AGEWELL 2021



Abacavir Sulfateabacavir sulfate oral solution 20 mg/mlXE "Abacavir Sulfate"Quantity Limit: 960 ML Per 30 Daysabacavir sulfate oral tablet 300 mgXE "Abacavir Sulfate"Quantity Limit: 60 EA Per 30 DaysAbacavir Sulfate-lamiVUDineabacavir sulfate-lamivudine oral tablet 600-300 mgXE "Abacavir Sulfate-lamiVUDine"Quantity Limit: 30 EA Per 30 DaysAbacavir-Lamivudine-Zidovudineabacavir-lamivudine-zidovudine oral tablet 300-150-300 mgXE "Abacavir-Lamivudine-Zidovudine"Quantity Limit: 60 EA Per 30 DaysAcetaminophen-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 DaysAfinitor DisperzAFINITOR DISPERZ ORAL TABLET SOLUBLE 2 MG, 3 MGXE "Afinitor Disperz"Quantity Limit: 30 EA Per 30 DaysAFINITOR DISPERZ ORAL TABLET SOLUBLE 5 MGXE "Afinitor Disperz"Quantity Limit: 60 EA Per 30 DaysAfinitorAFINITOR ORAL TABLET 10 MGXE "Afinitor"Quantity Limit: 30 EA Per 30 DaysAliniaALINIA ORAL SUSPENSION RECONSTITUTED 100 MG/5MLXE "Alinia"Quantity Limit: 150 ML Per 30 DaysALINIA ORAL TABLET 500 MGXE "Alinia"Quantity Limit: 6 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 DaysAlunbrigALUNBRIG ORAL TABLET 180 MGXE "Alunbrig"Quantity Limit: 30 EA Per 30 DaysALUNBRIG ORAL TABLET 30 MGXE "Alunbrig"Quantity Limit: 180 EA Per 30 DaysALUNBRIG ORAL TABLET 90 MGXE "Alunbrig"Quantity Limit: 60 EA Per 30 DaysALUNBRIG ORAL TABLET THERAPY PACK 90 & 180 MGXE "Alunbrig"Quantity Limit: 30 EA Per 30 DaysAprepitantaprepitant oral capsule 125 mg, 40 mg, 80 mgXE "Aprepitant"Quantity Limit: 30 EA Per 30 Daysaprepitant oral capsule 80 & 125 mgXE "Aprepitant"Quantity Limit: 12 EA Per 30 DaysAptivusAPTIVUS ORAL CAPSULE 250 MGXE "Aptivus"Quantity Limit: 120 EA Per 30 DaysAPTIVUS ORAL SOLUTION 100 MG/MLXE "Aptivus"Quantity Limit: 300 ML Per 30 DaysARIPiprazolearipiprazole oral solution 1 mg/mlXE "ARIPiprazole"Quantity Limit: 750 ML Per 30 Daysaripiprazole oral tablet 10 mg, 15 mg, 20 mg, 30 mgXE "ARIPiprazole"Quantity Limit: 30 EA Per 30 Daysaripiprazole oral tablet 2 mg, 5 mgXE "ARIPiprazole"Quantity Limit: 60 EA Per 30 Daysaripiprazole oral tablet dispersible 10 mg, 15 mgXE "ARIPiprazole"Quantity Limit: 60 EA Per 30 DaysArmodafinilarmodafinil oral tablet 150 mg, 200 mg, 250 mg, 50 mgXE "Armodafinil"Quantity Limit: 30 EA Per 30 DaysAscomp-CodeineASCOMP-CODEINE ORAL CAPSULE 50-325-40-30 MGXE "Ascomp-Codeine"Quantity Limit: 180 EA Per 30 DaysAtazanavir Sulfateatazanavir sulfate oral capsule 150 mg, 200 mgXE "Atazanavir Sulfate"Quantity Limit: 60 EA Per 30 Daysatazanavir sulfate oral capsule 300 mgXE "Atazanavir Sulfate"Quantity Limit: 30 EA Per 30 DaysAtomoxetine HClatomoxetine hcl oral capsule 10 mg, 18 mg, 25 mgXE "Atomoxetine HCl"Quantity Limit: 60 EA Per 30 Daysatomoxetine hcl oral capsule 100 mg, 40 mg, 60 mg, 80 mgXE "Atomoxetine HCl"Quantity Limit: 30 EA Per 30 DaysAtriplaATRIPLA ORAL TABLET 600-200-300 