Xatmep

Name: Xatmep
SKU: 5133
Price: 49.95 USD
Availability: InStock

$49.95

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BRAND NAME	GENERIC	PART D	MEDICARE	FPL	SHIP	RENEW	SUPPLY	COST	PROGRAM
3232 A Infant Formula	NO INFO ( PROGRAM AVAIL )
8-MOP	NO INFO ( PROGRAM AVAIL )
A-Hydrocort	NO INFO ( PROGRAM AVAIL )
A-Methapred	NO INFO ( PROGRAM AVAIL )
A+D Original Ointment	NO INFO ( PROGRAM AVAIL )
A+D Zinc Oxide Cream	NO INFO ( PROGRAM AVAIL )
Abilify	NO INFO ( PROGRAM AVAIL )
Abilify Maintena	NO INFO ( PROGRAM AVAIL )
Abraxane	NO INFO ( PROGRAM AVAIL )
Abreva Cream	NO INFO ( PROGRAM AVAIL )
Absorica	NO INFO ( PROGRAM AVAIL )
Abstral	NO INFO ( PROGRAM AVAIL )
Acanya	NO INFO ( PROGRAM AVAIL )
Accolate	NO INFO ( PROGRAM AVAIL )
Accu-Chek Aviva Plus Test Strip	NO INFO ( PROGRAM AVAIL )
Accu-Chek Compact Test Strip	NO INFO ( PROGRAM AVAIL )
Accu-Chek Nano SmartView System	NO INFO ( PROGRAM AVAIL )
Accu-Chek Nano Test Strip	NO INFO ( PROGRAM AVAIL )
Accu-Chek Test Strip	NO INFO ( PROGRAM AVAIL )
Accuneb	NO INFO ( PROGRAM AVAIL )
Accupril	NO INFO ( PROGRAM AVAIL )
Accuretic	NO INFO ( PROGRAM AVAIL )
ACE Brand Braces or Supports	NO INFO ( PROGRAM AVAIL )
ACE Brand Compression Products	NO INFO ( PROGRAM AVAIL )
ACE Brand Custom Dial Support	NO INFO ( PROGRAM AVAIL )
ACE Brand Elastic Bandages	NO INFO ( PROGRAM AVAIL )
Aceon	NO INFO ( PROGRAM AVAIL )
Acetadote	NO INFO ( PROGRAM AVAIL )
AcipHex	NO INFO ( PROGRAM AVAIL )
AcipHex Sprinkle	NO INFO ( PROGRAM AVAIL )
Aclovate	NO INFO ( PROGRAM AVAIL )
Actemra	NO INFO ( PROGRAM AVAIL )
Acthar Gel	NO INFO ( PROGRAM AVAIL )
Acthrel	NO INFO ( PROGRAM AVAIL )
Acticlate	NO INFO ( PROGRAM AVAIL )
Actigall	NO INFO ( PROGRAM AVAIL )
Actimmune	NO INFO ( PROGRAM AVAIL )
Activase	NO INFO ( PROGRAM AVAIL )
Activella	NO INFO ( PROGRAM AVAIL )
Actonel	NO INFO ( PROGRAM AVAIL )
Actos	NO INFO ( PROGRAM AVAIL )
Acular	NO INFO ( PROGRAM AVAIL )
Acuvail	NO INFO ( PROGRAM AVAIL )
Aczone	NO INFO ( PROGRAM AVAIL )
Adacel	NO INFO ( PROGRAM AVAIL )
Adacel Injection	tetanus toxoid/reduced diptheria toxoid/acellular pertussis	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$129.61	Sanofi
Adalat CC	NO INFO ( PROGRAM AVAIL )
Adasuve	NO INFO ( PROGRAM AVAIL )
Adcetris	NO INFO ( PROGRAM AVAIL )
Adcirca	NO INFO ( PROGRAM AVAIL )
Adderall XR	NO INFO ( PROGRAM AVAIL )
Adempas	NO INFO ( PROGRAM AVAIL )
Adipex-P	NO INFO ( PROGRAM AVAIL )
Adlyxin	NO INFO ( PROGRAM AVAIL )
Adrenaclick	NO INFO ( PROGRAM AVAIL )
Adriamycin	NO INFO ( PROGRAM AVAIL )
Adrucil	NO INFO ( PROGRAM AVAIL )
Advair	NO INFO ( PROGRAM AVAIL )
Advair Diskus	fluticasone propionate/salmeterol xinafoate	NO	NO	250	Patient	1 Year	90 Day	$296.83	BtA
Advair DiskusPowder	fluticasone propionate/salmeterol xinafoate	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$296.83	BtA
Advair HFA	fluticasone propionate/salmeterol xinafoate	NO	NO	250	Patient	1 Year	90 Day	$360.95	BtA
Advair HFAAerosol	fluticasone propionate/salmeterol xinafoate	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$360.95	BtA
Advate	NO INFO ( PROGRAM AVAIL )
Advicor	NO INFO ( PROGRAM AVAIL )
Advil Allergy and Congestion Relief	NO INFO ( PROGRAM AVAIL )
Advil Allergy Sinus	NO INFO ( PROGRAM AVAIL )
Advil Cold and Sinus	NO INFO ( PROGRAM AVAIL )
Advil Congestion Relief	NO INFO ( PROGRAM AVAIL )
Advil Film-Coated Tablets	NO INFO ( PROGRAM AVAIL )
Advil Liqui-Gels	NO INFO ( PROGRAM AVAIL )
Advil Migraine	NO INFO ( PROGRAM AVAIL )
Advil PM Caplets	NO INFO ( PROGRAM AVAIL )
Advil PM Liqui-Gels	NO INFO ( PROGRAM AVAIL )
Adynovate	NO INFO ( PROGRAM AVAIL )
Adzenys XR-ODT	NO INFO ( PROGRAM AVAIL )
Aerochamber	NO INFO ( PROGRAM AVAIL )
Aerochamber Plus Flow-Vu	NO INFO ( PROGRAM AVAIL )
Aerospan HFA	NO INFO ( PROGRAM AVAIL )
Afinitor	NO INFO ( PROGRAM AVAIL )
Afinitor Disperz	NO INFO ( PROGRAM AVAIL )
Afrezza	NO INFO ( PROGRAM AVAIL )
Afrin Extra Moisturizing No Drip	NO INFO ( PROGRAM AVAIL )
Afrin Original	NO INFO ( PROGRAM AVAIL )
Afrin Original No Drip	NO INFO ( PROGRAM AVAIL )
Afrin Original Pump Mist	NO INFO ( PROGRAM AVAIL )
Afrin Sinus	NO INFO ( PROGRAM AVAIL )
Afstyla	NO INFO ( PROGRAM AVAIL )
Aggrenox	NO INFO ( PROGRAM AVAIL )
Agrylin	NO INFO ( PROGRAM AVAIL )
Air Optix Aqua Multifocal Lenses	NO INFO ( PROGRAM AVAIL )
AirDuo RespiClick	NO INFO ( PROGRAM AVAIL )
Akynzeo	NO INFO ( PROGRAM AVAIL )
Alavert	NO INFO ( PROGRAM AVAIL )
Alaway	NO INFO ( PROGRAM AVAIL )
Alaway Children\'s Eye Itch Relief Drops	NO INFO ( PROGRAM AVAIL )
Albenza	NO INFO ( PROGRAM AVAIL )
Alcortin A	NO INFO ( PROGRAM AVAIL )
Aldactazide	NO INFO ( PROGRAM AVAIL )
Aldactone	NO INFO ( PROGRAM AVAIL )
Aldara	NO INFO ( PROGRAM AVAIL )
Aldurazyme	NO INFO ( PROGRAM AVAIL )
Alecensa	NO INFO ( PROGRAM AVAIL )
Aleve	NO INFO ( PROGRAM AVAIL )
Aleve Direct Therapy Refill Gel Pads	NO INFO ( PROGRAM AVAIL )
Aleve PM	NO INFO ( PROGRAM AVAIL )
Aleve-D Sinus and Cold	NO INFO ( PROGRAM AVAIL )
Alfamino Infant	NO INFO ( PROGRAM AVAIL )
Alfamino Junior	NO INFO ( PROGRAM AVAIL )
Alferon N Injection	NO INFO ( PROGRAM AVAIL )
Alimta	NO INFO ( PROGRAM AVAIL )
Alinia	NO INFO ( PROGRAM AVAIL )
Aliqopa	NO INFO ( PROGRAM AVAIL )
Alka-Seltzer Products	NO INFO ( PROGRAM AVAIL )
Alkeran	NO INFO ( PROGRAM AVAIL )
Allegra	NO INFO ( PROGRAM AVAIL )
Allegra Allergy 12 Hour	NO INFO ( PROGRAM AVAIL )
Allegra Allergy 24 Hour	NO INFO ( PROGRAM AVAIL )
Allegra Anti-itch Products	NO INFO ( PROGRAM AVAIL )
Allegra Products	NO INFO ( PROGRAM AVAIL )
Allegra-D 12 Hour	NO INFO ( PROGRAM AVAIL )
Allegra-D 24 Hour	NO INFO ( PROGRAM AVAIL )
AlloDerm	NO INFO ( PROGRAM AVAIL )
AlloSkin	NO INFO ( PROGRAM AVAIL )
AlloWrap	NO INFO ( PROGRAM AVAIL )
Alora	NO INFO ( PROGRAM AVAIL )
Aloxi	NO INFO ( PROGRAM AVAIL )
Alphagan P	NO INFO ( PROGRAM AVAIL )
Alphanate	NO INFO ( PROGRAM AVAIL )
AlphaNine SD	NO INFO ( PROGRAM AVAIL )
Alprolix	NO INFO ( PROGRAM AVAIL )
Alrex	NO INFO ( PROGRAM AVAIL )
Altabax	NO INFO ( PROGRAM AVAIL )
Altace	NO INFO ( PROGRAM AVAIL )
Altera Nebulizer for Cayston	NO INFO ( PROGRAM AVAIL )
Altoprev	NO INFO ( PROGRAM AVAIL )
Alunbrig	NO INFO ( PROGRAM AVAIL )
Alvesco	NO INFO ( PROGRAM AVAIL )
Always Sanitary Products	NO INFO ( PROGRAM AVAIL )
Amaryl	NO INFO ( PROGRAM AVAIL )
Ambien	NO INFO ( PROGRAM AVAIL )
Ambien CR	NO INFO ( PROGRAM AVAIL )
AmBisome	NO INFO ( PROGRAM AVAIL )
Amelior	NO INFO ( PROGRAM AVAIL )
Amicar	NO INFO ( PROGRAM AVAIL )
Amidate	NO INFO ( PROGRAM AVAIL )
Amitiza	Lubiprostone	YES	YES	400	Patient	1 Year	90 Day	$349.69	Takeda
AmLactin Cerapeutic Restoring Body Lotion	NO INFO ( PROGRAM AVAIL )
AmLactin Foot Cream Therapy	NO INFO ( PROGRAM AVAIL )
AmLactin Hydrating Body Cream	NO INFO ( PROGRAM AVAIL )
AmLactin Moisturizing Body Lotion	NO INFO ( PROGRAM AVAIL )
Ammonul	NO INFO ( PROGRAM AVAIL )
Amnesteem	NO INFO ( PROGRAM AVAIL )
Amnioband	NO INFO ( PROGRAM AVAIL )
AmnioExcel	NO INFO ( PROGRAM AVAIL )
AmnioMatrix	NO INFO ( PROGRAM AVAIL )
Ampyra	NO INFO ( PROGRAM AVAIL )
Anafranil	NO INFO ( PROGRAM AVAIL )
Analpram HC	NO INFO ( PROGRAM AVAIL )
Anaprox	NO INFO ( PROGRAM AVAIL )
Anaprox DS	NO INFO ( PROGRAM AVAIL )
Anaspaz	NO INFO ( PROGRAM AVAIL )
Ancobon	NO INFO ( PROGRAM AVAIL )
AndroGel	testosterone	YES	YES	300	Patient	1 Year	90 Day	$4,801.94	AbbVIe
Android	NO INFO ( PROGRAM AVAIL )
Androxy	NO INFO ( PROGRAM AVAIL )
Angeliq	NO INFO ( PROGRAM AVAIL )
Animi-3	NO INFO ( PROGRAM AVAIL )
Animi-3 with Vitamin D	NO INFO ( PROGRAM AVAIL )
Anoro Ellipta	umeclidinium bromide/vilanterol trifenatate	YES (LIS Denial)	YES	250	Patient	1 Year	90 Day	$345.27	BtA
Antara	NO INFO ( PROGRAM AVAIL )
Antivert	NO INFO ( PROGRAM AVAIL )
Anusol-HC	NO INFO ( PROGRAM AVAIL )
Anzemet	NO INFO ( PROGRAM AVAIL )
Apexicon	NO INFO ( PROGRAM AVAIL )
ApexiCon E	NO INFO ( PROGRAM AVAIL )
Apidra	NO INFO ( PROGRAM AVAIL )
Apidra SoloStar Pen	insulin glulisine [rDNA origin]	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$567.75	Sanofi
ApidraVials	insulin glulisine [rDNA origin]	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$294.38	Sanofi
Apligraf	NO INFO ( PROGRAM AVAIL )
Apokyn	NO INFO ( PROGRAM AVAIL )
Apresoline	NO INFO ( PROGRAM AVAIL )
Apriso	NO INFO ( PROGRAM AVAIL )
Aptensio XR	NO INFO ( PROGRAM AVAIL )
Aptiom	NO INFO ( PROGRAM AVAIL )
Aptivus	NO INFO ( PROGRAM AVAIL )
Aptivus Capsule	tipranavir	YES	YES	200	Patient	1 Year	90 Day	$1,519.72	BIC
Aptivus Oral Solution	tipranavir	YES	YES	200	Patient	1 Year	90 Day	$507.22	BIC
AquaSol A	NO INFO ( PROGRAM AVAIL )
Aquoral	NO INFO ( PROGRAM AVAIL )
Aralast NP	NO INFO ( PROGRAM AVAIL )
Aranesp	NO INFO ( PROGRAM AVAIL )
Arava	NO INFO ( PROGRAM AVAIL )
Arcapta	NO INFO ( PROGRAM AVAIL )
Arcapta NeohalerPowder	indaceterol	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$247.02	Novartis
Aredia	NO INFO ( PROGRAM AVAIL )
Arestin	NO INFO ( PROGRAM AVAIL )
Aricept	NO INFO ( PROGRAM AVAIL )
Arimidex	NO INFO ( PROGRAM AVAIL )
Arimidex Tablet	anastrozole	YES + LIS DENIAL + 3% OOP	YES	300	Patient	End Of Year	90 Day	$549.97	AZ&ME
Aristada (1064mg)	NO INFO ( PROGRAM AVAIL )
Aristada (441mg)	NO INFO ( PROGRAM AVAIL )
Aristada (662mg)	NO INFO ( PROGRAM AVAIL )
Aristada (882mg)	NO INFO ( PROGRAM AVAIL )
Aristocort	NO INFO ( PROGRAM AVAIL )
Armour Thyroid	thyroid desiccated	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day		Allergan
Arnicare Topical Products	NO INFO ( PROGRAM AVAIL )
Arnuity Ellipta	NO INFO ( PROGRAM AVAIL )
Aromasin	NO INFO ( PROGRAM AVAIL )
Aromasin Tablet	exemestane	YES	YES	400	Doctor	1 Year	90 Day	$1,058.72	Pfizer
Arranon	NO INFO ( PROGRAM AVAIL )
Arthriten	NO INFO ( PROGRAM AVAIL )
ArthroFlex	NO INFO ( PROGRAM AVAIL )
Arthrotec	NO INFO ( PROGRAM AVAIL )
Arthrotec Tablet	diclofenac sodium/misoprostol	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Arymo ER	NO INFO ( PROGRAM AVAIL )
Arzerra	NO INFO ( PROGRAM AVAIL )
Asacol	NO INFO ( PROGRAM AVAIL )
Asacol HD	NO INFO ( PROGRAM AVAIL )
Asmalpred	NO INFO ( PROGRAM AVAIL )
Asmanex	NO INFO ( PROGRAM AVAIL )
Asmanex HFA	NO INFO ( PROGRAM AVAIL )
Asmanex Twisthaler	NO INFO ( PROGRAM AVAIL )
Asmanex TwisthalerInhalation	mometasone	YES	YES	400	Patient	1 Year	90 Day	$309.92	Merck
Astagraf XL	NO INFO ( PROGRAM AVAIL )
Astelin	NO INFO ( PROGRAM AVAIL )
Astroglide Products	NO INFO ( PROGRAM AVAIL )
Atacand	NO INFO ( PROGRAM AVAIL )
Atacand HCT	NO INFO ( PROGRAM AVAIL )
Atelvia	NO INFO ( PROGRAM AVAIL )
Atgam	NO INFO ( PROGRAM AVAIL )
Ativan	NO INFO ( PROGRAM AVAIL )
Atralin	NO INFO ( PROGRAM AVAIL )
Atripla	NO INFO ( PROGRAM AVAIL )
Atrovent	NO INFO ( PROGRAM AVAIL )
