Covered Drugs Index
DRUG PAGE DRUG PAGE
62
September 2024
alprazolam oral tablet 2 mg ............................................................29
alprazolam oral tablet, disintegrating 0.25 mg, 0.5 mg, 1 mg .....29
alprazolam oral tablet, disintegrating 2 mg ................................29
altavera (28) ........................................................................................53
ALUNBRIG ORAL TABLET 30 MG ..............................................16
ALUNBRIG ORAL TABLET 180 MG, 90 MG .............................16
ALUNBRIG ORAL TABLETS, DOSE PACK ..............................16
alyacen 1/35 (28) ...............................................................................53
alyacen 7/7/7 (28) ..............................................................................53
amantadine hcl ...................................................................................10
ambrisentan .........................................................................................57
amethia .................................................................................................53
amethyst (28) ......................................................................................53
amikacin injection solution 1,000 mg/4 ml, 500 mg/2 ml ........13
amiloride ...............................................................................................34
amiloride-hydrochlorothiazide ........................................................34
aminocaproic acid oral .....................................................................36
amiodarone intravenous solution ..................................................34
amiodarone oral tablet 100 mg, 400 mg .....................................34
amiodarone oral tablet 200 mg ......................................................34
amitriptyline..........................................................................................29
amlodipine ............................................................................................34
amlodipine-benazepril ......................................................................34
amlodipine-valsartan .........................................................................34
amlodipine-valsartan-hcthiazid ......................................................34
ammonium lactate .............................................................................38
amoxapine ...........................................................................................29
amoxicillin oral capsule ....................................................................15
amoxicillin oral suspension for reconstitution ............................15
amoxicillin oral tablet ........................................................................15
amoxicillin oral tablet, chewable 125 mg, 250 mg ...................15
amoxicillin-pot clavulanate oral suspension
for reconstitution 200-28.5 mg/5 ml, 400-57 mg/5 ml,
600-42.9 mg/5 ml ...............................................................................15
amoxicillin-pot clavulanate oral suspension
for reconstitution 250-62.5 mg/5 ml ..............................................15
amoxicillin-pot clavulanate oral tablet ..........................................15
amoxicillin-pot clavulanate oral tablet, chewable
200-28.5 mg ........................................................................................15
amoxicillin-pot clavulanate oral tablet, chewable
400-57 mg ............................................................................................15
amoxicillin-pot clavulanate oral tablet extended
release 12 hr .......................................................................................15
amphotericin b ....................................................................................10
amphotericin b liposome ..................................................................10
ampicillin oral capsule 500 mg .......................................................15
ampicillin sodium ................................................................................15
ampicillin-sulbactam ..........................................................................15
anagrelide ............................................................................................40
anastrozole ..........................................................................................16
ANKTIVA ..............................................................................................16
ANORO ELLIPTA ...............................................................................57
apraclonidine .......................................................................................56
aprepitant .............................................................................................46
APRETUDE .........................................................................................10
apri .........................................................................................................53
APTIOM ORAL TABLET 200 MG ..................................................23
APTIOM ORAL TABLET 400 MG ..................................................23
APTIOM ORAL TABLET 600 MG, 800 MG ................................23
APTIVUS ..............................................................................................10
aranelle (28) ........................................................................................53
ARCALYST ..........................................................................................48
AREXVY (PF)......................................................................................48
arformoterol .........................................................................................57
ARIKAYCE ...........................................................................................13
aripiprazole oral solution ..................................................................29
aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 5 mg...................29
aripiprazole oral tablet 20 mg, 30 mg ..........................................29
aripiprazole oral tablet, disintegrating ..........................................29
ARISTADA INITIO ..............................................................................29
ARISTADA INTRAMUSCULAR SUSPENSION,
EXTENDED REL SYRING 1,064 MG/3.9 ML ...........................29
ARISTADA INTRAMUSCULAR SUSPENSION,
EXTENDED REL SYRING 441 MG/1.6 ML ...............................30
ARISTADA INTRAMUSCULAR SUSPENSION,
EXTENDED REL SYRING 662 MG/2.4 ML ...............................30
ARISTADA INTRAMUSCULAR SUSPENSION,
EXTENDED REL SYRING 882 MG/3.2 ML ...............................30
ARNUITY ELLIPTA............................................................................57
arsenic trioxide....................................................................................16
asenapine maleate sublingual tablet 5 mg .................................30
asenapine maleate sublingual tablet 10 mg, 2.5 mg ...............30