MGXE "Atripla"Quantity Limit: 30 EA Per 30 DaysBicalutamidebicalutamide oral tablet 50 mgXE "Bicalutamide"Quantity Limit: 30 EA Per 30 DaysBiktarvyBIKTARVY ORAL TABLET 50-200-25 MGXE "Biktarvy"Quantity Limit: 30 EA Per 30 DaysBraftoviBRAFTOVI ORAL CAPSULE 75 MGXE "Braftovi"Quantity Limit: 180 EA Per 30 DaysBrukinsaBRUKINSA ORAL CAPSULE 80 MGXE "Brukinsa"Quantity Limit: 120 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 DaysCalquenceCALQUENCE ORAL CAPSULE 100 MGXE "Calquence"Quantity Limit: 60 EA Per 30 DaysCaprelsaCAPRELSA ORAL TABLET 100 MGXE "Caprelsa"Quantity Limit: 60 EA Per 30 DaysCAPRELSA ORAL TABLET 300 MGXE "Caprelsa"Quantity Limit: 30 EA Per 30 DaysChlordiazePOXIDE HClchlordiazepoxide hcl oral capsule 10 mg, 25 mg, 5 mgXE "ChlordiazePOXIDE HCl"Quantity Limit: 120 EA Per 30 DaysCimduoCIMDUO ORAL TABLET 300-300 MGXE "Cimduo"Quantity Limit: 30 EA Per 30 DaysCinacalcet HClcinacalcet hcl oral tablet 30 mg, 60 mgXE "Cinacalcet HCl"Quantity Limit: 60 EA Per 30 Dayscinacalcet hcl oral tablet 90 mgXE "Cinacalcet HCl"Quantity Limit: 120 EA Per 30 DaysCloBAZamclobazam oral suspension 2.5 mg/mlXE "CloBAZam"Quantity Limit: 480 ML Per 30 Daysclobazam oral tablet 10 mg, 20 mgXE "CloBAZam"Quantity Limit: 60 EA Per 30 DaysClorazepate Dipotassiumclorazepate dipotassium oral tablet 15 mg, 3.75 mg, 7.5 mgXE "Clorazepate Dipotassium"Quantity Limit: 180 EA Per 30 DaysCodeine Sulfatecodeine sulfate oral tablet 15 mg, 30 mg, 60 mgXE "Codeine Sulfate"Quantity Limit: 180 EA Per 30 DaysCometriq (100 MG Daily Dose)COMETRIQ (100 MG DAILY DOSE) ORAL KIT 80 & 20 MGXE "Cometriq (100 MG Daily Dose)"Quantity Limit: 60 EA Per 30 DaysCometriq (140 MG Daily Dose)COMETRIQ (140 MG DAILY DOSE) ORAL KIT 3 X 20 MG & 80 MGXE "Cometriq (140 MG Daily Dose)"Quantity Limit: 120 EA Per 30 DaysCometriq (60 mg Daily Dose)COMETRIQ (60 MG DAILY DOSE) ORAL KIT 20 MGXE "Cometriq (60 mg Daily Dose)"Quantity Limit: 90 EA Per 30 DaysCompleraCOMPLERA ORAL TABLET 200-25-300 MGXE "Complera"Quantity Limit: 30 EA Per 30 DaysCopiktraCOPIKTRA ORAL CAPSULE 15 MG, 25 MGXE "Copiktra"Quantity Limit: 60 EA Per 30 DaysCrixivanCRIXIVAN ORAL CAPSULE 200 MGXE "Crixivan"Quantity Limit: 450 EA Per 30 DaysCRIXIVAN ORAL CAPSULE 400 MGXE "Crixivan"Quantity Limit: 270 EA Per 30 DaysDalfampridine ERdalfampridine er oral tablet extended release 12 hour 10 mgXE "Dalfampridine ER"Quantity Limit: 60 EA Per 30 DaysDalirespDALIRESP ORAL TABLET 250 MCG, 500 MCGXE "Daliresp"Quantity Limit: 30 EA Per 30 DaysDelstrigoDELSTRIGO ORAL TABLET 100-300-300 MGXE "Delstrigo"Quantity Limit: 30 EA Per 30 DaysDescovyDESCOVY ORAL TABLET 200-25 MGXE "Descovy"Quantity Limit: 30 EA Per 30 DaysDexmethylphenidate HCldexmethylphenidate hcl oral tablet 10 mgXE "Dexmethylphenidate HCl"Quantity Limit: 60 EA Per 30 Daysdexmethylphenidate hcl oral tablet 2.5 mgXE "Dexmethylphenidate HCl"Quantity Limit: 240 EA Per 30 Daysdexmethylphenidate hcl oral tablet 5 mgXE "Dexmethylphenidate HCl"Quantity Limit: 120 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 DaysDidanosinedidanosine oral capsule delayed release 250 mg, 400 mgXE "Didanosine"Quantity Limit: 30 EA Per 30 DaysDovatoDOVATO ORAL TABLET 50-300 MGXE "Dovato"Quantity Limit: 30 EA Per 30 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 DaysEdurantEDURANT ORAL TABLET 25 MGXE "Edurant"Quantity Limit: 30 EA Per 30 DaysEfavirenzefavirenz oral capsule 200 mgXE "Efavirenz"Quantity Limit: 120 EA Per 30 Daysefavirenz oral capsule 50 mgXE "Efavirenz"Quantity Limit: 480 EA Per 30 Daysefavirenz oral tablet 600 mgXE "Efavirenz"Quantity Limit: 30 EA Per 30 DaysEletriptan Hydrobromideeletriptan hydrobromide oral tablet 20 mg, 40 mgXE "Eletriptan Hydrobromide"Quantity Limit: 12 EA Per 30 DaysEmsamEMSAM TRANSDERMAL PATCH 24 HOUR 12 MG/24HR, 6 MG/24HR, 9 MG/24HRXE "Emsam"Quantity Limit: 30 EA Per 30 DaysEmtrivaEMTRIVA ORAL CAPSULE 200 MGXE "Emtriva"Quantity Limit: 30 EA Per 30 DaysEMTRIVA ORAL SOLUTION 10 MG/MLXE "Emtriva"Quantity Limit: 720 ML 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 DaysErlotinib HClerlotinib hcl oral tablet 100 mg, 150 mgXE "Erlotinib HCl"Quantity Limit: 30 EA Per 30 Dayserlotinib hcl oral tablet 25 mgXE "Erlotinib HCl"Quantity Limit: 90 EA Per 30 DaysEverolimuseverolimus oral tablet 2.5 mg, 5 mg, 7.5 mgXE "Everolimus"Quantity Limit: 30 EA Per 30 DaysEvotazEVOTAZ ORAL TABLET 300-150 MGXE "Evotaz"Quantity Limit: 30 EA Per 30 DaysExemestaneexemestane oral tablet 25 mgXE "Exemestane"Quantity Limit: 60 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 DaysFosamprenavir Calciumfosamprenavir calcium oral tablet 700 mgXE "Fosamprenavir Calcium"Quantity Limit: 120 EA Per 30 DaysFuzeonFUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED 90 MGXE "Fuzeon"Quantity Limit: 60 EA Per 30 DaysGalafoldGALAFOLD ORAL CAPSULE 123 MGXE "Galafold"Quantity Limit: 15 EA Per 30 DaysGenvoyaGENVOYA ORAL TABLET 150-150-200-10 MGXE "Genvoya"Quantity Limit: 60 EA Per 30 DaysGocovriGOCOVRI ORAL CAPSULE EXTENDED RELEASE 24 HOUR 137 MGXE "Gocovri"Quantity Limit: 60 EA Per 30 DaysGOCOVRI ORAL CAPSULE EXTENDED RELEASE 24 HOUR 68.5 MGXE "Gocovri"Quantity Limit: 30 EA Per 30 DaysGranisetron HClgranisetron hcl oral tablet 1 mgXE "Granisetron HCl"Quantity Limit: 60 EA Per 30 DaysHetliozHETLIOZ ORAL CAPSULE 20 MGXE "Hetlioz"Quantity Limit: 30 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 DaysHYDROmorphone HClhydromorphone hcl oral liquid 1 mg/mlXE "HYDROmorphone HCl"Quantity Limit: 1920 ML Per 30 Dayshydromorphone hcl oral tablet 2 mg, 4 mgXE "HYDROmorphone HCl"Quantity Limit: 360 EA Per 30 Dayshydromorphone hcl oral tablet 8 mgXE "HYDROmorphone HCl"Quantity Limit: 240 EA Per 30 DaysIDHIFAIDHIFA