AgeWell 2020



Acetaminophen-Codeine #3acetaminophen-codeine #3 oral tablet 300-30 mgXE "Acetaminophen-Codeine #3"Quantity Limit: 400 EA Per 30 DaysAcetaminophen-Codeineacetaminophen-codeine oral solution 120-12 mg/5mlXE "Acetaminophen-Codeine"Quantity Limit: 5000 ML Per 30 Daysacetaminophen-codeine oral tablet 300-15 mg, 300-60 mgXE "Acetaminophen-Codeine"Quantity Limit: 400 EA Per 30 DaysAlfuzosin HCl ERalfuzosin hcl er oral tablet extended release 24 hour 10 mgXE "Alfuzosin HCl ER"Quantity Limit: 30 EA Per 30 DaysALPRAZolam IntensolALPRAZOLAM INTENSOL ORAL CONCENTRATE 1 MG/MLXE "ALPRAZolam Intensol"Quantity Limit: 300 ML Per 30 DaysALPRAZolamalprazolam oral tablet 0.25 mg, 0.5 mgXE "ALPRAZolam"Quantity Limit: 120 EA Per 30 Daysalprazolam oral tablet 1 mgXE "ALPRAZolam"Quantity Limit: 180 EA Per 30 Daysalprazolam oral tablet 2 mgXE "ALPRAZolam"Quantity Limit: 150 EA Per 30 DaysARIPiprazolearipiprazole oral solution 1 mg/mlXE "ARIPiprazole"Quantity Limit: 750 ML Per 30 DaysAscomp-CodeineASCOMP-CODEINE ORAL CAPSULE 50-325-40-30 MGXE "Ascomp-Codeine"Quantity Limit: 180 EA Per 30 DaysBiktarvyBIKTARVY ORAL TABLET 50-200-25 MGXE "Biktarvy"Quantity Limit: 30 EA Per 30 DaysButalbital-APAP-Caff-Codbutalbital-apap-caff-cod oral capsule 50-325-40-30 mgXE "Butalbital-APAP-Caff-Cod"Quantity Limit: 370 EA Per 30 DaysButalbital-APAP-Caffeinebutalbital-apap-caffeine oral tablet 50-325-40 mgXE "Butalbital-APAP-Caffeine"Quantity Limit: 180 EA Per 30 DaysButalbital-ASA-Caff-Codeinebutalbital-asa-caff-codeine oral capsule 50-325-40-30 mgXE "Butalbital-ASA-Caff-Codeine"Quantity Limit: 180 EA Per 30 DaysChantix Continuing Month PakCHANTIX CONTINUING MONTH PAK ORAL TABLET 1 MGXE "Chantix Continuing Month Pak"Quantity Limit: 56 EA Per 28 DaysChantixCHANTIX ORAL TABLET 0.5 MGXE "Chantix"Quantity Limit: 60 EA Per 30 DaysCHANTIX ORAL TABLET 1 MGXE "Chantix"Quantity Limit: 180 EA Per 90 DaysChantix Starting Month PakCHANTIX STARTING MONTH PAK ORAL TABLET 0.5 MG X 11 & 1 MG X 42XE "Chantix Starting Month Pak"Quantity Limit: 53 EA Per 30 DaysClorazepate Dipotassiumclorazepate dipotassium oral tablet 15 mg, 3.75 mg, 7.5 mgXE "Clorazepate Dipotassium"Quantity Limit: 180 EA Per 30 DaysDalirespDALIRESP ORAL TABLET 250 MCG, 500 MCGXE "Daliresp"Quantity Limit: 30 EA Per 30 DaysDiazepamdiazepam oral concentrate 5 mg/mlXE "Diazepam"Quantity Limit: 240 ML Per 30 DaysDiazePAMdiazepam oral solution 5 mg/5mlXE "DiazePAM"Quantity Limit: 1200 ML Per 30 Daysdiazepam oral tablet 2 mgXE "DiazePAM"Quantity Limit: 600 EA Per 30 DaysdiazePAMdiazepam oral tablet 10 mgXE "diazePAM"Quantity Limit: 120 EA Per 30 Daysdiazepam oral tablet 5 mgXE "diazePAM"Quantity Limit: 240 EA Per 30 DaysDificidDIFICID ORAL TABLET 200 MGXE "Dificid"Quantity Limit: 20 EA Per 10 DaysDrizalma