Atrovent HFA	NO INFO ( PROGRAM AVAIL )
Atrovent HFAAerosol	ipratropium bromide HFA	YES	YES	200	Patient	1 Year	90 Day		BIC
Aubagio	NO INFO ( PROGRAM AVAIL )
Auryxia	NO INFO ( PROGRAM AVAIL )
Austedo	NO INFO ( PROGRAM AVAIL )
Auvi-Q	NO INFO ( PROGRAM AVAIL )
Auvi-Q Injectable	epinephrine	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies		Kaleo Cares
Avalide	NO INFO ( PROGRAM AVAIL )
Avandia	NO INFO ( PROGRAM AVAIL )
Avandia Tablets	rosiglitazon/glimepiride	NO	NO	250	Patient	1 Year	90 Day	$161.72	BtA
AvandiaTablet	rosiglitazone maleate	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$161.72	BtA
Avapro	NO INFO ( PROGRAM AVAIL )
Avar Family Products	NO INFO ( PROGRAM AVAIL )
Avastin	NO INFO ( PROGRAM AVAIL )
Aveed	NO INFO ( PROGRAM AVAIL )
Aveeno Products	NO INFO ( PROGRAM AVAIL )
Avelox	NO INFO ( PROGRAM AVAIL )
Avodart	NO INFO ( PROGRAM AVAIL )
Avodart Soft Gelatin Tablets	dutasteride	NO	NO	250	Patient	1 Year	90 Day	$211.87	BtA
Avodart Tablet	dutasteride	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$211.87	BtA
Avonex	NO INFO ( PROGRAM AVAIL )
Avycaz	NO INFO ( PROGRAM AVAIL )
Axid	NO INFO ( PROGRAM AVAIL )
Axona	NO INFO ( PROGRAM AVAIL )
Aygestin	NO INFO ( PROGRAM AVAIL )
Azasan	NO INFO ( PROGRAM AVAIL )
AzaSite	NO INFO ( PROGRAM AVAIL )
Azelex	NO INFO ( PROGRAM AVAIL )
Azilect	NO INFO ( PROGRAM AVAIL )
Azmacort	NO INFO ( PROGRAM AVAIL )
AZO	NO INFO ( PROGRAM AVAIL )
AZO Bladder Control	NO INFO ( PROGRAM AVAIL )
AZO Cranberry	NO INFO ( PROGRAM AVAIL )
AZO Itch Relief Max Strength	NO INFO ( PROGRAM AVAIL )
AZO PMS	NO INFO ( PROGRAM AVAIL )
AZO Test Strip	NO INFO ( PROGRAM AVAIL )
AZO Urinary Pain Relief	NO INFO ( PROGRAM AVAIL )
AZO Urinary Pain Relief Maximum Strength	NO INFO ( PROGRAM AVAIL )
AZO Urinary Tract Defense	NO INFO ( PROGRAM AVAIL )
AZO Yeast	NO INFO ( PROGRAM AVAIL )
Azopt	NO INFO ( PROGRAM AVAIL )
Azor	amlodipine/olmesartan medoxmil	NO	NO	200	Doctor	1 Year	90 day	$240	Daiichi Sankyo
Azulfidine	NO INFO ( PROGRAM AVAIL )
Azulfidine En-Tab	NO INFO ( PROGRAM AVAIL )
Bacitracin for Injection	NO INFO ( PROGRAM AVAIL )
Bactrim	NO INFO ( PROGRAM AVAIL )
Bactroban	NO INFO ( PROGRAM AVAIL )
Bactroban Cream	mupirocin calcium	NO	NO	250	Patient	1 Year	90 Day	$222.17	BtA
Bactroban Cream2	mupirocin calcium	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$222.17	BtA
Bactroban Nasal Ointment	mupirocin calcium	NO	NO	250	Patient	1 Year	90 Day	$168.98	BtA
Bactroban Ointment	mupirocin calcium	NO	NO	250	Patient	1 Year	90 Day	$168.98	BtA
Bactroban Ointment; Nasal2	mupirocin calcium	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$168.98	BtA
Bactroban Ointment2	mupirocin calcium	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$168.98	BtA
Balmex Diaper Rash Cream Stick	NO INFO ( PROGRAM AVAIL )
Balmex Diaper Rash Cream with ActivGuard	NO INFO ( PROGRAM AVAIL )
Balmex Multi-Purpose Healing Ointment	NO INFO ( PROGRAM AVAIL )
Balneol	NO INFO ( PROGRAM AVAIL )
Band-Aid Brand Products	NO INFO ( PROGRAM AVAIL )
Band-Aid Flexible Fabric	NO INFO ( PROGRAM AVAIL )
Banzel	NO INFO ( PROGRAM AVAIL )
Baraclude	NO INFO ( PROGRAM AVAIL )
Basaglar	NO INFO ( PROGRAM AVAIL )
Bavencio	NO INFO ( PROGRAM AVAIL )
Baxdela	NO INFO ( PROGRAM AVAIL )
Bayer Aspirin Products	NO INFO ( PROGRAM AVAIL )
BCAD 1 Infant Formula	NO INFO ( PROGRAM AVAIL )
BCAD 2 Medical Food	NO INFO ( PROGRAM AVAIL )
Beano	NO INFO ( PROGRAM AVAIL )
Beano Meltaways	NO INFO ( PROGRAM AVAIL )
Bebulin	NO INFO ( PROGRAM AVAIL )
Beconase AQ	beclomethasone	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day		GSK
Beconase AQSpray; Nasal0.042	beclomethasone	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day		GSK
Belbuca	NO INFO ( PROGRAM AVAIL )
Beleodaq	NO INFO ( PROGRAM AVAIL )
Belsomra	NO INFO ( PROGRAM AVAIL )
Belviq	NO INFO ( PROGRAM AVAIL )
Belviq XR	NO INFO ( PROGRAM AVAIL )
Benadryl Allergy Dye-Free Liqui-Gels	NO INFO ( PROGRAM AVAIL )
Benadryl Anti-Itch Gel for Kids	NO INFO ( PROGRAM AVAIL )
Benadryl Extra Strength Itch Relief Stick	NO INFO ( PROGRAM AVAIL )
Benadryl Extra Strength Spray	NO INFO ( PROGRAM AVAIL )
Benadryl Itch Stopping Cream Extra Strength	NO INFO ( PROGRAM AVAIL )
Benadryl Itch Stopping Cream Original Strength	NO INFO ( PROGRAM AVAIL )
Benadryl Itch Stopping Gel Extra Strength	NO INFO ( PROGRAM AVAIL )
Benadryl READYMIST	NO INFO ( PROGRAM AVAIL )
Benadryl ULTRATAB	NO INFO ( PROGRAM AVAIL )
Bendeka	NO INFO ( PROGRAM AVAIL )
Benefix	NO INFO ( PROGRAM AVAIL )
Bengay products	NO INFO ( PROGRAM AVAIL )
Bengay Zero Degrees	NO INFO ( PROGRAM AVAIL )
Benicar	NO INFO ( PROGRAM AVAIL )
Benicar HCT	NO INFO ( PROGRAM AVAIL )
Benicar Tablets	olmesartan	NO	NO	200	Doctor	1 Year	90 day	$320.20	Daiichi Sankyo
Benlysta	NO INFO ( PROGRAM AVAIL )
Bentyl	NO INFO ( PROGRAM AVAIL )
BenzoDox 30Kit	NO INFO ( PROGRAM AVAIL )
BenzoDox 60Kit	NO INFO ( PROGRAM AVAIL )
Bepreve	NO INFO ( PROGRAM AVAIL )
Berinert	NO INFO ( PROGRAM AVAIL )
Besivance	NO INFO ( PROGRAM AVAIL )
Besponsa	NO INFO ( PROGRAM AVAIL )
Betapace	NO INFO ( PROGRAM AVAIL )
Betaseron	NO INFO ( PROGRAM AVAIL )
Bethkis	NO INFO ( PROGRAM AVAIL )
Betimol	NO INFO ( PROGRAM AVAIL )
Betoptic S	NO INFO ( PROGRAM AVAIL )
Bevespi Aerosphere	NO INFO ( PROGRAM AVAIL )
Bevyxxa	NO INFO ( PROGRAM AVAIL )
Bexxar	NO INFO ( PROGRAM AVAIL )
Beyaz	NO INFO ( PROGRAM AVAIL )
Bicnu	NO INFO ( PROGRAM AVAIL )
BiDil	NO INFO ( PROGRAM AVAIL )
Biktarvy	NO INFO ( PROGRAM AVAIL )
Biltricide	NO INFO ( PROGRAM AVAIL )
Binosto	NO INFO ( PROGRAM AVAIL )
BioDFence	NO INFO ( PROGRAM AVAIL )
BioDFence DryFlex	NO INFO ( PROGRAM AVAIL )
Bionect Cream	NO INFO ( PROGRAM AVAIL )
Biotrue Multi-Purpose Solution	NO INFO ( PROGRAM AVAIL )
BioVance	NO INFO ( PROGRAM AVAIL )
Bivigam	NO INFO ( PROGRAM AVAIL )
Blenoxane	NO INFO ( PROGRAM AVAIL )
Blephamide	NO INFO ( PROGRAM AVAIL )
Blephamide S.O.P.	NO INFO ( PROGRAM AVAIL )
Blincyto	NO INFO ( PROGRAM AVAIL )
Bodhe Therapeutic Medical Apparel	NO INFO ( PROGRAM AVAIL )
Boniva	NO INFO ( PROGRAM AVAIL )
Boost Kid Essentials	NO INFO ( PROGRAM AVAIL )
Boost Kid Essentials 1.5	NO INFO ( PROGRAM AVAIL )
Boost Kid Essentials 1.5 Fiber	NO INFO ( PROGRAM AVAIL )
Boost Original	NO INFO ( PROGRAM AVAIL )
Boost Plus	NO INFO ( PROGRAM AVAIL )
Boost VHC	NO INFO ( PROGRAM AVAIL )
Boostrix	NO INFO ( PROGRAM AVAIL )
Bosulif	NO INFO ( PROGRAM AVAIL )
Bosulif Tablet	bosutinib	YES	YES	400	Varies	1 Year	90 Day	$3,196.96	Pfizer
Botox	NO INFO ( PROGRAM AVAIL )
BrainStrong Prenatal Supplement	NO INFO ( PROGRAM AVAIL )
Brava Accessories	NO INFO ( PROGRAM AVAIL )
Bravelle	NO INFO ( PROGRAM AVAIL )
Breathe Right Advance	NO INFO ( PROGRAM AVAIL )
Breathe Right Clear	NO INFO ( PROGRAM AVAIL )
Breathe Right Extra	NO INFO ( PROGRAM AVAIL )
Breathe Right Extra Clear	NO INFO ( PROGRAM AVAIL )
Breathe Right Kids	NO INFO ( PROGRAM AVAIL )
Breathe Right Menthol	NO INFO ( PROGRAM AVAIL )
Breathe Right Original Tan	NO INFO ( PROGRAM AVAIL )
Breo Ellipta	fluticasone furoate/vilanterol trifenatate	NO	NO	250	Patient	1 Year	90 Day	$317.59	BtA
Breo ElliptaInhalation Powder	fluticasone furoate/vilanterol trifenatate	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$317.59	BtA
Brevibloc	NO INFO ( PROGRAM AVAIL )
Bridion	NO INFO ( PROGRAM AVAIL )
Brilinta	NO INFO ( PROGRAM AVAIL )
Brilinta Tablet	ticagrelor	YES + LIS DENIAL + 3% OOP	YES	300	Patient	End Of Year	90 Day	$170.89	AZ&ME
Brineura	NO INFO ( PROGRAM AVAIL )
Brisdelle	NO INFO ( PROGRAM AVAIL )
Briviact	NO INFO ( PROGRAM AVAIL )
Bromfed DM	NO INFO ( PROGRAM AVAIL )
BromSite	NO INFO ( PROGRAM AVAIL )
BumpKlear Lotion	NO INFO ( PROGRAM AVAIL )
BumpKlear Wash	NO INFO ( PROGRAM AVAIL )
Bunavail	NO INFO ( PROGRAM AVAIL )
Buphenyl	NO INFO ( PROGRAM AVAIL )
Busulfex	NO INFO ( PROGRAM AVAIL )
Butrans	NO INFO ( PROGRAM AVAIL )
Butrans Transdermal	buprenorphine	NO	NO	139	Patient	1 Year	30 Day		Purdue
Bydureon	NO INFO ( PROGRAM AVAIL )
Bydureon BCise	NO INFO ( PROGRAM AVAIL )
Bydureon Pen	NO INFO ( PROGRAM AVAIL )
Bydureon Vial ER	exenatide synthetic	YES + 3% OOP	YES	300	Patient	1 Year	90 Day	$613.83	AZ&ME
Byetta	NO INFO ( PROGRAM AVAIL )
Byetta Injection	exenatide	YES + 3% OOP	YES	300	Patient	1 Year	90 Day	$658.59	AZ&ME
Bystolic	NO INFO ( PROGRAM AVAIL )
Bystolic Tablets	nebivolol	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$118.55	Allergan
Byvalson	NO INFO ( PROGRAM AVAIL )
Cabometyx	NO INFO ( PROGRAM AVAIL )
Caduet	NO INFO ( PROGRAM AVAIL )
Caduet Tablets	amlodipine besylate/atorvastatin calcium	YES	YES	400	Varies	1 Year	90 Day	$408.15	Pfizer
Calan	NO INFO ( PROGRAM AVAIL )
Calan SR	NO INFO ( PROGRAM AVAIL )
Calcijex	NO INFO ( PROGRAM AVAIL )
Calcilo XD	NO INFO ( PROGRAM AVAIL )
Calcitrene	NO INFO ( PROGRAM AVAIL )
Calendula Cream	NO INFO ( PROGRAM AVAIL )
Calendula Gel	NO INFO ( PROGRAM AVAIL )
Calendula Lotion	NO INFO ( PROGRAM AVAIL )
Calendula Ointment	NO INFO ( PROGRAM AVAIL )
Callex	NO INFO ( PROGRAM AVAIL )
Calquence	NO INFO ( PROGRAM AVAIL )
Cambia	NO INFO ( PROGRAM AVAIL )
Camilia-Teething Relief	NO INFO ( PROGRAM AVAIL )
Campath	NO INFO ( PROGRAM AVAIL )
Campral	NO INFO ( PROGRAM AVAIL )
Camptosar	NO INFO ( PROGRAM AVAIL )
Canasa	NO INFO ( PROGRAM AVAIL )
Cancidas	NO INFO ( PROGRAM AVAIL )
Capex	NO INFO ( PROGRAM AVAIL )
Capoten	NO INFO ( PROGRAM AVAIL )
Caprelsa	NO INFO ( PROGRAM AVAIL )
Carac	NO INFO ( PROGRAM AVAIL )
Carafate	NO INFO ( PROGRAM AVAIL )
Carbaglu	NO INFO ( PROGRAM AVAIL )
Carbatrol	carbamazepine	YES	YES	300	Card	1 Year	90 Day		Shire Cares
Cardizem	NO INFO ( PROGRAM AVAIL )
Cardizem CD	NO INFO ( PROGRAM AVAIL )
Cardizem LA	NO INFO ( PROGRAM AVAIL )
Cardura	NO INFO ( PROGRAM AVAIL )
Carimune	NO INFO ( PROGRAM AVAIL )
Carimune NF	NO INFO ( PROGRAM AVAIL )
Carmex Classic Lip Balm product	NO INFO ( PROGRAM AVAIL )
Carmex Cold Sore Treatment	NO INFO ( PROGRAM AVAIL )
Carmex Daily Care Stick	NO INFO ( PROGRAM AVAIL )
Carmex Lip Comfort Care product	NO INFO ( PROGRAM AVAIL )
Carnitor	NO INFO ( PROGRAM AVAIL )
Carnitor SF	NO INFO ( PROGRAM AVAIL )
Carospir	NO INFO ( PROGRAM AVAIL )
Cartia XT	NO INFO ( PROGRAM AVAIL )
Casodex	NO INFO ( PROGRAM AVAIL )
Cataflam	NO INFO ( PROGRAM AVAIL )
Catapres	NO INFO ( PROGRAM AVAIL )
Catapres-TTS-3	NO INFO ( PROGRAM AVAIL )
Cathflo	NO INFO ( PROGRAM AVAIL )
Caverjec tInjection	alprostadil	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Caverject Impulse	NO INFO ( PROGRAM AVAIL )
Cayston	NO INFO ( PROGRAM AVAIL )
CeeNU	NO INFO ( PROGRAM AVAIL )
Celebrex	NO INFO ( PROGRAM AVAIL )
Celebrex Capsule	celecoxib	YES	YES	400	Doctor	1 Year	90 Day	$761.35	Pfizer