ORAL TABLET 100 MGXE "IDHIFA"Quantity Limit: 30 EA Per 30 DaysIDHIFA ORAL TABLET 50 MGXE "IDHIFA"Quantity Limit: 60 EA Per 30 DaysInlytaINLYTA ORAL TABLET 1 MGXE "Inlyta"Quantity Limit: 180 EA Per 30 DaysINLYTA ORAL TABLET 5 MGXE "Inlyta"Quantity Limit: 60 EA Per 30 DaysIntelenceINTELENCE ORAL TABLET 100 MG, 25 MGXE "Intelence"Quantity Limit: 120 EA Per 30 DaysINTELENCE ORAL TABLET 200 MGXE "Intelence"Quantity Limit: 60 EA Per 30 DaysInviraseINVIRASE ORAL TABLET 500 MGXE "Invirase"Quantity Limit: 120 EA Per 30 DaysIsentress HDISENTRESS HD ORAL TABLET 600 MGXE "Isentress HD"Quantity Limit: 60 EA Per 30 DaysIsentressISENTRESS ORAL PACKET 100 MGXE "Isentress"Quantity Limit: 60 EA Per 30 DaysISENTRESS ORAL TABLET 400 MGXE "Isentress"Quantity Limit: 120 EA Per 30 DaysISENTRESS ORAL TABLET CHEWABLE 100 MG, 25 MGXE "Isentress"Quantity Limit: 180 EA Per 30 DaysJakafiJAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MGXE "Jakafi"Quantity Limit: 60 EA Per 30 DaysJulucaJULUCA ORAL TABLET 50-25 MGXE "Juluca"Quantity Limit: 30 EA Per 30 DaysJuxtapidJUXTAPID ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 5 MG, 60 MGXE "Juxtapid"Quantity Limit: 30 EA Per 30 DaysKorlymKORLYM ORAL TABLET 300 MGXE "Korlym"Quantity Limit: 120 EA Per 30 DaysLamiVUDinelamivudine oral solution 10 mg/mlXE "LamiVUDine"Quantity Limit: 960 ML Per 30 Dayslamivudine oral tablet 100 mgXE "LamiVUDine"Quantity Limit: 90 EA Per 30 Dayslamivudine oral tablet 150 mgXE "LamiVUDine"Quantity Limit: 60 EA Per 30 Dayslamivudine oral tablet 300 mgXE "LamiVUDine"Quantity Limit: 30 EA Per 30 DaysLamivudine-Zidovudinelamivudine-zidovudine oral tablet 150-300 mgXE "Lamivudine-Zidovudine"Quantity Limit: 60 EA Per 30 DaysLidocainelidocaine external patch 5 %XE "Lidocaine"Quantity Limit: 90 EA Per 30 DaysLidocaine HCllidocaine hcl external solution 4 %XE "Lidocaine HCl"Quantity Limit: 50 ML Per 30 DaysLidocaine HCl Urethral/Mucosallidocaine hcl urethral/mucosal external gel 2 %XE "Lidocaine HCl Urethral/Mucosal"Quantity Limit: 30 ML Per 30 DaysLidocaine-Prilocainelidocaine-prilocaine external cream 2.5-2.5 %XE "Lidocaine-Prilocaine"Quantity Limit: 30 GM Per 30 DaysLORazepam IntensolLORAZEPAM INTENSOL ORAL CONCENTRATE 2 MG/MLXE "LORazepam Intensol"Quantity Limit: 240 ML Per 30 DaysLORazepamlorazepam oral tablet 0.5 mg, 1 mg, 2 mgXE "LORazepam"Quantity Limit: 150 EA Per 30 DaysLorbrenaLORBRENA ORAL TABLET 100 MGXE "Lorbrena"Quantity Limit: 30 EA Per 30 DaysLORBRENA ORAL TABLET 25 MGXE "Lorbrena"Quantity Limit: 90 EA Per 30 DaysMektoviMEKTOVI ORAL TABLET 15 MGXE "Mektovi"Quantity Limit: 180 EA Per 30 DaysMethadone HClmethadone hcl oral solution 10 mg/5ml, 5 mg/5mlXE "Methadone HCl"Quantity Limit: 450 ML Per 30 Daysmethadone hcl oral tablet 10 mg, 5 mgXE "Methadone HCl"Quantity Limit: 240 EA Per 30 DaysMethylphenidate