SprinkleDRIZALMA SPRINKLE ORAL CAPSULE DELAYED RELEASE SPRINKLE 20 MG, 30 MG, 40 MG, 60 MGXE "Drizalma Sprinkle"Quantity Limit: 60 EA Per 30 DaysDronabinoldronabinol oral capsule 10 mg, 2.5 mg, 5 mgXE "Dronabinol"Quantity Limit: 60 EA Per 30 DaysEndariENDARI ORAL PACKET 5 GMXE "Endari"Quantity Limit: 180 EA Per 30 DaysErgotamine-Caffeineergotamine-caffeine oral tablet 1-100 mgXE "Ergotamine-Caffeine"Quantity Limit: 40 EA Per 28 DaysEstazolamestazolam oral tablet 1 mgXE "Estazolam"Quantity Limit: 60 EA Per 30 Daysestazolam oral tablet 2 mgXE "Estazolam"Quantity Limit: 30 EA Per 30 DaysFentaNYL Citratefentanyl citrate buccal lozenge on a handle 1200 mcg, 1600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcgXE "FentaNYL Citrate"Quantity Limit: 120 EA Per 30 DaysFentaNYLfentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 37.5 mcg/hr, 50 mcg/hr, 62.5 mcg/hr, 75 mcg/hr, 87.5 mcg/hrXE "FentaNYL"Quantity Limit: 10 EA Per 30 DaysFlurazepam HClflurazepam hcl oral capsule 15 mgXE "Flurazepam HCl"Quantity Limit: 60 EA Per 30 Daysflurazepam hcl oral capsule 30 mgXE "Flurazepam HCl"Quantity Limit: 30 EA Per 30 DaysGalafoldGALAFOLD ORAL CAPSULE 123 MGXE "Galafold"Quantity Limit: 15 EA Per 30 DaysGranisetron HClgranisetron hcl oral tablet 1 mgXE "Granisetron HCl"Quantity Limit: 60 EA Per 30 DaysHYDROcodone-Acetaminophenhydrocodone-acetaminophen oral solution 7.5-325 mg/15mlXE "HYDROcodone-Acetaminophen"Quantity Limit: 5500 ML Per 30 Dayshydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mgXE "HYDROcodone-Acetaminophen"Quantity Limit: 370 EA Per 30 DaysHydrocodone-Ibuprofenhydrocodone-ibuprofen oral tablet 5-200 mg, 7.5-200 mgXE "Hydrocodone-Ibuprofen"Quantity Limit: 150 EA Per 30 DaysLidocainelidocaine external ointment 5 %XE "Lidocaine"Quantity Limit: 50 GM Per 30 Dayslidocaine external patch 5 %XE "Lidocaine"Quantity Limit: 90 EA Per 30 DaysLORazepamlorazepam oral concentrate 2 mg/mlXE "LORazepam"Quantity Limit: 240 ML Per 30 Dayslorazepam oral tablet 0.5 mg, 1 mg, 2 mgXE "LORazepam"Quantity Limit: 150 EA Per 30 DaysModafinilmodafinil oral tablet 100 mg, 200 mgXE "Modafinil"Quantity Limit: 30 EA Per 30 DaysOndansetron HClondansetron hcl oral tablet 24 mgXE "Ondansetron HCl"Quantity Limit: 30 EA Per 30 Daysondansetron hcl oral tablet 4 mg, 8 mgXE "Ondansetron HCl"Quantity Limit: 90 EA Per 30 DaysOndansetronondansetron oral tablet dispersible 4 mg, 8 mgXE "Ondansetron"Quantity Limit: 90 EA Per 30 DaysOxycodone-Acetaminophenoxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mgXE "Oxycodone-Acetaminophen"Quantity Limit: 370 EA Per 30 DaysoxyCODONE-Aspirinoxycodone-aspirin oral tablet 4.8355-325 mgXE "oxyCODONE-Aspirin"Quantity Limit: 360 EA Per 30 DaysoxyCODONE-Ibuprofenoxycodone-ibuprofen oral tablet 5-400 mgXE "oxyCODONE-Ibuprofen"Quantity Limit: 360 EA Per 30 DaysSymfi LoSYMFI LO ORAL TABLET 400-300-300 MGXE "Symfi Lo"Quantity Limit: 30 EA Per 30 DaysSymfiSYMFI ORAL TABLET 600-300-300 MGXE "Symfi"Quantity Limit: 30 EA Per 30 DaysSyndrosSYNDROS ORAL SOLUTION 5 MG/MLXE "Syndros"Quantity Limit: 120 ML Per 30 DaysTazverikTAZVERIK ORAL TABLET 200 MGXE "Tazverik"Quantity Limit: 240 EA Per 30 DaysTegsediTEGSEDI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 284 MG/1.5MLXE "Tegsedi"Quantity Limit: 6 ML Per 28 DaysTemazepamtemazepam oral capsule 15 mg, 22.5 mg, 30 mgXE "Temazepam"Quantity Limit: 30 EA Per 30 Daystemazepam oral capsule 7.5 mgXE "Temazepam"Quantity Limit: 120 EA Per 30 DaysTolterodine Tartrate ERtolterodine tartrate er oral capsule extended release 24 hour 2 mg, 4 mgXE "Tolterodine Tartrate ER"Quantity Limit: 30 EA Per 30 DaystraMADol HCltramadol hcl oral tablet 100 mgXE "traMADol HCl"Quantity Limit: 120 EA Per 30 Daystramadol hcl oral tablet 50 mgXE "traMADol HCl"Quantity Limit: 240 EA Per 30 DaysTramadol-Acetaminophentramadol-acetaminophen oral tablet 37.5-325 mgXE "Tramadol-Acetaminophen"Quantity Limit: 370 EA Per 30 DaysTriazolamtriazolam oral tablet 0.125 mgXE "Triazolam"Quantity Limit: 30 EA Per 30 Daystriazolam oral tablet 0.25 mgXE "Triazolam"Quantity Limit: 60 EA Per 30 DaysVizimproVIZIMPRO ORAL TABLET 15 MG, 30 MG, 45 MGXE "Vizimpro"Quantity Limit: 30 EA Per 30 DaysVyndamaxVYNDAMAX ORAL CAPSULE 61 MGXE "Vyndamax"Quantity Limit: 30 EA Per 30 DaysZaleplonzaleplon oral capsule 10 mgXE "Zaleplon"Quantity Limit: 60 EA Per 30 Dayszaleplon oral capsule 5 mgXE "Zaleplon"Quantity Limit: 30 EA Per 30 DaysZolpidem Tartratezolpidem tartrate oral tablet 10 mg, 5 mgXE "Zolpidem Tartrate"Quantity Limit: 30 EA Per 30 DaysZTlidoZTLIDO EXTERNAL PATCH 1.8 %XE "ZTlido"Quantity Limit: 90 EA Per 30 DaysIndexINDEX \e "" \c "2" \h "A" \z "1033" AAcetaminophen-Codeine1Acetaminophen-Codeine #31Alfuzosin HCl ER1ALPRAZolam1ALPRAZolam Intensol1ARIPiprazole1Ascomp-Codeine2BBiktarvy2Butalbital-APAP-Caff-Cod2Butalbital-APAP-Caffeine2Butalbital-ASA-Caff-Codeine2CChantix2Chantix Continuing Month Pak2Chantix Starting Month Pak3Clorazepate Dipotassium3DDaliresp3diazePAM3Diazepam3DiazePAM3Dificid3Drizalma Sprinkle4Dronabinol4EEndari4Ergotamine-Caffeine4Estazolam4FFentaNYL4FentaNYL Citrate4Flurazepam HCl5GGalafold5Granisetron HCl5HHYDROcodone-Acetaminophen5Hydrocodone-Ibuprofen5LLidocaine5LORazepam5, 6MModafinil6OOndansetron6Ondansetron HCl6Oxycodone-Acetaminophen6oxyCODONE-Aspirin6oxyCODONE-Ibuprofen6SSymfi7Symfi Lo6Syndros7TTazverik7Tegsedi7Temazepam7Tolterodine Tartrate ER7traMADol HCl7Tramadol-Acetaminophen8Triazolam8VVizimpro8Vyndamax8ZZaleplon8Zolpidem Tartrate8ZTlido8 ................
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