Celestone	NO INFO ( PROGRAM AVAIL )
Celestone Soluspan	NO INFO ( PROGRAM AVAIL )
Celexa	NO INFO ( PROGRAM AVAIL )
Cellcept	NO INFO ( PROGRAM AVAIL )
Celontin	NO INFO ( PROGRAM AVAIL )
Celontin Capsule	methsuximide	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Cenestin	NO INFO ( PROGRAM AVAIL )
Centrum Kids Products	NO INFO ( PROGRAM AVAIL )
Centrum Men\'s Products	NO INFO ( PROGRAM AVAIL )
Centrum Silver Products	NO INFO ( PROGRAM AVAIL )
Centrum Specialty Products	NO INFO ( PROGRAM AVAIL )
Centrum Women\'s Products	NO INFO ( PROGRAM AVAIL )
Cepacol Antibacterial Mouthwash	NO INFO ( PROGRAM AVAIL )
Cepacol Sensations	NO INFO ( PROGRAM AVAIL )
Cepacol Sore Throat Spray	NO INFO ( PROGRAM AVAIL )
CeraVe Moisturizers	NO INFO ( PROGRAM AVAIL )
Cerdelga	NO INFO ( PROGRAM AVAIL )
CerefolinNAC	NO INFO ( PROGRAM AVAIL )
Cerezyme	NO INFO ( PROGRAM AVAIL )
Cerubidine	NO INFO ( PROGRAM AVAIL )
Cesamet	NO INFO ( PROGRAM AVAIL )
Cetrotide	NO INFO ( PROGRAM AVAIL )
Chantix	NO INFO ( PROGRAM AVAIL )
Chantix Tablet	varenicline	YES	YES	400	Doctor	1 Year	90 Day	$369.34	Pfizer
Chemet	NO INFO ( PROGRAM AVAIL )
Chestal Products-Adult\'s	NO INFO ( PROGRAM AVAIL )
Chestal Products-Children\'s	NO INFO ( PROGRAM AVAIL )
Children\'s Advil Suspension	NO INFO ( PROGRAM AVAIL )
Children\'s Allegra Products	NO INFO ( PROGRAM AVAIL )
Children\'s Benadryl	NO INFO ( PROGRAM AVAIL )
Children\'s Benadryl-D	NO INFO ( PROGRAM AVAIL )
Children\'s Dimetapp Cold and Allergy Chewable Tablets	NO INFO ( PROGRAM AVAIL )
Children\'s Dimetapp Cold and Allergy Syrup	NO INFO ( PROGRAM AVAIL )
Children\'s Dimetapp Cough and Cold	NO INFO ( PROGRAM AVAIL )
Children\'s Dimetapp Long Acting Cough Plus Cold	NO INFO ( PROGRAM AVAIL )
Children\'s Dimetapp Multi-Symptom Cold and Flu	NO INFO ( PROGRAM AVAIL )
Children\'s Dimetapp Nighttime Cold and Congestion	NO INFO ( PROGRAM AVAIL )
Children\'s Oscillococcinum	NO INFO ( PROGRAM AVAIL )
Children\'s Sudafed PE Cold and Cough	NO INFO ( PROGRAM AVAIL )
Children\'s Sudafed PE Nasal Decongestant	NO INFO ( PROGRAM AVAIL )
Childrens Claritin Products	NO INFO ( PROGRAM AVAIL )
Chloraseptic Sore Throat Lozenges	NO INFO ( PROGRAM AVAIL )
Chloraseptic Sore Throat Spray	NO INFO ( PROGRAM AVAIL )
Chloraseptic Throat Spray for Kids	NO INFO ( PROGRAM AVAIL )
Cholbam	NO INFO ( PROGRAM AVAIL )
Cialis	tadalafil	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$109.56	Lilly Cares
Ciloxan	NO INFO ( PROGRAM AVAIL )
Cimzia	NO INFO ( PROGRAM AVAIL )
Cimzia Container	NO INFO ( PROGRAM AVAIL )
Cinqair	NO INFO ( PROGRAM AVAIL )
Cinryze	NO INFO ( PROGRAM AVAIL )
Cinvanti	NO INFO ( PROGRAM AVAIL )
Cipro	NO INFO ( PROGRAM AVAIL )
Ciprodex	NO INFO ( PROGRAM AVAIL )
Citracal Plus Magnesium	NO INFO ( PROGRAM AVAIL )
CitraNatal 90 DHA	NO INFO ( PROGRAM AVAIL )
CitraNatal Assure	NO INFO ( PROGRAM AVAIL )
CitraNatal B-Calm	NO INFO ( PROGRAM AVAIL )
CitraNatal DHA	NO INFO ( PROGRAM AVAIL )
CitraNatal Harmony	NO INFO ( PROGRAM AVAIL )
Claravis	NO INFO ( PROGRAM AVAIL )
Clarinex	NO INFO ( PROGRAM AVAIL )
ClariSpray	NO INFO ( PROGRAM AVAIL )
Claritin	NO INFO ( PROGRAM AVAIL )
Claritin Products	NO INFO ( PROGRAM AVAIL )
Claritin-D Products	NO INFO ( PROGRAM AVAIL )
ClarixFlo	NO INFO ( PROGRAM AVAIL )
Clean and Clear Advantage Acne Spot Treatment	NO INFO ( PROGRAM AVAIL )
Clean and Clear Advantage Kit	NO INFO ( PROGRAM AVAIL )
Clean and Clear Continuous Control	NO INFO ( PROGRAM AVAIL )
Clean and Clear Deep Action	NO INFO ( PROGRAM AVAIL )
Clean and Clear Morning Burst	NO INFO ( PROGRAM AVAIL )
Clear Care	NO INFO ( PROGRAM AVAIL )
Clear Eyes All Season Outdoor	NO INFO ( PROGRAM AVAIL )
Clear Eyes Complete	NO INFO ( PROGRAM AVAIL )
Clear Eyes Contact Lens Multi-Action Relief	NO INFO ( PROGRAM AVAIL )
Clear Eyes Cooling Comfort Itchy Eye Relief	NO INFO ( PROGRAM AVAIL )
Clear Eyes Cooling Comfort Redness Relief	NO INFO ( PROGRAM AVAIL )
Clear Eyes Maximum Itchy Eye Relief	NO INFO ( PROGRAM AVAIL )
Clear Eyes Maximum Strength Redness Relief	NO INFO ( PROGRAM AVAIL )
Clear Eyes Natural Tears	NO INFO ( PROGRAM AVAIL )
Clear Eyes Pure Relief Dry Eyes	NO INFO ( PROGRAM AVAIL )
Clear Eyes Pure Relief Multi-Symtom	NO INFO ( PROGRAM AVAIL )
Clear Eyes Redness Relief	NO INFO ( PROGRAM AVAIL )
Clear Eyes Traveler\'s Eye Relief Drops	NO INFO ( PROGRAM AVAIL )
Clear Eyes Triple Action Relief	NO INFO ( PROGRAM AVAIL )
Clenpiq	NO INFO ( PROGRAM AVAIL )
Cleocin	NO INFO ( PROGRAM AVAIL )
Cleocin Capsule	clindamycin phosphate	YES	YES	400	Doctor	1 Year	90 Day	$248.61	Pfizer
Cleocin PediatricSolution	clindamycin phosphate	YES	YES	400	Doctor	1 Year	90 Day	$137.71	Pfizer
Cleocin PhosphateInjection	clindamycin phosphate	YES	YES	400	Doctor	1 Year	90 Day	$121.95	Pfizer
Cleocin Suppository; Vaginal	clindamycin phosphate	YES	YES	400	Doctor	1 Year	90 Day	$170.00	Pfizer
Cleocin Swab1	clindamycin phosphate	YES	YES	400	Doctor	1 Year	90 Day		Pfizer
Cleviprex	NO INFO ( PROGRAM AVAIL )
Climara	NO INFO ( PROGRAM AVAIL )
Climara Pro	NO INFO ( PROGRAM AVAIL )
Clindagel	NO INFO ( PROGRAM AVAIL )
Clindesse	NO INFO ( PROGRAM AVAIL )
Clobex	NO INFO ( PROGRAM AVAIL )
Clodan	NO INFO ( PROGRAM AVAIL )
Cloderm	NO INFO ( PROGRAM AVAIL )
Clolar	NO INFO ( PROGRAM AVAIL )
ClolarVial	clofarabine	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$3,170.53	Sanofi
CloSYS Alcohol-Free Oral Health Products	NO INFO ( PROGRAM AVAIL )
Coartem	NO INFO ( PROGRAM AVAIL )
Coartem Tablet	artmether and lumefantrine	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$1,224.43	Novartis
Cocyntal	NO INFO ( PROGRAM AVAIL )
Cogentin	NO INFO ( PROGRAM AVAIL )
Colace	NO INFO ( PROGRAM AVAIL )
Colace Clear	NO INFO ( PROGRAM AVAIL )
Colazal	NO INFO ( PROGRAM AVAIL )
Colcrys	colchicine	YES	YES	400	Patient	1 Year	90 Day	$234.84	Takeda
Coldcalm	NO INFO ( PROGRAM AVAIL )
Colestid	NO INFO ( PROGRAM AVAIL )
Colestid Granules; Flavored	colestipol	YES	YES	400	Varies	1 Year	90 Day	$385.12	Pfizer
Colestid Tablet	colestipol	YES	YES	400	Varies	1 Year	90 Day	$244.04	Pfizer
Colgate Enamel Health Products	NO INFO ( PROGRAM AVAIL )
Colgate Orabase	NO INFO ( PROGRAM AVAIL )
Colgate Peroxyl Products	NO INFO ( PROGRAM AVAIL )
Colgate PreviDent Products	NO INFO ( PROGRAM AVAIL )
Colgate Sensitive Products	NO INFO ( PROGRAM AVAIL )
Collagenase SANTYL	NO INFO ( PROGRAM AVAIL )
Combigan	NO INFO ( PROGRAM AVAIL )
Combivent	NO INFO ( PROGRAM AVAIL )
Combivent Respimat	NO INFO ( PROGRAM AVAIL )
Combivent RespimatSpray	ipratropium bromide/albuterol	YES	YES	200	Patient	1 Year	90 Day	$340.40	BIC
Combivir	NO INFO ( PROGRAM AVAIL )
Cometriq	NO INFO ( PROGRAM AVAIL )
Compazine	NO INFO ( PROGRAM AVAIL )
Compleat	NO INFO ( PROGRAM AVAIL )
Compleat Pediatric	NO INFO ( PROGRAM AVAIL )
Compleat Pediatric Reduced Calorie	NO INFO ( PROGRAM AVAIL )
Complera	NO INFO ( PROGRAM AVAIL )
Compound W Freeze Off Advanced Products	NO INFO ( PROGRAM AVAIL )
Compound W Products	NO INFO ( PROGRAM AVAIL )
Compro	NO INFO ( PROGRAM AVAIL )
Comtan	NO INFO ( PROGRAM AVAIL )
Concept DHA	NO INFO ( PROGRAM AVAIL )
Concerta	methylphenidate	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$354.66	J&J
Contour Next EZ Meter	NO INFO ( PROGRAM AVAIL )
Contour Next One Meter	NO INFO ( PROGRAM AVAIL )
Contour Next One Test Strip	NO INFO ( PROGRAM AVAIL )
Contour Next USB Meter	NO INFO ( PROGRAM AVAIL )
Contour Test Strip	NO INFO ( PROGRAM AVAIL )
Contrave	NO INFO ( PROGRAM AVAIL )
ConvaTec Ostomy Products	NO INFO ( PROGRAM AVAIL )
Conveen Active	NO INFO ( PROGRAM AVAIL )
ConZip Products	NO INFO ( PROGRAM AVAIL )
CoolSculpting	NO INFO ( PROGRAM AVAIL )
Copaxone	NO INFO ( PROGRAM AVAIL )
Copegus	NO INFO ( PROGRAM AVAIL )
Cordarone	NO INFO ( PROGRAM AVAIL )
Cordran	NO INFO ( PROGRAM AVAIL )
Cordran Cream	NO INFO ( PROGRAM AVAIL )
Cordran Lotion	NO INFO ( PROGRAM AVAIL )
Cordran Ointment	NO INFO ( PROGRAM AVAIL )
Coreg	NO INFO ( PROGRAM AVAIL )
Coreg CR	carvedilol phosphate	NO	NO	250	Patient	1 Year	90 Day	$317.76	BtA
Coreg CR Capsule ER	carvedilol	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$317.76	BtA
Corgard	NO INFO ( PROGRAM AVAIL )
Coricidin HBP Chest Congestion and Cough	NO INFO ( PROGRAM AVAIL )
Coricidin HBP Cold and Flu	NO INFO ( PROGRAM AVAIL )
Coricidin HBP Cough and Cold	NO INFO ( PROGRAM AVAIL )
Coricidin HBP Day and Night Multi-Symptom Cold	NO INFO ( PROGRAM AVAIL )
Coricidin HBP Maximum Strength Flu	NO INFO ( PROGRAM AVAIL )
Coricidin HBP NightTime Multi-Sympton Cold	NO INFO ( PROGRAM AVAIL )
Corifact	NO INFO ( PROGRAM AVAIL )
Corlanor	NO INFO ( PROGRAM AVAIL )
Cormax	NO INFO ( PROGRAM AVAIL )
Cortef	NO INFO ( PROGRAM AVAIL )
Cortef Tablet	hydrocortisone	YES	YES	400	Varies	1 Year	90 Day	$97.55	Pfizer
Cortisporin	NO INFO ( PROGRAM AVAIL )
Cortizone-10 Products	NO INFO ( PROGRAM AVAIL )
Cortone	NO INFO ( PROGRAM AVAIL )
Corvert	NO INFO ( PROGRAM AVAIL )
Corvite FE	NO INFO ( PROGRAM AVAIL )
Corzide	NO INFO ( PROGRAM AVAIL )
Cosamin ASU	NO INFO ( PROGRAM AVAIL )
Cosamin Avoca	NO INFO ( PROGRAM AVAIL )
Cosamin DS	NO INFO ( PROGRAM AVAIL )
Cosamin Verde	NO INFO ( PROGRAM AVAIL )
Cosentyx	NO INFO ( PROGRAM AVAIL )
Cosentyx Container	NO INFO ( PROGRAM AVAIL )
Cosmegen	NO INFO ( PROGRAM AVAIL )
Cosopt	NO INFO ( PROGRAM AVAIL )
Cosopt PF	NO INFO ( PROGRAM AVAIL )
Cotellic	NO INFO ( PROGRAM AVAIL )
Cotempla XR-ODT	NO INFO ( PROGRAM AVAIL )
Coumadin	NO INFO ( PROGRAM AVAIL )
Covaryx	NO INFO ( PROGRAM AVAIL )
Covaryx HS	NO INFO ( PROGRAM AVAIL )
Cozaar	NO INFO ( PROGRAM AVAIL )
CranRx Products	NO INFO ( PROGRAM AVAIL )
Creon	pancrelipase	YES	YES	300	Patient	1 Year	90 Day	$481.89	AbbVIe
Cresemba	NO INFO ( PROGRAM AVAIL )
Crestor	NO INFO ( PROGRAM AVAIL )
Crinone	NO INFO ( PROGRAM AVAIL )
Crixivan	NO INFO ( PROGRAM AVAIL )
Cubicin	NO INFO ( PROGRAM AVAIL )
Culturelle Digestive Health	NO INFO ( PROGRAM AVAIL )
Culturelle Kids Health	NO INFO ( PROGRAM AVAIL )
Culturelle Pro-Well Health Wellness	NO INFO ( PROGRAM AVAIL )
Cuprimine	NO INFO ( PROGRAM AVAIL )
Cutivate	NO INFO ( PROGRAM AVAIL )
Cuvitru	NO INFO ( PROGRAM AVAIL )
Cuvposa	NO INFO ( PROGRAM AVAIL )
Cyclinex	NO INFO ( PROGRAM AVAIL )
Cyclogyl	NO INFO ( PROGRAM AVAIL )
Cycloset	NO INFO ( PROGRAM AVAIL )
Cyklokapron	NO INFO ( PROGRAM AVAIL )
Cymbalta	duloxetine	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$502.63	Lilly Cares
Cymetra	NO INFO ( PROGRAM AVAIL )
Cyramza	NO INFO ( PROGRAM AVAIL )
Cystadane	NO INFO ( PROGRAM AVAIL )
Cystagon	NO INFO ( PROGRAM AVAIL )
Cystaran	NO INFO ( PROGRAM AVAIL )
