - MISC. Sodium Chloride Inhal Nebulization Sol 0.9 % Sodium Chloride Inhal Nebulization Sol 10 % Sodium Chloride Inhal Nebulization Sol 3 % Sodium Chloride Inhal Nebulization Sol 7 % VASOPRESORES AGENTES PARA TERAPIA DE ANAFILAXIS Epipen 2-pak Inj Sol Auto-injector 0.3 Mg/0.3ml Epipen Jr 2-pak Inj Sol Auto-injector 0.15 Mg/0.3ml VASOPRESORES Midodrine Hcl Oral Tab 10 Mg Midodrine Hcl Oral Tab 2.5 Mg Midodrine Hcl Oral Tab 5 Mg a cambios de acuerdo con las actividades de gestión del formulario. La presencia de un medicamento en la lista del formulario no garantiza la cubierta. Para determinar el estatus más actualizado de su medicamento, porfavor visite la página web para los asegurados, o llame al número de servicio al cliente que aparece en su tarjeta del plan. Relevo de Responsabilidad de Formulario: La cubierta de algunos medicamentos puede estar limitada a las formas de dosis específicas y / o fortalezas. El diseño del plan, determinando lo que está cubierto y el copago aplicable. Los medicamentos que aparecen en este formulario están sujetos