HClmethylphenidate hcl oral solution 10 mg/5mlXE "Methylphenidate HCl"Quantity Limit: 900 ML Per 30 Daysmethylphenidate hcl oral solution 5 mg/5mlXE "Methylphenidate HCl"Quantity Limit: 1800 ML Per 30 DaysModafinilmodafinil oral tablet 100 mg, 200 mgXE "Modafinil"Quantity Limit: 30 EA Per 30 DaysNerlynxNERLYNX ORAL TABLET 40 MGXE "Nerlynx"Quantity Limit: 180 EA Per 30 DaysNevirapine ERnevirapine er oral tablet extended release 24 hour 100 mgXE "Nevirapine ER"Quantity Limit: 90 EA Per 30 Daysnevirapine er oral tablet extended release 24 hour 400 mgXE "Nevirapine ER"Quantity Limit: 30 EA Per 30 DaysNevirapinenevirapine oral suspension 50 mg/5mlXE "Nevirapine"Quantity Limit: 1200 ML Per 30 Daysnevirapine oral tablet 200 mgXE "Nevirapine"Quantity Limit: 60 EA Per 30 DaysNexAVARNEXAVAR ORAL TABLET 200 MGXE "NexAVAR"Quantity Limit: 120 EA Per 30 DaysNilutamidenilutamide oral tablet 150 mgXE "Nilutamide"Quantity Limit: 60 EA Per 30 DaysNorvirNORVIR ORAL PACKET 100 MGXE "Norvir"Quantity Limit: 360 EA Per 30 DaysNORVIR ORAL SOLUTION 80 MG/MLXE "Norvir"Quantity Limit: 480 ML Per 30 DaysOdefseyODEFSEY ORAL TABLET 200-25-25 MGXE "Odefsey"Quantity Limit: 30 EA Per 30 DaysOndansetron HClondansetron hcl oral solution 4 mg/5mlXE "Ondansetron HCl"Quantity Limit: 450 ML Per 30 Daysondansetron 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 DaysOxazepamoxazepam oral capsule 10 mg, 15 mg, 30 mgXE "Oxazepam"Quantity Limit: 120 EA Per 30 DaysOxyCODONE HCloxycodone hcl oral capsule 5 mgXE "OxyCODONE HCl"Quantity Limit: 180 EA Per 30 Daysoxycodone hcl oral concentrate 100 mg/5mlXE "OxyCODONE HCl"Quantity Limit: 180 ML Per 30 Daysoxycodone hcl oral solution 5 mg/5mlXE "OxyCODONE HCl"Quantity Limit: 1080 ML Per 30 DaysoxyCODONE HCloxycodone hcl oral tablet 10 mg, 15 mg, 20 mg, 30 mg, 5 mgXE "oxyCODONE HCl"Quantity Limit: 180 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 DaysOxymorphone HCloxymorphone hcl oral tablet 10 mg, 5 mgXE "Oxymorphone HCl"Quantity Limit: 180 EA Per 30 DaysPaliperidone ERpaliperidone er oral tablet extended release 24 hour 1.5 mg, 3 mg, 9 mgXE "Paliperidone ER"Quantity Limit: 30 EA Per 30 Dayspaliperidone er oral tablet extended release 24 hour 6 mgXE "Paliperidone ER"Quantity Limit: 60 EA Per 30 DaysPifeltroPIFELTRO ORAL TABLET 100 MGXE "Pifeltro"Quantity Limit: 30 EA Per 30 DaysPrezcobixPREZCOBIX ORAL TABLET 800-150 MGXE "Prezcobix"Quantity Limit: 30 EA Per 30 DaysPrezistaPREZISTA ORAL SUSPENSION 100 MG/MLXE "Prezista"Quantity Limit: 360 ML Per 30 DaysPREZISTA ORAL TABLET 150 MGXE "Prezista"Quantity Limit: 240 EA Per 30 DaysPREZISTA ORAL TABLET 600 MGXE "Prezista"Quantity Limit: 60 EA Per 30 DaysPREZISTA ORAL TABLET 75 MGXE "Prezista"Quantity Limit: 480 EA Per 30 DaysPREZISTA ORAL TABLET 800 MGXE "Prezista"Quantity Limit: 30 EA Per 30 DaysPromactaPROMACTA ORAL PACKET 