Cystex Liquid Supplement	NO INFO ( PROGRAM AVAIL )
Cystex Plus	NO INFO ( PROGRAM AVAIL )
Cytadren	NO INFO ( PROGRAM AVAIL )
Cytogam	NO INFO ( PROGRAM AVAIL )
Cytomel	NO INFO ( PROGRAM AVAIL )
Cytosar-U	NO INFO ( PROGRAM AVAIL )
Cytotec	NO INFO ( PROGRAM AVAIL )
Cytovene	NO INFO ( PROGRAM AVAIL )
Cytoxan	NO INFO ( PROGRAM AVAIL )
Cytra-K	NO INFO ( PROGRAM AVAIL )
Dacogen	NO INFO ( PROGRAM AVAIL )
Dailies AquaComfort Plus Contact Lenses	NO INFO ( PROGRAM AVAIL )
Dailies Total 1 Contact Lenses	NO INFO ( PROGRAM AVAIL )
Daklinza	NO INFO ( PROGRAM AVAIL )
Daliresp	NO INFO ( PROGRAM AVAIL )
Daliresp Tablets	roflumilast	YES + 3% OOP	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$317.56	AZ&ME
Dalvance	NO INFO ( PROGRAM AVAIL )
Daraprim	NO INFO ( PROGRAM AVAIL )
Darzalex	NO INFO ( PROGRAM AVAIL )
Daypro	NO INFO ( PROGRAM AVAIL )
Daytrana	NO INFO ( PROGRAM AVAIL )
Debrox Removal Kit	NO INFO ( PROGRAM AVAIL )
Decadron	NO INFO ( PROGRAM AVAIL )
Defitelio	NO INFO ( PROGRAM AVAIL )
Delestrogen	NO INFO ( PROGRAM AVAIL )
Delsym 12-Hour Products	NO INFO ( PROGRAM AVAIL )
Delsym Childrens\' Products	NO INFO ( PROGRAM AVAIL )
Delsym Cough+ Products	NO INFO ( PROGRAM AVAIL )
Delsym Soothing Action Lozenges	NO INFO ( PROGRAM AVAIL )
Deltasone	NO INFO ( PROGRAM AVAIL )
Delzicol	NO INFO ( PROGRAM AVAIL )
Demadex	NO INFO ( PROGRAM AVAIL )
Demser	NO INFO ( PROGRAM AVAIL )
Depakene	NO INFO ( PROGRAM AVAIL )
Depakote	NO INFO ( PROGRAM AVAIL )
Depakote ER	NO INFO ( PROGRAM AVAIL )
Depakote Sprinkle Capsules	NO INFO ( PROGRAM AVAIL )
Depen	NO INFO ( PROGRAM AVAIL )
Depend Real Fit for Men	NO INFO ( PROGRAM AVAIL )
Depend Silhouette for Women	NO INFO ( PROGRAM AVAIL )
Depend Underwear for Men and Women	NO INFO ( PROGRAM AVAIL )
Deplin	NO INFO ( PROGRAM AVAIL )
Depo-Estradiol	NO INFO ( PROGRAM AVAIL )
Depo-EstradiolInjection	estradiol cypionate	YES	YES	400	Doctor	1 Year	90 Day	$92.60	Pfizer
Depo-Medrol	NO INFO ( PROGRAM AVAIL )
Depo-MedrolInjection	methylprednisolone acetate	YES	YES	400	Doctor	1 Year	90 Day	$1,201.59	Pfizer
Depo-Provera	NO INFO ( PROGRAM AVAIL )
Depo-ProveraInjection	medroxyprogesterone acetate	YES	YES	400	Doctor	1 Year	90 Day	$5,012.83	Pfizer
Depo-SubQ Provera 104	NO INFO ( PROGRAM AVAIL )
Depo-Testosterone	NO INFO ( PROGRAM AVAIL )
DepoCyt	NO INFO ( PROGRAM AVAIL )
Derma-Smoothe	NO INFO ( PROGRAM AVAIL )
Derma-Smoothe-FS-Body Oil	NO INFO ( PROGRAM AVAIL )
Derma-Smoothe/FS-Scalp Oil	NO INFO ( PROGRAM AVAIL )
DermaCell	NO INFO ( PROGRAM AVAIL )
Dermagraft	NO INFO ( PROGRAM AVAIL )
DermaPure	NO INFO ( PROGRAM AVAIL )
Dermarest Eczema Medicated Lotion	NO INFO ( PROGRAM AVAIL )
Dermarest Eczema Medicated Moisturizer for Sensative Skin	NO INFO ( PROGRAM AVAIL )
Dermarest-Psoriasis Medicated Moisturizer	NO INFO ( PROGRAM AVAIL )
Dermarest-Psoriasis Medicated Shampoo plus Conditioner	NO INFO ( PROGRAM AVAIL )
Dermarest-Psoriasis Medicated Treatment Gel	NO INFO ( PROGRAM AVAIL )
Dermasorb TA	NO INFO ( PROGRAM AVAIL )
Dermatop	NO INFO ( PROGRAM AVAIL )
DermaVest	NO INFO ( PROGRAM AVAIL )
DerMend	NO INFO ( PROGRAM AVAIL )
DermOtic Oil Ear Drop	NO INFO ( PROGRAM AVAIL )
Descovy	NO INFO ( PROGRAM AVAIL )
Desferal	NO INFO ( PROGRAM AVAIL )
Desitin Maximum Strength Original Paste	NO INFO ( PROGRAM AVAIL )
Desitin Multi-Purpose Ointment	NO INFO ( PROGRAM AVAIL )
Desitin Soothing Rash Bath Treatment	NO INFO ( PROGRAM AVAIL )
Desonate	NO INFO ( PROGRAM AVAIL )
DesOwen	NO INFO ( PROGRAM AVAIL )
Desoxyn	NO INFO ( PROGRAM AVAIL )
Detachol	NO INFO ( PROGRAM AVAIL )
Detrol	NO INFO ( PROGRAM AVAIL )
Detrol LA	NO INFO ( PROGRAM AVAIL )
Detrol Tablet	tolterodine tartrate	YES	YES	400	Doctor	1 Year	90 Day	$446.57	Pfizer
Dexilant	dexlansoprazole	YES	YES	400	Patient	1 Year	90 Day	$244.10	Takeda
DexPak	NO INFO ( PROGRAM AVAIL )
DexPak TaperPaks	NO INFO ( PROGRAM AVAIL )
Diabeta	NO INFO ( PROGRAM AVAIL )
Diabetisource AC	NO INFO ( PROGRAM AVAIL )
Diastat	NO INFO ( PROGRAM AVAIL )
Dibenzyline	NO INFO ( PROGRAM AVAIL )
Diclegis	NO INFO ( PROGRAM AVAIL )
Differin	NO INFO ( PROGRAM AVAIL )
Dificid	NO INFO ( PROGRAM AVAIL )
Diflucan	NO INFO ( PROGRAM AVAIL )
Digox	NO INFO ( PROGRAM AVAIL )
Dilacor XR	NO INFO ( PROGRAM AVAIL )
Dilantin	NO INFO ( PROGRAM AVAIL )
Dilantin Capsule	phenytoin	YES	YES	400	Doctor	1 Year	90 Day	$93.80	Pfizer
Dilantin-125	NO INFO ( PROGRAM AVAIL )
Dilantin-125Oral Suspension	phenytoin	YES	YES	400	Doctor	1 Year	90 Day	$124.44	Pfizer
Dilatrate SR	NO INFO ( PROGRAM AVAIL )
Dilt-CD	NO INFO ( PROGRAM AVAIL )
Dilt-XR	NO INFO ( PROGRAM AVAIL )
Diltzac	NO INFO ( PROGRAM AVAIL )
Diovan	NO INFO ( PROGRAM AVAIL )
Diovan HCT	NO INFO ( PROGRAM AVAIL )
Dipentum	NO INFO ( PROGRAM AVAIL )
Diphen	NO INFO ( PROGRAM AVAIL )
Diprolene	NO INFO ( PROGRAM AVAIL )
Diprolene AF	NO INFO ( PROGRAM AVAIL )
Diprolene Cream0.05	betamethasone	YES	YES	400	Patient	1 Year	90 Day	$197.16	Merck
Diprolene Lotion0.05	betamethasone	YES	YES	400	Patient	1 Year	90 Day	$199.41	Merck
Diprolene Ointment0.05	betamethasone	YES	YES	400	Patient	1 Year	90 Day	$197.16	Merck
Ditropan	NO INFO ( PROGRAM AVAIL )
Diurex Products	NO INFO ( PROGRAM AVAIL )
Diuril	NO INFO ( PROGRAM AVAIL )
Divigel	NO INFO ( PROGRAM AVAIL )
Docefrez	NO INFO ( PROGRAM AVAIL )
Doctor\'s Night Guard Dental Protector,The	NO INFO ( PROGRAM AVAIL )
Domeboro Cooling Gel	NO INFO ( PROGRAM AVAIL )
Domeboro Soothing Soak	NO INFO ( PROGRAM AVAIL )
Donnatal	NO INFO ( PROGRAM AVAIL )
Donnatal Elixir	NO INFO ( PROGRAM AVAIL )
Doryx	NO INFO ( PROGRAM AVAIL )
Doryx MPC	NO INFO ( PROGRAM AVAIL )
Dovonex	NO INFO ( PROGRAM AVAIL )
Doxil	doxorubicin	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day	$1,240.98	J&J
Doxycycline	NO INFO ( PROGRAM AVAIL )
Dramamine for Kids	NO INFO ( PROGRAM AVAIL )
Dramamine Less Drowsy Formula	NO INFO ( PROGRAM AVAIL )
Dramamine Original Formula	NO INFO ( PROGRAM AVAIL )
Drisdol	NO INFO ( PROGRAM AVAIL )
Droxia	NO INFO ( PROGRAM AVAIL )
DTIC-Dome	NO INFO ( PROGRAM AVAIL )
Duac	NO INFO ( PROGRAM AVAIL )
DuacGel1/5	clindamycin phosphate/benzoyl peroxide	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$387.06	BtA
Duavee	NO INFO ( PROGRAM AVAIL )
Duet DHA Balanced Prescription Prenatal Vitamins	NO INFO ( PROGRAM AVAIL )
Duexis	NO INFO ( PROGRAM AVAIL )
DulcoEase Pink Products	NO INFO ( PROGRAM AVAIL )
DulcoEase Products	NO INFO ( PROGRAM AVAIL )
Dulcolax Laxatives Tablets	NO INFO ( PROGRAM AVAIL )
Dulcolax Stool Softener Products	NO INFO ( PROGRAM AVAIL )
Dulera	NO INFO ( PROGRAM AVAIL )
Dulera Aerosol	mometasone furoate/formoterol fumarate dihydrate	YES	YES	400	Patient	1 Year	90 Day	$299.19	Merck
DuoNeb	NO INFO ( PROGRAM AVAIL )
Duopa	NO INFO ( PROGRAM AVAIL )
Dupixent	NO INFO ( PROGRAM AVAIL )
Duragesic CII	NO INFO ( PROGRAM AVAIL )
Duragesic CIIPatch	fentanyl transdermal system	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$3,375.36	J&J
Durezol	NO INFO ( PROGRAM AVAIL )
Durlaza	NO INFO ( PROGRAM AVAIL )
Dutoprol	NO INFO ( PROGRAM AVAIL )
Duzallo	NO INFO ( PROGRAM AVAIL )
Dyanavel XR	NO INFO ( PROGRAM AVAIL )
Dyazide	NO INFO ( PROGRAM AVAIL )
Dymista	NO INFO ( PROGRAM AVAIL )
Dynacin	NO INFO ( PROGRAM AVAIL )
Dynacirc CR	NO INFO ( PROGRAM AVAIL )
Dyrenium	NO INFO ( PROGRAM AVAIL )
Dysport	NO INFO ( PROGRAM AVAIL )
E.E.S.	NO INFO ( PROGRAM AVAIL )
Ec-Naprosyn	NO INFO ( PROGRAM AVAIL )
Econopred	NO INFO ( PROGRAM AVAIL )
Ecotrin	NO INFO ( PROGRAM AVAIL )
Ecoza	NO INFO ( PROGRAM AVAIL )
Edarbi	NO INFO ( PROGRAM AVAIL )
Edarbyclor	NO INFO ( PROGRAM AVAIL )
Edurant	rilpivirne	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$992.24	J&J
Effexor XR	NO INFO ( PROGRAM AVAIL )
Effexor XRCapsule ER	venlafaxine	YES	YES	400	Doctor	1 Year	90 Day	$406.59	Pfizer
Effient	prasugrel	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$416.93	Lilly Cares
Efudex	NO INFO ( PROGRAM AVAIL )
Egrifta	NO INFO ( PROGRAM AVAIL )
Elaprase	NO INFO ( PROGRAM AVAIL )
Eldepryl	NO INFO ( PROGRAM AVAIL )
Eldopaque	NO INFO ( PROGRAM AVAIL )
EleCare	NO INFO ( PROGRAM AVAIL )
EleCare Jr.	NO INFO ( PROGRAM AVAIL )
EleCare w/ DHA	NO INFO ( PROGRAM AVAIL )
Elelyso	NO INFO ( PROGRAM AVAIL )
Elestrin	NO INFO ( PROGRAM AVAIL )
Eletone	NO INFO ( PROGRAM AVAIL )
Elidel	NO INFO ( PROGRAM AVAIL )
Eligard	NO INFO ( PROGRAM AVAIL )
ELIgard Injection	leuprolide	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies		Eligard
Eliphos	NO INFO ( PROGRAM AVAIL )
Eliquis	NO INFO ( PROGRAM AVAIL )
Eliquis Tablet	apixaban	YES + 3% OOP	YES	300	Doctor	1 Year	Varies	$383.13	Bristol-Myers
Elitek	NO INFO ( PROGRAM AVAIL )
Elitek Vial	rasburicase	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$2,491.76	Sanofi
Elixophyllin	NO INFO ( PROGRAM AVAIL )
Ellence	NO INFO ( PROGRAM AVAIL )
Ellence Injection	epirubicin	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Elmiron	pentosan polysulfate sodium	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day		J&J
Elocon	NO INFO ( PROGRAM AVAIL )
Eloctate	NO INFO ( PROGRAM AVAIL )
Eloxatin	NO INFO ( PROGRAM AVAIL )
Elspar	NO INFO ( PROGRAM AVAIL )
Embeda	NO INFO ( PROGRAM AVAIL )
Embeda CII	NO INFO ( PROGRAM AVAIL )
Emcyt	NO INFO ( PROGRAM AVAIL )
Emcyt Capsule	estramustine phosphate sodium	YES	YES	400	Doctor	1 Year	90 Day	$2,404.72	Pfizer
Emend	NO INFO ( PROGRAM AVAIL )
Emflaza	NO INFO ( PROGRAM AVAIL )
Empliciti	NO INFO ( PROGRAM AVAIL )
EMSAM	NO INFO ( PROGRAM AVAIL )
EMSAM Transdermal	selegiline	NO	NO	200	Doctor	1 Year	90 Dya		Mylan
Emtriva	NO INFO ( PROGRAM AVAIL )
Emverm	NO INFO ( PROGRAM AVAIL )
Enablex	NO INFO ( PROGRAM AVAIL )
Enbrel	NO INFO ( PROGRAM AVAIL )
Endometrin	NO INFO ( PROGRAM AVAIL )
Enemeez	NO INFO ( PROGRAM AVAIL )
Enfagrow Toddler Transitions Gentlease	NO INFO ( PROGRAM AVAIL )
Enfagrow Toddler Transitions Soy	NO INFO ( PROGRAM AVAIL )
Enfamil	NO INFO ( PROGRAM AVAIL )
Enfamil 24	NO INFO ( PROGRAM AVAIL )
Enfamil A.R.	NO INFO ( PROGRAM AVAIL )
Enfamil Dietary Needs Formulas	NO INFO ( PROGRAM AVAIL )
Enfamil EnfaCare	NO INFO ( PROGRAM AVAIL )
Enfamil Enfagrow Toddler Transitions	NO INFO ( PROGRAM AVAIL )
Enfamil Enfaport DHA and ARA	NO INFO ( PROGRAM AVAIL )
Enfamil Gentlease	NO INFO ( PROGRAM AVAIL )
Enfamil Human Milk Fortifier	NO INFO ( PROGRAM AVAIL )
Enfamil Infant Formula	NO INFO ( PROGRAM AVAIL )
Enfamil Metabolic Formulas	NO INFO ( PROGRAM AVAIL )
Enfamil Nutramigen Hypoallergenic Formula	NO INFO ( PROGRAM AVAIL )
Enfamil Nutramigen with Enflora LGG	NO INFO ( PROGRAM AVAIL )
Enfamil Pregestimil DHA and ARA	NO INFO ( PROGRAM AVAIL )
Enfamil Premature	NO INFO ( PROGRAM AVAIL )
Enfamil Premature 30	NO INFO ( PROGRAM AVAIL )
Enfamil Premature High Protein 24	NO INFO ( PROGRAM AVAIL )
Enfamil Premature LIPIL with Iron	NO INFO ( PROGRAM AVAIL )
Enfamil Premature Low Iron 20	NO INFO ( PROGRAM AVAIL )
Enfamil Premature Low Iron 24	NO INFO ( PROGRAM AVAIL )
Enfamil Premature with Iron 20	NO INFO ( PROGRAM AVAIL )
Enfamil Premature with Iron 24	NO INFO ( PROGRAM AVAIL )
Enfamil Premium Infant	NO INFO ( PROGRAM AVAIL )
Enfamil Premium Newborn	NO INFO ( PROGRAM AVAIL )
Enfamil ProSobee	NO INFO ( PROGRAM AVAIL )
Enfamil Reguline	NO INFO ( PROGRAM AVAIL )
Enfamil Solutions Formulas	NO INFO ( PROGRAM AVAIL )
Enfaport	NO INFO ( PROGRAM AVAIL )
Engerix-B	NO INFO ( PROGRAM AVAIL )
Enjuvia	NO INFO ( PROGRAM AVAIL )
Enoxaparin SodiumInjectable	enoxaparin sodium	NO RX COVERAGE	NO	250	Card	1 Year	Varies		Sanofi
Enstilar	NO INFO ( PROGRAM AVAIL )
Ensure Active Products	NO INFO ( PROGRAM AVAIL )
Ensure Complete Products	NO INFO ( PROGRAM AVAIL )
Ensure Nutrition Shake	NO INFO ( PROGRAM AVAIL )
Ensure Original	NO INFO ( PROGRAM AVAIL )
Ensure Plus	NO INFO ( PROGRAM AVAIL )
Ensure Plus Products	NO INFO ( PROGRAM AVAIL )
EnteraGam	NO INFO ( PROGRAM AVAIL )
Entereg	NO INFO ( PROGRAM AVAIL )
Entocort EC	NO INFO ( PROGRAM AVAIL )
Entresto	NO INFO ( PROGRAM AVAIL )
Entyvio	NO INFO ( PROGRAM AVAIL )
Enulose	NO INFO ( PROGRAM AVAIL )
Envarsus XR	NO INFO ( PROGRAM AVAIL )
Epaned	NO INFO ( PROGRAM AVAIL )
Epclusa	NO INFO ( PROGRAM AVAIL )
EpiCeram Skin Barrier Emulsion	NO INFO ( PROGRAM AVAIL )
Epiduo	NO INFO ( PROGRAM AVAIL )
Epiduo Forte	NO INFO ( PROGRAM AVAIL )
EpiFix	NO INFO ( PROGRAM AVAIL )
EpiLocker	NO INFO ( PROGRAM AVAIL )
EpiPen	NO INFO ( PROGRAM AVAIL )
EpiPen 2-Pak	NO INFO ( PROGRAM AVAIL )
EpiPen 2-PakInjection	epinephrine	NO	NO		Doctor	1 Year	90 Day		EpiPen4school
EpiPen Jr 2-Pak	NO INFO ( PROGRAM AVAIL )
EpiPen Jr 2-Pak Injection	epinephrine	NO	NO		Doctor	1 Year	90 Day		EpiPen4school
Episil	NO INFO ( PROGRAM AVAIL )
Epitol	NO INFO ( PROGRAM AVAIL )
Epivir	NO INFO ( PROGRAM AVAIL )
Epivir-HBV	NO INFO ( PROGRAM AVAIL )
Epivir-HBVOral Solution	lamivudine	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$128.71	BtA
Epivir-HBVTablet	lamivudine	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$479.31	BtA
Epogen	NO INFO ( PROGRAM AVAIL )
Epzicom	NO INFO ( PROGRAM AVAIL )
Equetro	NO INFO ( PROGRAM AVAIL )
Eraxis	NO INFO ( PROGRAM AVAIL )
Erbitux	cetuximab	No	YES	300	Doctor	1 Year	Varies		PatientOne
Ergamisol	NO INFO ( PROGRAM AVAIL )
Erivedge	NO INFO ( PROGRAM AVAIL )
Erleada	NO INFO ( PROGRAM AVAIL )
Erwinaze	NO INFO ( PROGRAM AVAIL )
ERY-TAB	NO INFO ( PROGRAM AVAIL )
EryPed	NO INFO ( PROGRAM AVAIL )
Erythromycin Family Products	NO INFO ( PROGRAM AVAIL )
Esbriet	NO INFO ( PROGRAM AVAIL )
Estrace	Estradiol	Yes	Must have a LIS Denial Letter	300	Doctor	1 Year	90 dAY		Allergan
Estraderm	NO INFO ( PROGRAM AVAIL )
Estrasorb	NO INFO ( PROGRAM AVAIL )
Estring	NO INFO ( PROGRAM AVAIL )
Estring Vaginal Ring	Estradiol	YES	YES	400	Doctor	1 Year	90 Day	$372.09	Pfizer
EstroGel	NO INFO ( PROGRAM AVAIL )
Estroven Energy	NO INFO ( PROGRAM AVAIL )
Estroven Femcare	NO INFO ( PROGRAM AVAIL )
Estroven Intimacy Kit	NO INFO ( PROGRAM AVAIL )
Estroven Maximum Strength	NO INFO ( PROGRAM AVAIL )
Estroven Mood and Memory	NO INFO ( PROGRAM AVAIL )
Estroven Nighttime	NO INFO ( PROGRAM AVAIL )
Estroven Peri-Menopause Support+Weight Management	NO INFO ( PROGRAM AVAIL )
Estroven Weight Management	NO INFO ( PROGRAM AVAIL )
Ethyol	NO INFO ( PROGRAM AVAIL )
Etopophos	NO INFO ( PROGRAM AVAIL )
Eucrisa	NO INFO ( PROGRAM AVAIL )
Eulexin	NO INFO ( PROGRAM AVAIL )
Eurax	NO INFO ( PROGRAM AVAIL )
Evamist	NO INFO ( PROGRAM AVAIL )
Evekeo	NO INFO ( PROGRAM AVAIL )
Evista	raloxifene	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day		Lilly Cares
Evomela	NO INFO ( PROGRAM AVAIL )
Evotaz	NO INFO ( PROGRAM AVAIL )
Evoxac	NO INFO ( PROGRAM AVAIL )
Evzio	NO INFO ( PROGRAM AVAIL )
Exalgo	NO INFO ( PROGRAM AVAIL )
Excedrin Extra Strength	NO INFO ( PROGRAM AVAIL )
Excedrin Migraine	NO INFO ( PROGRAM AVAIL )
Excedrin PM Headache	NO INFO ( PROGRAM AVAIL )
Excedrin Tension Headache	NO INFO ( PROGRAM AVAIL )
Excellagen	NO INFO ( PROGRAM AVAIL )
Exelderm	NO INFO ( PROGRAM AVAIL )
Exelon	NO INFO ( PROGRAM AVAIL )
Exforge	NO INFO ( PROGRAM AVAIL )
Exforge HCT	NO INFO ( PROGRAM AVAIL )
Exjade	NO INFO ( PROGRAM AVAIL )
Extavia	NO INFO ( PROGRAM AVAIL )
Eylea	NO INFO ( PROGRAM AVAIL )
EZ Derm	NO INFO ( PROGRAM AVAIL )
Fabior	NO INFO ( PROGRAM AVAIL )
Fabrazyme	NO INFO ( PROGRAM AVAIL )
Famvir	NO INFO ( PROGRAM AVAIL )
Fanapt	NO INFO ( PROGRAM AVAIL )
Fareston	NO INFO ( PROGRAM AVAIL )
Farxiga	NO INFO ( PROGRAM AVAIL )
Farxiga Tablet	dapagliflozin	YES + 3% OOP	YES	300	Patient	1 Year	90 Day	$424.63	AZ&ME
Farydak	NO INFO ( PROGRAM AVAIL )
Fasenra	NO INFO ( PROGRAM AVAIL )
Faslodex	NO INFO ( PROGRAM AVAIL )
Faslodex Injection	fulvestrant	YES + LIS DENIAL + 3% OOP	YES	300	Patient	End Of Year	90 Day	$2,013.52	AZ&ME
Feiba VH	NO INFO ( PROGRAM AVAIL )
Felbatol	NO INFO ( PROGRAM AVAIL )
Feldene	NO INFO ( PROGRAM AVAIL )
Feldene Capsule	piroxicam	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Fem pH	NO INFO ( PROGRAM AVAIL )
Femara	NO INFO ( PROGRAM AVAIL )
Femhrt	NO INFO ( PROGRAM AVAIL )
Femring	NO INFO ( PROGRAM AVAIL )
Fenoglide	NO INFO ( PROGRAM AVAIL )
Fentora	NO INFO ( PROGRAM AVAIL )
Feosol Natural Release	NO INFO ( PROGRAM AVAIL )
Feosol Original	NO INFO ( PROGRAM AVAIL )
Feraheme	NO INFO ( PROGRAM AVAIL )
Feriva FA	NO INFO ( PROGRAM AVAIL )
Ferralet 90	NO INFO ( PROGRAM AVAIL )
Ferriprox	NO INFO ( PROGRAM AVAIL )
Ferrlecit	NO INFO ( PROGRAM AVAIL )
Fetzima	NO INFO ( PROGRAM AVAIL )
Fetzima ER Capsules	levomilnacipran	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$323.36	Allergan
Fetzima ER Capsules Titration Pack	levomilnacipran	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$301.87	Allergan
Fetzima Titration Pack	NO INFO ( PROGRAM AVAIL )
FeverAll Children\'s Strength	NO INFO ( PROGRAM AVAIL )
FeverAll Infants\' Strength	NO INFO ( PROGRAM AVAIL )
FeverAll Jr. Strength	NO INFO ( PROGRAM AVAIL )
Fiasp	NO INFO ( PROGRAM AVAIL )
Fiber Choice Chewable Tablets	NO INFO ( PROGRAM AVAIL )
Fiber Choice plus Antioxidants	NO INFO ( PROGRAM AVAIL )
Fiber Choice plus Calcium	NO INFO ( PROGRAM AVAIL )
Fiber Choice Weight Management	NO INFO ( PROGRAM AVAIL )
Fibricor	NO INFO ( PROGRAM AVAIL )
Finacea	NO INFO ( PROGRAM AVAIL )
Finacea Foam	NO INFO ( PROGRAM AVAIL )
Firazyr	NO INFO ( PROGRAM AVAIL )
Firazyr Container	NO INFO ( PROGRAM AVAIL )
Firmagon	NO INFO ( PROGRAM AVAIL )
First Response Pre-Seed Lubricant	NO INFO ( PROGRAM AVAIL )
First Response Test Products	NO INFO ( PROGRAM AVAIL )
Flagyl	NO INFO ( PROGRAM AVAIL )
Flarex	NO INFO ( PROGRAM AVAIL )
Flebogamma DIF	NO INFO ( PROGRAM AVAIL )
Flector Patch	NO INFO ( PROGRAM AVAIL )
FlexHD	NO INFO ( PROGRAM AVAIL )
Flintstones Chewable Multivitamins	NO INFO ( PROGRAM AVAIL )
Flintstones Dino Eggs Multivitamins	NO INFO ( PROGRAM AVAIL )
Flintstones Gummies Supplements	NO INFO ( PROGRAM AVAIL )
Flintstones Gummy Multivitamins	NO INFO ( PROGRAM AVAIL )
Flo-Pred	NO INFO ( PROGRAM AVAIL )
Flolan	NO INFO ( PROGRAM AVAIL )
Flomax	NO INFO ( PROGRAM AVAIL )
Flonase	NO INFO ( PROGRAM AVAIL )
Florastor	NO INFO ( PROGRAM AVAIL )
Florastor Kids	NO INFO ( PROGRAM AVAIL )
FlorastorMax	NO INFO ( PROGRAM AVAIL )
Flovent	NO INFO ( PROGRAM AVAIL )
Flovent Diskus	fluticasone propionate	NO	NO	250	Patient	1 Year	90 Day	$163.36	BtA
Flovent HFA	fluticasone propionate	NO	NO	250	Patient	1 Year	90 Day	$230.15	BtA
Flowtuss	NO INFO ( PROGRAM AVAIL )
Fludara	NO INFO ( PROGRAM AVAIL )
Flumadine	NO INFO ( PROGRAM AVAIL )
Fluoroplex	NO INFO ( PROGRAM AVAIL )
Fluoxetine HCI	NO INFO ( PROGRAM AVAIL )
FML	NO INFO ( PROGRAM AVAIL )
FML-Forte	NO INFO ( PROGRAM AVAIL )
Focalin	NO INFO ( PROGRAM AVAIL )
Focalin XR	NO INFO ( PROGRAM AVAIL )
Focalin XRCapsule ER	dexmethyiphenidate HCI	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$396.50	Novartis
Folgard	NO INFO ( PROGRAM AVAIL )
Folgard OS	NO INFO ( PROGRAM AVAIL )
Folgard RX	NO INFO ( PROGRAM AVAIL )
Follistim AQ Cartridge	NO INFO ( PROGRAM AVAIL )
Folotyn	NO INFO ( PROGRAM AVAIL )
Foradil	NO INFO ( PROGRAM AVAIL )
Foradil Aerolizer	NO INFO ( PROGRAM AVAIL )
Forfivo XL	NO INFO ( PROGRAM AVAIL )
Fortaderm	NO INFO ( PROGRAM AVAIL )
Fortaderm Antimicrobial	NO INFO ( PROGRAM AVAIL )
Forteo	teriparatide	YES + $1100 OOP	YES	300	Patient	1 Year	90 Day	$2,947.07	Lilly Cares
Fortesta	NO INFO ( PROGRAM AVAIL )
Fortical	NO INFO ( PROGRAM AVAIL )
Fosamax	NO INFO ( PROGRAM AVAIL )
Fosamax Plus D	NO INFO ( PROGRAM AVAIL )
Foscavir	NO INFO ( PROGRAM AVAIL )
Fosrenol	lanthanum carbonate	YES	YES	300	Card	1 Year	90 Day		Shire Cares
Fragmin	NO INFO ( PROGRAM AVAIL )
FreeStyle Freedom Lite Blood Glucose Monitoring System	NO INFO ( PROGRAM AVAIL )
FreeStyle InsuLinx Glucose Monitoring System	NO INFO ( PROGRAM AVAIL )
FreeStyle Lite Glucose Monitoring System	NO INFO ( PROGRAM AVAIL )
FreeStyle Precision Neo Blood Glucose Monitoring System	NO INFO ( PROGRAM AVAIL )
FreshLook Contact Lenses	NO INFO ( PROGRAM AVAIL )
Frova	NO INFO ( PROGRAM AVAIL )
FUDR	NO INFO ( PROGRAM AVAIL )
FungiCURE Products	NO INFO ( PROGRAM AVAIL )
Fusilev	NO INFO ( PROGRAM AVAIL )
Fusion	NO INFO ( PROGRAM AVAIL )
Fusion Plus	NO INFO ( PROGRAM AVAIL )
Fusion Sprinkles	NO INFO ( PROGRAM AVAIL )
Futuro Compression Socks or Hosiery Products	NO INFO ( PROGRAM AVAIL )
Futuro Support or Brace Products	NO INFO ( PROGRAM AVAIL )
Fuzeon	NO INFO ( PROGRAM AVAIL )
Fycompa	NO INFO ( PROGRAM AVAIL )
GA Infant Formula	NO INFO ( PROGRAM AVAIL )
Gabitril	tiagabine	YES	NO	300	Patient	1 Year	90 Day	$270.56	TevaCares
Gablofen	NO INFO ( PROGRAM AVAIL )
Galzin	NO INFO ( PROGRAM AVAIL )
Gammagard	NO INFO ( PROGRAM AVAIL )
Gammagard Liquid	NO INFO ( PROGRAM AVAIL )
Gammagard S/D	NO INFO ( PROGRAM AVAIL )
GammaGraft	NO INFO ( PROGRAM AVAIL )
Gammaked	NO INFO ( PROGRAM AVAIL )
Gammaplex	NO INFO ( PROGRAM AVAIL )
Gamunex	NO INFO ( PROGRAM AVAIL )
Gamunex-C	NO INFO ( PROGRAM AVAIL )
Ganirelix Acetate	NO INFO ( PROGRAM AVAIL )
Gardasil 9	NO INFO ( PROGRAM AVAIL )
Gas-X Products	NO INFO ( PROGRAM AVAIL )
Gastrocrom	NO INFO ( PROGRAM AVAIL )
Gattex	NO INFO ( PROGRAM AVAIL )
Gazyva	NO INFO ( PROGRAM AVAIL )
Gelnique	NO INFO ( PROGRAM AVAIL )
Gelsyn-3	NO INFO ( PROGRAM AVAIL )
Gemzar	NO INFO ( PROGRAM AVAIL )
Gengraf	NO INFO ( PROGRAM AVAIL )
Gengraf Capsules	cyclosporine	YES	YES	300	Doctor	1 Year	90 Day	$165.30	AbbVIe