12.5 MGXE "Promacta"Quantity Limit: 360 EA Per 30 DaysPROMACTA ORAL PACKET 25 MGXE "Promacta"Quantity Limit: 180 EA Per 30 DaysPROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MGXE "Promacta"Quantity Limit: 30 EA Per 30 DaysQinlockQINLOCK ORAL TABLET 50 MGXE "Qinlock"Quantity Limit: 90 EA Per 30 DaysRetevmoRETEVMO ORAL CAPSULE 40 MGXE "Retevmo"Quantity Limit: 60 EA Per 30 DaysRETEVMO ORAL CAPSULE 80 MGXE "Retevmo"Quantity Limit: 120 EA Per 30 DaysRitonavirritonavir oral tablet 100 mgXE "Ritonavir"Quantity Limit: 360 EA Per 30 DaysRivastigminerivastigmine transdermal patch 24 hour 13.3 mg/24hr, 4.6 mg/24hr, 9.5 mg/24hrXE "Rivastigmine"Quantity Limit: 30 EA Per 30 DaysRukobiarukobia oral tablet extended release 12 hour 600 mgXE "Rukobia"Quantity Limit: 60 EA Per 30 DaysRydaptRYDAPT ORAL CAPSULE 25 MGXE "Rydapt"Quantity Limit: 240 EA Per 30 DaysSelzentrySELZENTRY ORAL SOLUTION 20 MG/MLXE "Selzentry"Quantity Limit: 1800 ML Per 30 DaysSELZENTRY ORAL TABLET 150 MGXE "Selzentry"Quantity Limit: 240 EA Per 30 DaysSELZENTRY ORAL TABLET 25 MG, 300 MGXE "Selzentry"Quantity Limit: 120 EA Per 30 DaysSELZENTRY ORAL TABLET 75 MGXE "Selzentry"Quantity Limit: 60 EA Per 30 DaysSildenafil Citratesildenafil citrate oral tablet 20 mgXE "Sildenafil Citrate"Quantity Limit: 90 EA Per 30 DaysStavudinestavudine oral capsule 15 mg, 20 mgXE "Stavudine"Quantity Limit: 120 EA Per 30 Daysstavudine oral capsule 30 mg, 40 mgXE "Stavudine"Quantity Limit: 60 EA Per 30 DaysStribildSTRIBILD ORAL TABLET 150-150-200-300 MGXE "Stribild"Quantity Limit: 30 EA Per 30 DaysSUMAtriptansumatriptan nasal solution 20 mg/act, 5 mg/actXE "SUMAtriptan"Quantity Limit: 18 EA Per 30 DaysSUMAtriptan Succinatesumatriptan succinate oral tablet 100 mg, 25 mg, 50 mgXE "SUMAtriptan Succinate"Quantity Limit: 12 EA Per 30 Dayssumatriptan succinate subcutaneous solution 6 mg/0.5mlXE "SUMAtriptan Succinate"Quantity Limit: 8 ML Per 30 Dayssumatriptan succinate subcutaneous solution auto-injector 4 mg/0.5mlXE "SUMAtriptan Succinate"Quantity Limit: 4.5 ML Per 30 Dayssumatriptan succinate subcutaneous solution auto-injector 6 mg/0.5mlXE "SUMAtriptan Succinate"Quantity Limit: 10 ML Per 30 Dayssumatriptan succinate subcutaneous solution prefilled syringe 6 mg/0.5mlXE "SUMAtriptan Succinate"Quantity Limit: 8 ML Per 30 DaysSUMAtriptan Succinate Refillsumatriptan succinate refill subcutaneous solution cartridge 4 mg/0.5ml, 6 mg/0.5mlXE "SUMAtriptan Succinate Refill"Quantity Limit: 10 ML Per 30 DaysSunosiSUNOSI ORAL TABLET 150 MG, 75 MGXE "Sunosi"Quantity Limit: 30 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 DaysSympazanSYMPAZAN ORAL FILM 10 MG, 20 MG, 5 MGXE "Sympazan"Quantity Limit: 60 EA Per 30 DaysSymtuzaSYMTUZA ORAL TABLET 800-150-200-10 MGXE "Symtuza"Quantity Limit: 30 EA Per 30 DaysSyndrosSYNDROS ORAL SOLUTION 5 MG/MLXE "Syndros"Quantity