Genotropin	NO INFO ( PROGRAM AVAIL )
GenTeal	NO INFO ( PROGRAM AVAIL )
Genvoya	NO INFO ( PROGRAM AVAIL )
Geodon	NO INFO ( PROGRAM AVAIL )
Geritol Multivitamin	NO INFO ( PROGRAM AVAIL )
Geritol Tonic	NO INFO ( PROGRAM AVAIL )
Giazo	NO INFO ( PROGRAM AVAIL )
Gilenya	NO INFO ( PROGRAM AVAIL )
Gilotrif	NO INFO ( PROGRAM AVAIL )
Glassia	NO INFO ( PROGRAM AVAIL )
Glatopa	NO INFO ( PROGRAM AVAIL )
Gleevec	NO INFO ( PROGRAM AVAIL )
Gleostine	NO INFO ( PROGRAM AVAIL )
Gliadel	NO INFO ( PROGRAM AVAIL )
Gluca Gen HypokitInjection	glucagon	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$257.57	Novo Nordisk
GlucaGen Hypokit	NO INFO ( PROGRAM AVAIL )
Glucagon	NO INFO ( PROGRAM AVAIL )
Glucerna 1.2	NO INFO ( PROGRAM AVAIL )
Glucerna Hunger Smart Shakes	NO INFO ( PROGRAM AVAIL )
Glucerna Hunger Smart Snack Bars	NO INFO ( PROGRAM AVAIL )
Glucerna Meal Bars	NO INFO ( PROGRAM AVAIL )
Glucerna Shake	NO INFO ( PROGRAM AVAIL )
Glucerna Shakes	NO INFO ( PROGRAM AVAIL )
Glucerna Snack Bars	NO INFO ( PROGRAM AVAIL )
Glucerna Snack Shakes	NO INFO ( PROGRAM AVAIL )
Glucophage	NO INFO ( PROGRAM AVAIL )
Glucophage XR	NO INFO ( PROGRAM AVAIL )
Glucotrol	NO INFO ( PROGRAM AVAIL )
Glucotrol XL	NO INFO ( PROGRAM AVAIL )
Glucovance	NO INFO ( PROGRAM AVAIL )
Glutarex	NO INFO ( PROGRAM AVAIL )
Glynase	NO INFO ( PROGRAM AVAIL )
Glyset	NO INFO ( PROGRAM AVAIL )
Glyset Tablet	miglitol	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Glytrol	NO INFO ( PROGRAM AVAIL )
Glyxambi	NO INFO ( PROGRAM AVAIL )
Gocovri	NO INFO ( PROGRAM AVAIL )
Gold Bond Medicated Baby Powder	NO INFO ( PROGRAM AVAIL )
Gold Bond Medicated Intensive Healing Cream	NO INFO ( PROGRAM AVAIL )
Gold Bond Ultimate Diabetics Dry Skin Relief	NO INFO ( PROGRAM AVAIL )
Gold Bond Ultimate Rough & Bumpy Skin	NO INFO ( PROGRAM AVAIL )
Gonal-F	NO INFO ( PROGRAM AVAIL )
Goody\'s Pain Relief Products	NO INFO ( PROGRAM AVAIL )
Grafix CORE	NO INFO ( PROGRAM AVAIL )
Grafix PRIME	NO INFO ( PROGRAM AVAIL )
Graftjacket	NO INFO ( PROGRAM AVAIL )
Graftjacket Xpress	NO INFO ( PROGRAM AVAIL )
Gralise	NO INFO ( PROGRAM AVAIL )
Granisol	NO INFO ( PROGRAM AVAIL )
Granix	NO INFO ( PROGRAM AVAIL )
Grastek	NO INFO ( PROGRAM AVAIL )
Gynazole 1	NO INFO ( PROGRAM AVAIL )
Gynodiol	NO INFO ( PROGRAM AVAIL )
H.P. Acthar Gel	NO INFO ( PROGRAM AVAIL )
Haegarda	NO INFO ( PROGRAM AVAIL )
Halaven	NO INFO ( PROGRAM AVAIL )
Halcion	NO INFO ( PROGRAM AVAIL )
Haldol	NO INFO ( PROGRAM AVAIL )
Haldol Decanoate	NO INFO ( PROGRAM AVAIL )
Haldol Injection	haloperidol	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$212.90	J&J
Halog	NO INFO ( PROGRAM AVAIL )
Harvoni	NO INFO ( PROGRAM AVAIL )
Havrix	NO INFO ( PROGRAM AVAIL )
HCY 1 Infant Formula	NO INFO ( PROGRAM AVAIL )
HCY 2 Medical Food	NO INFO ( PROGRAM AVAIL )
Head and Shoulders Products	NO INFO ( PROGRAM AVAIL )
Hecoria	NO INFO ( PROGRAM AVAIL )
Hectorol	NO INFO ( PROGRAM AVAIL )
Helicoll	NO INFO ( PROGRAM AVAIL )
HelioCare	NO INFO ( PROGRAM AVAIL )
Helixate FS	NO INFO ( PROGRAM AVAIL )
Hemabate	NO INFO ( PROGRAM AVAIL )
Hemangeol	NO INFO ( PROGRAM AVAIL )
Hemlibra	NO INFO ( PROGRAM AVAIL )
Hemofil-M	NO INFO ( PROGRAM AVAIL )
HepaGam B	NO INFO ( PROGRAM AVAIL )
Heparin	NO INFO ( PROGRAM AVAIL )
Heplisav-B	NO INFO ( PROGRAM AVAIL )
Hepsera	NO INFO ( PROGRAM AVAIL )
Herceptin	NO INFO ( PROGRAM AVAIL )
Hetlioz	NO INFO ( PROGRAM AVAIL )
Hexalen	NO INFO ( PROGRAM AVAIL )
Hi-Cal	NO INFO ( PROGRAM AVAIL )
Hizentra	NO INFO ( PROGRAM AVAIL )
Hollister Colostomy Supplies	NO INFO ( PROGRAM AVAIL )
Hominex	NO INFO ( PROGRAM AVAIL )
Horizant	NO INFO ( PROGRAM AVAIL )
Humalog	insulin lispro	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$77.14	Lilly Cares
Humalog KwikPen	NO INFO ( PROGRAM AVAIL )
Humalog Mix 50/50	NO INFO ( PROGRAM AVAIL )
Humalog Mix 50/50 KwikPen	NO INFO ( PROGRAM AVAIL )
Humalog Mix 50/50 Pen	NO INFO ( PROGRAM AVAIL )
Humalog Mix 75/25	NO INFO ( PROGRAM AVAIL )
Humalog Mix 75/25 Pen	NO INFO ( PROGRAM AVAIL )
Humalog Mix50/50	insulin lispro	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$264.04	Lilly Cares
Humalog Mix75/25	insulin lispro	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$264.04	Lilly Cares
Humalog Pen	NO INFO ( PROGRAM AVAIL )
Humalog U-200 KwikPen	NO INFO ( PROGRAM AVAIL )
Humate-P	NO INFO ( PROGRAM AVAIL )
Humatrope	somatropinå	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$784.98	Lilly Cares
HUMIRA	adalimumab	YES	YES	300	Doctor	1 Year	90 Day	$2,477.43	AbbVIe
Humira Container	NO INFO ( PROGRAM AVAIL )
Humulin 70/30	insulin human	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$138.35	Lilly Cares
Humulin N	nph human insulin	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$138.35	Lilly Cares
Humulin R	regular insulin humanå	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$138.35	Lilly Cares
Humulin R (U-100)	NO INFO ( PROGRAM AVAIL )
Humulin R (U-500)	NO INFO ( PROGRAM AVAIL )
Hyalgan	NO INFO ( PROGRAM AVAIL )
Hyalomatrix	NO INFO ( PROGRAM AVAIL )
Hycamtin	NO INFO ( PROGRAM AVAIL )
Hycofenix	NO INFO ( PROGRAM AVAIL )
Hydrea	NO INFO ( PROGRAM AVAIL )
Hyland\'s Homeopathic Products	NO INFO ( PROGRAM AVAIL )
Hylands Homeopathic 4Kids Products	NO INFO ( PROGRAM AVAIL )
Hylands Homeopathic Adult Products	NO INFO ( PROGRAM AVAIL )
Hymovis	NO INFO ( PROGRAM AVAIL )
Hyophen	NO INFO ( PROGRAM AVAIL )
HyQvia	NO INFO ( PROGRAM AVAIL )
Hysingla ER	NO INFO ( PROGRAM AVAIL )
Hyzaar	NO INFO ( PROGRAM AVAIL )
I-Caps Eye Lutein and Omega-3 Vitamin	NO INFO ( PROGRAM AVAIL )
I-Caps Eye Multivitamin Formula	NO INFO ( PROGRAM AVAIL )
I-Caps Eye Vitamin AREDS Formula	NO INFO ( PROGRAM AVAIL )
I-Caps Eye Vitamin Lutein and Zeaxanthin Formula	NO INFO ( PROGRAM AVAIL )
I-Valex	NO INFO ( PROGRAM AVAIL )
Ibrance	NO INFO ( PROGRAM AVAIL )
Iclusig	NO INFO ( PROGRAM AVAIL )
Idamycin PFS	NO INFO ( PROGRAM AVAIL )
Idamycin PFSInjection	idarubicin	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Idelvion	NO INFO ( PROGRAM AVAIL )
Idhifa	NO INFO ( PROGRAM AVAIL )
Ifex	NO INFO ( PROGRAM AVAIL )
Ilaris	NO INFO ( PROGRAM AVAIL )
Ilevro	NO INFO ( PROGRAM AVAIL )
Iluvien	NO INFO ( PROGRAM AVAIL )
Imbruvica	ibrutinib	YES + 4% OOP	YES	500	Card/Doctor	1 Year	90 Day	$14,397.38	J&J
Imfinzi	NO INFO ( PROGRAM AVAIL )
Imitrex	NO INFO ( PROGRAM AVAIL )
Imitrex Nasal Spray	sumatriptan	NO	NO	250	Patient	1 Year	90 Day	$521.31	BtA
Imitrex Spray	sumatriptan	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$417.91	BtA
Imlygic	NO INFO ( PROGRAM AVAIL )
Imodium A-D	NO INFO ( PROGRAM AVAIL )
Imogam	NO INFO ( PROGRAM AVAIL )
Imogam Injection	rabies immune globulin	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$809.05	Sanofi
Imovax	NO INFO ( PROGRAM AVAIL )
Imovax Injection	rabies vaccine	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$964.03	Sanofi
Impact Peptide 1.5	NO INFO ( PROGRAM AVAIL )
Implanon	NO INFO ( PROGRAM AVAIL )
Imuran	NO INFO ( PROGRAM AVAIL )
Incivek	NO INFO ( PROGRAM AVAIL )
Increlex	NO INFO ( PROGRAM AVAIL )
Incruse Ellipta	NO INFO ( PROGRAM AVAIL )
Inderal LA	NO INFO ( PROGRAM AVAIL )
Indocin	NO INFO ( PROGRAM AVAIL )
Infants Advil Drops	NO INFO ( PROGRAM AVAIL )
Infed	NO INFO ( PROGRAM AVAIL )
Infergen	NO INFO ( PROGRAM AVAIL )
Inflectra	NO INFO ( PROGRAM AVAIL )
Ingrezza	NO INFO ( PROGRAM AVAIL )
Injectafer	NO INFO ( PROGRAM AVAIL )
Inlyta	NO INFO ( PROGRAM AVAIL )
Inlyta Tablet	axitinib	YES	YES	400	Doctor	1 Year	90 Day	$6,561.79	Pfizer
InnoPran XL	NO INFO ( PROGRAM AVAIL )
Inomax	NO INFO ( PROGRAM AVAIL )
Inspra	NO INFO ( PROGRAM AVAIL )
Inspra Tablet	eplerenone	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Integra	NO INFO ( PROGRAM AVAIL )
Integra DRT	NO INFO ( PROGRAM AVAIL )
Integra F	NO INFO ( PROGRAM AVAIL )
Integra Flowable	NO INFO ( PROGRAM AVAIL )
Integra Plus	NO INFO ( PROGRAM AVAIL )
Integrilin	NO INFO ( PROGRAM AVAIL )
Intelence	etravirine	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$587.79	J&J
Intrarosa	NO INFO ( PROGRAM AVAIL )
Intron A	NO INFO ( PROGRAM AVAIL )
Intuniv	guanfacine	YES	YES	300	Card	1 Year	90 Day		Shire Cares
Invanz	NO INFO ( PROGRAM AVAIL )
Invega	paliperidone palmitate	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$1,170.92	J&J
Invega Sustenna	NO INFO ( PROGRAM AVAIL )
Invega Sustenna ER	paliperidone palmitate	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$1,147.07	J&J
Invega Trinza	NO INFO ( PROGRAM AVAIL )
Invirase	NO INFO ( PROGRAM AVAIL )
Invokamet	NO INFO ( PROGRAM AVAIL )
Invokamet XR	NO INFO ( PROGRAM AVAIL )
Invokana	canagliflozin	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$462.74	J&J
Iopidine	NO INFO ( PROGRAM AVAIL )
Iressa	NO INFO ( PROGRAM AVAIL )
Irospan 24-6	NO INFO ( PROGRAM AVAIL )
Isentress	NO INFO ( PROGRAM AVAIL )
Isentress HD	NO INFO ( PROGRAM AVAIL )
Isoptin	NO INFO ( PROGRAM AVAIL )
Isopto Atropine	NO INFO ( PROGRAM AVAIL )
Isordil	NO INFO ( PROGRAM AVAIL )
Istalol	NO INFO ( PROGRAM AVAIL )
Istodax	NO INFO ( PROGRAM AVAIL )
Ixempra	ixabepilone	No	YES	300	Doctor	1 Year	Varies		R-Pharm
Ixinity	NO INFO ( PROGRAM AVAIL )
Jadenu	NO INFO ( PROGRAM AVAIL )
Jadenu Sprinkle	NO INFO ( PROGRAM AVAIL )
Jakafi	NO INFO ( PROGRAM AVAIL )
Jalyn	NO INFO ( PROGRAM AVAIL )
Jalyn Capsule	dutasteride and tamsulosin	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$211.67	BtA
Jantoven	NO INFO ( PROGRAM AVAIL )
Janumet	NO INFO ( PROGRAM AVAIL )
Janumet Tablet	metformin/sitagliptin phosphate	YES	YES	400	Patient	1 Year	90 Day	$391.89	Merck
Janumet XR	NO INFO ( PROGRAM AVAIL )
Janumet XRTablet ER	metformin/sitagliptin phosphate	YES	YES	400	Patient	1 Year	90 Day	$391.89	Merck
Januvia	NO INFO ( PROGRAM AVAIL )
Januvia Tablet	sitagliptin	YES	YES	400	Patient	1 Year	90 Day	$388.66	Merck
Jardiance	NO INFO ( PROGRAM AVAIL )
Jentadueto	NO INFO ( PROGRAM AVAIL )
Jentadueto XR	NO INFO ( PROGRAM AVAIL )
Jetrea	NO INFO ( PROGRAM AVAIL )
Jevity 1.2 Cal	NO INFO ( PROGRAM AVAIL )
Jevtana	NO INFO ( PROGRAM AVAIL )
Jevtana Injection	cabazitaxel	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$10,519.98	Sanofi
Jublia	NO INFO ( PROGRAM AVAIL )
Juluca	NO INFO ( PROGRAM AVAIL )
Junior Strength Advil	NO INFO ( PROGRAM AVAIL )
Juvederm Ultra XC	NO INFO ( PROGRAM AVAIL )
Juvederm Vollure XC	NO INFO ( PROGRAM AVAIL )
Juvederm Voluma XC	NO INFO ( PROGRAM AVAIL )
Juvederm XC	NO INFO ( PROGRAM AVAIL )
Juxtapid	NO INFO ( PROGRAM AVAIL )
K-Dur	NO INFO ( PROGRAM AVAIL )
Kadcyla	NO INFO ( PROGRAM AVAIL )
Kalbitor	NO INFO ( PROGRAM AVAIL )
KALETRA	lopinavir/ritonavir	YES	YES	500	Doctor	1 Year	90 Day	$476.79	AbbVIe
Kalydeco	NO INFO ( PROGRAM AVAIL )
Kanuma	NO INFO ( PROGRAM AVAIL )
Karbinal ER	NO INFO ( PROGRAM AVAIL )
Kayexalate	NO INFO ( PROGRAM AVAIL )
Kazano	algoliptin/metformin hci	YES	YES	400	Patient	1 Year	90 Day	$431.48	Takeda
Kcentra	NO INFO ( PROGRAM AVAIL )
Kenacort	NO INFO ( PROGRAM AVAIL )
Kenalog	NO INFO ( PROGRAM AVAIL )
Keppra	NO INFO ( PROGRAM AVAIL )
Keppra Oral Solution	levetiracetam	YES/No Coverage	YES	300	Doctor	6 Months	90 Day		UCBCares
Keppra Tablet	levetiracetam	YES/No Coverage	YES	300	Doctor	6 Months	90 Day		UCBCares
Keppra XR	NO INFO ( PROGRAM AVAIL )
Keppra XR Tablet	levetiracetam	YES/No Coverage	YES	300	Doctor	6 Months	90 Day		UCBCares
Keralac	NO INFO ( PROGRAM AVAIL )
Kerasal Fungal Nail Renewal Treatment	NO INFO ( PROGRAM AVAIL )
Kerasal Intensive Foot Repair	NO INFO ( PROGRAM AVAIL )
Kerydin	NO INFO ( PROGRAM AVAIL )
Ketonex	NO INFO ( PROGRAM AVAIL )
Keveyis	NO INFO ( PROGRAM AVAIL )
Kevzara	NO INFO ( PROGRAM AVAIL )
Keytruda	NO INFO ( PROGRAM AVAIL )
Khedezla	NO INFO ( PROGRAM AVAIL )
Kineret	NO INFO ( PROGRAM AVAIL )
Kionex	NO INFO ( PROGRAM AVAIL )
Kisqali	NO INFO ( PROGRAM AVAIL )
Kisqali Femara	NO INFO ( PROGRAM AVAIL )
Kitabis Pak	NO INFO ( PROGRAM AVAIL )
Klonopin	NO INFO ( PROGRAM AVAIL )
Koate DVI	NO INFO ( PROGRAM AVAIL )
Kogenate FS	NO INFO ( PROGRAM AVAIL )
Kogenate FS with Bio-Set	NO INFO ( PROGRAM AVAIL )
Kombiglyze XR	NO INFO ( PROGRAM AVAIL )
Kombiglyze XRTablet	saxagliptin/metformin	YES + 3% OOP	YES	300	Patient	1 Year	90 Day	$190.49	AZ&ME
Korlym	NO INFO ( PROGRAM AVAIL )
Kovaltry	NO INFO ( PROGRAM AVAIL )
Kristalose	NO INFO ( PROGRAM AVAIL )
Krystexxa	NO INFO ( PROGRAM AVAIL )
Kuvan	NO INFO ( PROGRAM AVAIL )
Kybella	NO INFO ( PROGRAM AVAIL )
Kyleena	NO INFO ( PROGRAM AVAIL )
Kymriah	NO INFO ( PROGRAM AVAIL )
Kynamro	NO INFO ( PROGRAM AVAIL )
Kyprolis	NO INFO ( PROGRAM AVAIL )
Kytril	NO INFO ( PROGRAM AVAIL )
Lacrisert	NO INFO ( PROGRAM AVAIL )
Lactaid Fast Act Supplements	NO INFO ( PROGRAM AVAIL )
Lactaid Products	NO INFO ( PROGRAM AVAIL )
Lamictal	NO INFO ( PROGRAM AVAIL )
Lamictal CD	NO INFO ( PROGRAM AVAIL )
Lamictal ODT	NO INFO ( PROGRAM AVAIL )
Lamictal ODTPatient Titration Kit	lamotrigine	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$719.23	BtA
Lamictal Tablet	lamotrigine	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$854.82	BtA
Lamictal XR	NO INFO ( PROGRAM AVAIL )
Lamictal XRPatient Titration Kit	lamotrigine	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$719.23	BtA
Lamictal XRTablet ER	lamotrigine	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$854.82	BtA
Lamisil Jock Itch Products	NO INFO ( PROGRAM AVAIL )
Lamisil Oral Granules	terbinafine	NO RX COVERAGE	NO	250	Card	1 Year	Varies		Novartis
Lamisil Ringworm Products	NO INFO ( PROGRAM AVAIL )
LamisilAT Athletes Foot Products	NO INFO ( PROGRAM AVAIL )
Lanacane Anti-Chafing Gel	NO INFO ( PROGRAM AVAIL )
Lanoxin	NO INFO ( PROGRAM AVAIL )
Lantus	NO INFO ( PROGRAM AVAIL )
Lantus SoloSTAR Pen	insulin glargine	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$372.27	Sanofi
Lantus U-100	NO INFO ( PROGRAM AVAIL )
Lantus U-100Vial	insulin glargine	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$248.51	Sanofi
Lartruvo	NO INFO ( PROGRAM AVAIL )
Lasix	NO INFO ( PROGRAM AVAIL )
Lastacaft	NO INFO ( PROGRAM AVAIL )
Latisse	NO INFO ( PROGRAM AVAIL )
Latuda	lurasidone	NO	YES	300	Doctor	1 Year	90 Day		Sunovion
Lemtrada	NO INFO ( PROGRAM AVAIL )
Lenvima	NO INFO ( PROGRAM AVAIL )
Lescol	NO INFO ( PROGRAM AVAIL )
Letairis	NO INFO ( PROGRAM AVAIL )
Leukeran	NO INFO ( PROGRAM AVAIL )
Leukine	NO INFO ( PROGRAM AVAIL )
Leukine Vial	sargramostim	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$1,337.54	Sanofi
Leustatin	NO INFO ( PROGRAM AVAIL )
Levaquin	NO INFO ( PROGRAM AVAIL )
Levatol	NO INFO ( PROGRAM AVAIL )
Levemir	NO INFO ( PROGRAM AVAIL )
Levemir FlexPenInjection	insulin detemir	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$411.59	Novo Nordisk
Levemir Injection	insulin detemir	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$274.56	Novo Nordisk
Levitra	NO INFO ( PROGRAM AVAIL )
Levo-T	NO INFO ( PROGRAM AVAIL )
Levoxyl	NO INFO ( PROGRAM AVAIL )
Levsin	NO INFO ( PROGRAM AVAIL )
Levulan Kerastick	NO INFO ( PROGRAM AVAIL )
Lexapro	NO INFO ( PROGRAM AVAIL )
Lexiscan	NO INFO ( PROGRAM AVAIL )
Lexiva	NO INFO ( PROGRAM AVAIL )
Lialda	mesalamine	YES	YES	300	Card	1 Year	90 Day		Shire Cares
Librax	NO INFO ( PROGRAM AVAIL )
Lidoderm	NO INFO ( PROGRAM AVAIL )
Liletta	NO INFO ( PROGRAM AVAIL )
Limbrel 500	NO INFO ( PROGRAM AVAIL )
Lincocin	NO INFO ( PROGRAM AVAIL )
Lincocin Injection	lincomycin	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Linzess	NO INFO ( PROGRAM AVAIL )
Linzess Capsules	linaclotide	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$348.83	Allergan
Lioresal	NO INFO ( PROGRAM AVAIL )
Lipitor	NO INFO ( PROGRAM AVAIL )
Lipofen	NO INFO ( PROGRAM AVAIL )
Liptruzet	NO INFO ( PROGRAM AVAIL )
Listerine Products	NO INFO ( PROGRAM AVAIL )
Lithobid	NO INFO ( PROGRAM AVAIL )
Lithostat	NO INFO ( PROGRAM AVAIL )
Livalo	NO INFO ( PROGRAM AVAIL )
LMD Infant Formula	NO INFO ( PROGRAM AVAIL )
LMX	NO INFO ( PROGRAM AVAIL )
Lo Loestrin Fe	NO INFO ( PROGRAM AVAIL )
Locoid	NO INFO ( PROGRAM AVAIL )
Lodine	NO INFO ( PROGRAM AVAIL )
Lodosyn	NO INFO ( PROGRAM AVAIL )
Lofibra (Micronized)	NO INFO ( PROGRAM AVAIL )
Lomaira	NO INFO ( PROGRAM AVAIL )
Lomotil	NO INFO ( PROGRAM AVAIL )
Lonox	NO INFO ( PROGRAM AVAIL )
Lonsurf	NO INFO ( PROGRAM AVAIL )
Lopid	NO INFO ( PROGRAM AVAIL )
Lopressor	NO INFO ( PROGRAM AVAIL )
Lopressor HCT	NO INFO ( PROGRAM AVAIL )
Loprox Shampoo	NO INFO ( PROGRAM AVAIL )
Lopurin	NO INFO ( PROGRAM AVAIL )
Lorzone	NO INFO ( PROGRAM AVAIL )
Lotemax	NO INFO ( PROGRAM AVAIL )
Lotemax Gel	NO INFO ( PROGRAM AVAIL )
Lotemax Ointment	NO INFO ( PROGRAM AVAIL )
Lotensin	NO INFO ( PROGRAM AVAIL )
Lotensin HCT	NO INFO ( PROGRAM AVAIL )
Lotrel	NO INFO ( PROGRAM AVAIL )
Lotrimin AF Athlete\'s Foot Antifungal Cream	NO INFO ( PROGRAM AVAIL )
Lotrimin AF Athlete\'s Foot Antifungal Powder	NO INFO ( PROGRAM AVAIL )
Lotrimin AF Athlete\'s Foot Deodorant Powder Spray	NO INFO ( PROGRAM AVAIL )
Lotrimin AF Athlete\'s Foot Powder Spray	NO INFO ( PROGRAM AVAIL )
Lotrimin AF Ringworm Cream	NO INFO ( PROGRAM AVAIL )
Lotrimin Jock Itch Products	NO INFO ( PROGRAM AVAIL )
Lotrimin Ultra AF Athlete\'s Foot Cream	NO INFO ( PROGRAM AVAIL )
Lotrisone	NO INFO ( PROGRAM AVAIL )
Lotrisone Cream	clotrimazole/betamethasone	YES	YES	400	Patient	1 Year	90 Day	$123.16	Merck
Lotronex	NO INFO ( PROGRAM AVAIL )
Lovaza	NO INFO ( PROGRAM AVAIL )
Lovaza Capsule	omega-3-acid ethyl esters	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day		GSK
Lovenox	NO INFO ( PROGRAM AVAIL )
Lovenox Injection	enoxaparin sodium	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$381.37	Sanofi
Lubriderm Daily Moisture Lotion Products	NO INFO ( PROGRAM AVAIL )
Lubriderm Mens Lotion	NO INFO ( PROGRAM AVAIL )
Lubriderm Therapeutic Lotion Products	NO INFO ( PROGRAM AVAIL )
Lucentis	NO INFO ( PROGRAM AVAIL )
Lufyllin	NO INFO ( PROGRAM AVAIL )
Lumigan	NO INFO ( PROGRAM AVAIL )
Lumizyme	NO INFO ( PROGRAM AVAIL )
Lunelle	NO INFO ( PROGRAM AVAIL )
Lunesta	NO INFO ( PROGRAM AVAIL )
Lupaneta Pack	NO INFO ( PROGRAM AVAIL )
Lupron	NO INFO ( PROGRAM AVAIL )
Lupron Depot	NO INFO ( PROGRAM AVAIL )
LUPRON DEPOT GYN	norethindrone acetate	YES	YES	300	Doctor	1 Year	Varies		AbbVIe
Lupron Depot-PED	NO INFO ( PROGRAM AVAIL )
Luxiq	NO INFO ( PROGRAM AVAIL )
Luzu	NO INFO ( PROGRAM AVAIL )
Lycelle	NO INFO ( PROGRAM AVAIL )
Lymphoseek	NO INFO ( PROGRAM AVAIL )
Lynparza	NO INFO ( PROGRAM AVAIL )
Lyrica	NO INFO ( PROGRAM AVAIL )
Lyrica Capsule	pregabalin	YES	YES	400	Doctor	1 Year	90 Day	$566.18	Pfizer
Lyrica Oral Solution	pregabalin	YES	YES	400	Doctor	1 Year	90 Day	$792.15	Pfizer
Lysimax	NO INFO ( PROGRAM AVAIL )
Lysodren	NO INFO ( PROGRAM AVAIL )
M-M-R II	NO INFO ( PROGRAM AVAIL )
Macugen	NO INFO ( PROGRAM AVAIL )
Makena	NO INFO ( PROGRAM AVAIL )
Malarone	NO INFO ( PROGRAM AVAIL )
Malarone Tablet	atovaquone and proguanil	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day		GSK
Marinol	NO INFO ( PROGRAM AVAIL )
Marplan	NO INFO ( PROGRAM AVAIL )
Marqibo	NO INFO ( PROGRAM AVAIL )
Marqibo Kit	NO INFO ( PROGRAM AVAIL )
Mastisol	NO INFO ( PROGRAM AVAIL )
MatriStem Burn Matrix	NO INFO ( PROGRAM AVAIL )
MatriStem MicroMatrix	NO INFO ( PROGRAM AVAIL )
MatriStem Wound Matrix	NO INFO ( PROGRAM AVAIL )
Matulane	NO INFO ( PROGRAM AVAIL )
Matzim	NO INFO ( PROGRAM AVAIL )
Mavik	NO INFO ( PROGRAM AVAIL )
Mavyret	NO INFO ( PROGRAM AVAIL )
Maxair	NO INFO ( PROGRAM AVAIL )
Maxalt	NO INFO ( PROGRAM AVAIL )
Maxalt Tablet	rizatriptan benzoate	YES	YES	400	Patient	1 Year	90 Day	$226.29	Merck
Maxalt-MLT	NO INFO ( PROGRAM AVAIL )
Maxalt-MLTTablet	rizatriptan benzoate	YES	YES	400	Patient	1 Year	90 Day	$226.28	Merck
Maxidex	NO INFO ( PROGRAM AVAIL )
Maxitrol	NO INFO ( PROGRAM AVAIL )
Maxzide	NO INFO ( PROGRAM AVAIL )
Mederma Advanced Scars Gel	NO INFO ( PROGRAM AVAIL )
Mederma PM Intensive Overnight Scar Cream	NO INFO ( PROGRAM AVAIL )
Mederma Quick Dry Oil	NO INFO ( PROGRAM AVAIL )
Mederma Scars Cream Plus SPF 30	NO INFO ( PROGRAM AVAIL )
Mederma Stretch Marks Therapy	NO INFO ( PROGRAM AVAIL )
Medrol	NO INFO ( PROGRAM AVAIL )
Megace	NO INFO ( PROGRAM AVAIL )
Megace ES	NO INFO ( PROGRAM AVAIL )
Mekinist	NO INFO ( PROGRAM AVAIL )
Menactra	NO INFO ( PROGRAM AVAIL )
Menactra Injection	diphtheria toxid conjugate vaccine	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$113.36	Sanofi
Menest	NO INFO ( PROGRAM AVAIL )
Menomune	NO INFO ( PROGRAM AVAIL )
Menomune Injection	meningococcal polysacchaaide vaccine	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$123.55	Sanofi
Menopur	NO INFO ( PROGRAM AVAIL )
Menostar	NO INFO ( PROGRAM AVAIL )
Menstridol	NO INFO ( PROGRAM AVAIL )
Mephyton	NO INFO ( PROGRAM AVAIL )
Mepron	NO INFO ( PROGRAM AVAIL )
Mepron Suspension	atovaquone	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$1,564.26	BtA
Mepsevii	NO INFO ( PROGRAM AVAIL )
Merrem	NO INFO ( PROGRAM AVAIL )
Merrem Injection	meropenem	YES + LIS DENIAL + 3% OOP	YES	300	Patient	End Of Year	90 Day	386.89	AZ&ME
Mesnex	NO INFO ( PROGRAM AVAIL )
Mestinon	NO INFO ( PROGRAM AVAIL )
Metadate CD	NO INFO ( PROGRAM AVAIL )
Metamucil Clear and Natural	NO INFO ( PROGRAM AVAIL )
Metamucil Fiber Capsules	NO INFO ( PROGRAM AVAIL )
Metamucil Fiber MultiGrain Wafers	NO INFO ( PROGRAM AVAIL )
Metamucil Fiber Powder	NO INFO ( PROGRAM AVAIL )