Limit: 120 ML Per 30 DaysTabrectaTABRECTA ORAL TABLET 150 MG, 200 MGXE "Tabrecta"Quantity Limit: 120 EA Per 30 DaysTalzennaTALZENNA ORAL CAPSULE 0.25 MGXE "Talzenna"Quantity Limit: 90 EA Per 30 DaysTALZENNA ORAL CAPSULE 1 MGXE "Talzenna"Quantity Limit: 30 EA 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 DaysTenofovir Disoproxil Fumaratetenofovir disoproxil fumarate oral tablet 300 mgXE "Tenofovir Disoproxil Fumarate"Quantity Limit: 30 EA Per 30 DaysTibsovoTIBSOVO ORAL TABLET 250 MGXE "Tibsovo"Quantity Limit: 60 EA Per 30 DaysTivicayTIVICAY ORAL TABLET 10 MG, 25 MG, 50 MGXE "Tivicay"Quantity Limit: 60 EA Per 30 DaysTivicay PDTIVICAY PD ORAL TABLET SOLUBLE 5 MGXE "Tivicay PD"Quantity Limit: 360 EA Per 30 DaysToremifene Citratetoremifene citrate oral tablet 60 mgXE "Toremifene Citrate"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 DaysTriumeqTRIUMEQ ORAL TABLET 600-50-300 MGXE "Triumeq"Quantity Limit: 30 EA Per 30 DaysTruvadaTRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG, 200-300 MGXE "Truvada"Quantity Limit: 30 EA Per 30 DaysTukysaTUKYSA ORAL TABLET 150 MG, 50 MGXE "Tukysa"Quantity Limit: 120 EA Per 30 DaysTuralioTURALIO ORAL CAPSULE 200 MGXE "Turalio"Quantity Limit: 120 EA Per 30 DaysTybostTYBOST ORAL TABLET 150 MGXE "Tybost"Quantity Limit: 30 EA Per 30 DaysTykerbTYKERB ORAL TABLET 250 MGXE "Tykerb"Quantity Limit: 150 EA Per 30 DaysViraceptVIRACEPT ORAL TABLET 250 MGXE "Viracept"Quantity Limit: 300 EA Per 30 DaysVIRACEPT ORAL TABLET 625 MGXE "Viracept"Quantity Limit: 120 EA Per 30 DaysVireadVIREAD ORAL POWDER 40 MG/GMXE "Viread"Quantity Limit: 240 GM Per 30 DaysVIREAD ORAL TABLET 150 MG, 200 MG, 250 MGXE "Viread"Quantity Limit: 30 EA Per 30 DaysVizimproVIZIMPRO ORAL TABLET 15 MG, 30 MG, 45 MGXE "Vizimpro"Quantity Limit: 30 EA Per 30 DaysVoriconazolevoriconazole oral suspension reconstituted 40 mg/mlXE "Voriconazole"Quantity Limit: 300 ML Per 30 Daysvoriconazole oral tablet 200 mg, 50 mgXE "Voriconazole"Quantity Limit: 120 EA Per 30 DaysVotrientVOTRIENT ORAL TABLET 200 MGXE "Votrient"Quantity Limit: 120 EA Per 30 DaysVyndamaxVYNDAMAX ORAL CAPSULE 61 MGXE "Vyndamax"Quantity Limit: 30 EA Per 30 DaysXalkoriXALKORI ORAL CAPSULE 200 MG, 250 MGXE "Xalkori"Quantity Limit: 60 EA Per 30 DaysXyremXYREM ORAL SOLUTION 500 MG/MLXE "Xyrem"Quantity Limit: 540 ML 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 DaysZejulaZEJULA ORAL CAPSULE 100 MGXE "Zejula"Quantity Limit: 90 EA Per 30 DaysZelborafZELBORAF ORAL TABLET 240 MGXE "Zelboraf"Quantity Limit: 240 EA Per 30 DaysZidovudinezidovudine oral capsule 100 mgXE "Zidovudine"Quantity Limit: 180 EA Per 30 Dayszidovudine oral syrup 50 mg/5mlXE "Zidovudine"Quantity Limit: 1800 ML Per 30 Dayszidovudine oral tablet 300 mgXE "Zidovudine"Quantity Limit: 60 EA Per 30 DaysZolinzaZOLINZA ORAL CAPSULE 100 MGXE "Zolinza"Quantity Limit: 120 EA Per 30 DaysZolpidem Tartrate ERzolpidem tartrate er oral tablet extended release 12.5 mg, 6.25 mgXE "Zolpidem Tartrate ER"Quantity Limit: 30 EA Per 30 DaysZolpidem Tartratezolpidem tartrate oral tablet 10 mg, 5 mgXE "Zolpidem Tartrate"Quantity Limit: 30 EA Per 30 DaysZydeligZYDELIG ORAL TABLET 100 MG, 150 MGXE "Zydelig"Quantity Limit: 60 EA Per 30 DaysIndexINDEX \e "" \c "2" \h "A" \z "1033" AAbacavir Sulfate1Abacavir Sulfate-lamiVUDine1Abacavir-Lamivudine-Zidovudine1Acetaminophen-Codeine1Acetaminophen-Codeine #31Afinitor2Afinitor Disperz1Alinia2ALPRAZolam2ALPRAZolam Intensol2Alunbrig2Aprepitant2, 3Aptivus3ARIPiprazole3Armodafinil3Ascomp-Codeine3Atazanavir Sulfate3Atomoxetine HCl4Atripla4BBicalutamide4Biktarvy4Braftovi4Brukinsa4Butalbital-APAP-Caff-Cod4Butalbital-APAP-Caffeine5Butalbital-ASA-Caff-Codeine5CCalquence5Caprelsa5ChlordiazePOXIDE HCl5Cimduo5Cinacalcet HCl5CloBAZam6Clorazepate Dipotassium6Codeine Sulfate6Cometriq (100 MG Daily Dose)6Cometriq (140 MG Daily Dose)6Cometriq (60 mg Daily Dose)6Complera6Copiktra7Crixivan7DDalfampridine ER7Daliresp7Delstrigo7Descovy7Dexmethylphenidate HCl7diazePAM8Diazepam8DiazePAM8Didanosine8Dovato8Drizalma Sprinkle8Dronabinol8EEdurant9Efavirenz9Eletriptan Hydrobromide9Emsam9Emtriva9Endari9Ergotamine-Caffeine9Erlotinib HCl10Everolimus10Evotaz10Exemestane10FFentaNYL10FentaNYL Citrate10Fosamprenavir Calcium10Fuzeon11GGalafold11Genvoya11Gocovri11Granisetron HCl11HHetlioz11HYDROcodone-Acetaminophen11Hydrocodone-Ibuprofen12HYDROmorphone HCl12IIDHIFA12Inlyta12Intelence12Invirase12Isentress13Isentress HD13JJakafi13Juluca13Juxtapid13KKorlym13LLamiVUDine13, 14Lamivudine-Zidovudine14Lidocaine14Lidocaine HCl14Lidocaine HCl Urethral/Mucosal14Lidocaine-Prilocaine14LORazepam14LORazepam Intensol14Lorbrena15MMektovi15Methadone HCl15Methylphenidate HCl15Modafinil15NNerlynx15Nevirapine16Nevirapine ER15NexAVAR16Nilutamide16Norvir16OOdefsey16Ondansetron16Ondansetron HCl16Oxazepam17oxyCODONE HCl17OxyCODONE HCl17Oxycodone-Acetaminophen17oxyCODONE-Aspirin17Oxymorphone HCl17PPaliperidone ER17, 18Pifeltro18Prezcobix18Prezista18Promacta18QQinlock18RRetevmo19Ritonavir19Rivastigmine19Rukobia19Rydapt19SSelzentry19Sildenafil Citrate19Stavudine20Stribild20SUMAtriptan20SUMAtriptan Succinate20SUMAtriptan Succinate Refill20Sunosi21Symfi21Symfi Lo21Sympazan21Symtuza21Syndros21TTabrecta21Talzenna21Tazverik22Tegsedi22Temazepam22Tenofovir Disoproxil Fumarate22Tibsovo22Tivicay22Tivicay PD22Toremifene Citrate22traMADol HCl23Tramadol-Acetaminophen23Triazolam23Triumeq23Truvada23Tukysa23Turalio23Tybost24Tykerb24VViracept24Viread24Vizimpro24Voriconazole24Votrient24Vyndamax25XXalkori25Xyrem25ZZaleplon25Zejula25Zelboraf25Zidovudine25Zolinza26Zolpidem Tartrate26Zolpidem Tartrate ER26Zydelig26 ................
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