Metamucil Fiber Singles	NO INFO ( PROGRAM AVAIL )
Metanx	NO INFO ( PROGRAM AVAIL )
Metastron	NO INFO ( PROGRAM AVAIL )
Methotrexate LPF	NO INFO ( PROGRAM AVAIL )
Metopirone	NO INFO ( PROGRAM AVAIL )
Metozolv	NO INFO ( PROGRAM AVAIL )
MetroCream	NO INFO ( PROGRAM AVAIL )
MetroGel	NO INFO ( PROGRAM AVAIL )
MetroLotion	NO INFO ( PROGRAM AVAIL )
Mevacor	NO INFO ( PROGRAM AVAIL )
Miacalcin	NO INFO ( PROGRAM AVAIL )
Micardis	NO INFO ( PROGRAM AVAIL )
Micardis HCT	NO INFO ( PROGRAM AVAIL )
MiCort HC	NO INFO ( PROGRAM AVAIL )
MicroSkin Ostomy Pouching Systems	NO INFO ( PROGRAM AVAIL )
Microzide	NO INFO ( PROGRAM AVAIL )
Midol Complete	NO INFO ( PROGRAM AVAIL )
Midol PM	NO INFO ( PROGRAM AVAIL )
Midol Teen Formula	NO INFO ( PROGRAM AVAIL )
Mifeprex	NO INFO ( PROGRAM AVAIL )
Migergot	NO INFO ( PROGRAM AVAIL )
Migranal	NO INFO ( PROGRAM AVAIL )
Millipred	NO INFO ( PROGRAM AVAIL )
Minivelle	NO INFO ( PROGRAM AVAIL )
Minocin	NO INFO ( PROGRAM AVAIL )
Minocin Kit	NO INFO ( PROGRAM AVAIL )
MiraLax	NO INFO ( PROGRAM AVAIL )
MiraLax NeatPAX	NO INFO ( PROGRAM AVAIL )
Mirapex	NO INFO ( PROGRAM AVAIL )
Mirapex ER	NO INFO ( PROGRAM AVAIL )
Mirena	NO INFO ( PROGRAM AVAIL )
Mirvaso	NO INFO ( PROGRAM AVAIL )
Mitigare	NO INFO ( PROGRAM AVAIL )
Mitosol	NO INFO ( PROGRAM AVAIL )
Mobic	NO INFO ( PROGRAM AVAIL )
Moderiba	NO INFO ( PROGRAM AVAIL )
Monistat 1 Products	NO INFO ( PROGRAM AVAIL )
Monistat 3 Products	NO INFO ( PROGRAM AVAIL )
Monistat 7 Products	NO INFO ( PROGRAM AVAIL )
Monistat Complete Care Chafing Relief Powder Gel	NO INFO ( PROGRAM AVAIL )
Monistat Complete Care Instant Itch Relief Cream	NO INFO ( PROGRAM AVAIL )
Monistat Complete Care Probiotics plus Antioxidants	NO INFO ( PROGRAM AVAIL )
Monistat Complete Care Stay Fresh Gel	NO INFO ( PROGRAM AVAIL )
Monistat Complete Care Vaginal Health Test	NO INFO ( PROGRAM AVAIL )
Monoclate-P	NO INFO ( PROGRAM AVAIL )
Monoket	NO INFO ( PROGRAM AVAIL )
Mononine	NO INFO ( PROGRAM AVAIL )
Monovisc	NO INFO ( PROGRAM AVAIL )
Monurol	NO INFO ( PROGRAM AVAIL )
Morphabond ER	NO INFO ( PROGRAM AVAIL )
Motrin IB	NO INFO ( PROGRAM AVAIL )
Motrin PM	NO INFO ( PROGRAM AVAIL )
Movantik	naloxegol oxalate	YES + 3% OOP	Yes	300	Patient	1 Year	90 Day	$362.04	AZ&ME
MoviPrep	NO INFO ( PROGRAM AVAIL )
Moxeza	NO INFO ( PROGRAM AVAIL )
Mozobil	NO INFO ( PROGRAM AVAIL )
Mozobil Injection	plerixafor	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$7,846.82	Sanofi
Mucomyst	NO INFO ( PROGRAM AVAIL )
MuGard	NO INFO ( PROGRAM AVAIL )
Multaq	dronedarone	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$566.43	Sanofi
Mustargen	NO INFO ( PROGRAM AVAIL )
Mutamycin	NO INFO ( PROGRAM AVAIL )
Myalept	NO INFO ( PROGRAM AVAIL )
Mycamine	NO INFO ( PROGRAM AVAIL )
Mycobutin	NO INFO ( PROGRAM AVAIL )
Mycobutin Capsule	rifabutin	YES	YES	400	Doctor	1 Year	90 Day	$1,829.65	Pfizer
Mydayis	NO INFO ( PROGRAM AVAIL )
Myfortic	NO INFO ( PROGRAM AVAIL )
Myfortic Tablet; Delayed Release	mycophenolic acid	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$1,176.55	Novartis
Myleran	NO INFO ( PROGRAM AVAIL )
Mylotarg	NO INFO ( PROGRAM AVAIL )
Myobloc	NO INFO ( PROGRAM AVAIL )
Myorisan	NO INFO ( PROGRAM AVAIL )
Myrbetriq	NO INFO ( PROGRAM AVAIL )
Mysoline	NO INFO ( PROGRAM AVAIL )
Mytesi	NO INFO ( PROGRAM AVAIL )
Naftin Gel	NO INFO ( PROGRAM AVAIL )
Nalfon	NO INFO ( PROGRAM AVAIL )
Namenda	NO INFO ( PROGRAM AVAIL )
Namenda Oral Solution	memantine	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$904.46	Allergan
Namenda Tablets	memantine	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$468.08	Allergan
Namenda Titration Pak	memantine	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$234.50	Allergan
Namenda XR	NO INFO ( PROGRAM AVAIL )
Namenda XR ER Capsules Titration Pack	memantine	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$387.08	Allergan
Namenda XRER Capsules	memantine	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$387.08	Allergan
Namzaric	memantine-donepezil	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day		Allergan
Naprelan	NO INFO ( PROGRAM AVAIL )
Naprosyn	NO INFO ( PROGRAM AVAIL )
Narcan	NO INFO ( PROGRAM AVAIL )
Nardil	NO INFO ( PROGRAM AVAIL )
Nasacort	NO INFO ( PROGRAM AVAIL )
NasalCrom Nasal Allergy Spray	NO INFO ( PROGRAM AVAIL )
Nascobal	NO INFO ( PROGRAM AVAIL )
Nasonex	NO INFO ( PROGRAM AVAIL )
Nasonex Spray	mometasone furoate monohydrate	YES	YES	400	Patient	1 Year	90 Day	$244.58	Merck
Natazia	NO INFO ( PROGRAM AVAIL )
Natesto	NO INFO ( PROGRAM AVAIL )
Natpara	NO INFO ( PROGRAM AVAIL )
Nature\'s Way Nutritional and Natural Products	NO INFO ( PROGRAM AVAIL )
Nauzene Products	NO INFO ( PROGRAM AVAIL )
Navelbine	NO INFO ( PROGRAM AVAIL )
Nebcin	NO INFO ( PROGRAM AVAIL )
NebuSal	NO INFO ( PROGRAM AVAIL )
Neo-Polycin	NO INFO ( PROGRAM AVAIL )
Neo-Synalar	NO INFO ( PROGRAM AVAIL )
Neocate Infant DHA and ARA	NO INFO ( PROGRAM AVAIL )
Neocera	NO INFO ( PROGRAM AVAIL )
NeoProfen	NO INFO ( PROGRAM AVAIL )
Neoral	NO INFO ( PROGRAM AVAIL )
Neoral Capsule	cyclosporine USP	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$134.96	Novartis
Neoral Oral Solution	cyclosporine	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$486.43	Novartis
Neosalus Cream	NO INFO ( PROGRAM AVAIL )
Neosar	NO INFO ( PROGRAM AVAIL )
Neosporin	NO INFO ( PROGRAM AVAIL )
Neosporin + Pain Relief Neo To Go Products	NO INFO ( PROGRAM AVAIL )
Neosporin + Pain Relief Products	NO INFO ( PROGRAM AVAIL )
Neosporin Eczema Essentials Products	NO INFO ( PROGRAM AVAIL )
Neosporin for Kids Products	NO INFO ( PROGRAM AVAIL )
Neosporin Lip Care Products	NO INFO ( PROGRAM AVAIL )
Neosporin Original Products	NO INFO ( PROGRAM AVAIL )
Neosporin-Polysporin	NO INFO ( PROGRAM AVAIL )
Nepro with Carb Steady	NO INFO ( PROGRAM AVAIL )
Nerlynx	NO INFO ( PROGRAM AVAIL )
Nesina	algoliptin	YES	YES	400	Patient	1 Year	90 Day	$431.48	Takeda
Nestabs	NO INFO ( PROGRAM AVAIL )
Nestabs ABC	NO INFO ( PROGRAM AVAIL )
Nestabs DHA	NO INFO ( PROGRAM AVAIL )
Neulasta	NO INFO ( PROGRAM AVAIL )
Neulasta Onpro Kit	NO INFO ( PROGRAM AVAIL )
Neupogen	NO INFO ( PROGRAM AVAIL )
Neupro	NO INFO ( PROGRAM AVAIL )
Neurontin	NO INFO ( PROGRAM AVAIL )
Neutrexin	NO INFO ( PROGRAM AVAIL )
Neutrogena Acne Products	NO INFO ( PROGRAM AVAIL )
Neutrogena Anti-Aging Products	NO INFO ( PROGRAM AVAIL )
Neutrogena Cleansers	NO INFO ( PROGRAM AVAIL )
Neutrogena Men\'s Products	NO INFO ( PROGRAM AVAIL )
Neutrogena Moisturizers	NO INFO ( PROGRAM AVAIL )
Neutrogena Suncare Products	NO INFO ( PROGRAM AVAIL )
Neutrogena T-Gel Hair & Scalp Products	NO INFO ( PROGRAM AVAIL )
New Skin Liquid Bandage	NO INFO ( PROGRAM AVAIL )
New-Skin Liquid Spray Bandage	NO INFO ( PROGRAM AVAIL )
Nexavar	NO INFO ( PROGRAM AVAIL )
Nexcare Absolute Waterproof First Aid Tape	NO INFO ( PROGRAM AVAIL )
Nexcare Sensitive Skin Tape	NO INFO ( PROGRAM AVAIL )
Nexcare Tegaderm Transparent Dressings	NO INFO ( PROGRAM AVAIL )
Nexium	NO INFO ( PROGRAM AVAIL )
Nexium 24HR	NO INFO ( PROGRAM AVAIL )
Nexplanon	NO INFO ( PROGRAM AVAIL )
Nexterone	NO INFO ( PROGRAM AVAIL )
Niacor	NO INFO ( PROGRAM AVAIL )
Niaspan	NO INFO ( PROGRAM AVAIL )
Nicaprin	NO INFO ( PROGRAM AVAIL )
NicoDerm CQ Step 1	NO INFO ( PROGRAM AVAIL )
NicoDerm CQ Step 2	NO INFO ( PROGRAM AVAIL )
NicoDerm CQ Step 3	NO INFO ( PROGRAM AVAIL )
Nicomide	NO INFO ( PROGRAM AVAIL )
Nicorette Gum	NO INFO ( PROGRAM AVAIL )
Nicorette Lozenge	NO INFO ( PROGRAM AVAIL )
Nicotrol	NO INFO ( PROGRAM AVAIL )
Nicotrol Inhalation System	nicotine cartridge	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Nifediac	NO INFO ( PROGRAM AVAIL )
Nilandron	NO INFO ( PROGRAM AVAIL )
Ninlaro	NO INFO ( PROGRAM AVAIL )
Nipent	NO INFO ( PROGRAM AVAIL )
Niravam	NO INFO ( PROGRAM AVAIL )
Nitro-Dur	nitroglycerin	YES	YES	400	Patient	1 Year	90 Day	$182.52	Merck
Nitrostat	NO INFO ( PROGRAM AVAIL )
Nityr	NO INFO ( PROGRAM AVAIL )
Nix Complete Lice Elimination Kit	NO INFO ( PROGRAM AVAIL )
Nix Lice Control Spray	NO INFO ( PROGRAM AVAIL )
Nix Lice Killing Creme Rinse	NO INFO ( PROGRAM AVAIL )
Nix Premium Metal Two-Sided Comb	NO INFO ( PROGRAM AVAIL )
Nizoral	NO INFO ( PROGRAM AVAIL )
Nolix	NO INFO ( PROGRAM AVAIL )
Nolvadex	NO INFO ( PROGRAM AVAIL )
NonyX Nail Gel	NO INFO ( PROGRAM AVAIL )
Norditropin	NO INFO ( PROGRAM AVAIL )
Norditropin FlexPro	NO INFO ( PROGRAM AVAIL )
Norditropin NordiFlex	NO INFO ( PROGRAM AVAIL )
Norel AD	NO INFO ( PROGRAM AVAIL )
Noritate	NO INFO ( PROGRAM AVAIL )
Norpace	NO INFO ( PROGRAM AVAIL )
Norpace Capsule	disopyramide phosphate	YES	YES	400	Varies	1 Year	90 Day	$463.22	Pfizer
Norpace CR	NO INFO ( PROGRAM AVAIL )
Norpace CRCapsule ER	disopyramide phosphate	YES	YES	400	Varies	1 Year	90 Day	$603.92	Pfizer
Norpramin	NO INFO ( PROGRAM AVAIL )
Northera	NO INFO ( PROGRAM AVAIL )
Norvasc	NO INFO ( PROGRAM AVAIL )
Norvir	ritonavir	YES	YES	300	Doctor	1 Year	90 Day		AbbVie
Novacort	NO INFO ( PROGRAM AVAIL )
Novantrone	NO INFO ( PROGRAM AVAIL )
Novarel	NO INFO ( PROGRAM AVAIL )
Novo Nordisk Needles	NO INFO ( PROGRAM AVAIL )
Novoeight	NO INFO ( PROGRAM AVAIL )
Novolin 70-30	NO INFO ( PROGRAM AVAIL )
Novolin 70/30 VialInjection	human/insulin susp isophane	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$140.79	Novo Nordisk
Novolin N	NO INFO ( PROGRAM AVAIL )
Novolin N VialInjection	insulin human	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$140.79	Novo Nordisk
Novolin R	NO INFO ( PROGRAM AVAIL )
Novolin R VialInjection	insulin human	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$140.79	Novo Nordisk
NovoLog	NO INFO ( PROGRAM AVAIL )
NovoLog FlexPenInjection	insulin aspartå	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$542.72	Novo Nordisk
NovoLog Injection	insulin aspartå	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$281.26	Novo Nordisk
NovoLog Mix 70/30	NO INFO ( PROGRAM AVAIL )
NovoLog Mix 70/30 FlexPen Cartridges	insulin aspart protamine	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$291.71	Novo Nordisk
NovoLog Mix 70/30Vial	insulin aspart protamine	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$291.71	Novo Nordisk
NovoSeven RT	NO INFO ( PROGRAM AVAIL )
Noxafil	NO INFO ( PROGRAM AVAIL )
Nplate	NO INFO ( PROGRAM AVAIL )
Nucala	NO INFO ( PROGRAM AVAIL )
Nucort	NO INFO ( PROGRAM AVAIL )
Nucynta	NO INFO ( PROGRAM AVAIL )
Nucynta ER	NO INFO ( PROGRAM AVAIL )
Nuedexta	NO INFO ( PROGRAM AVAIL )
Nulojix	NO INFO ( PROGRAM AVAIL )
Nulojix Injection	belatacept	YES + 3% OOP	YES	300	Doctor	1 Year	Varies	$1,022.91	Bristol-Myers
Nuplazid	NO INFO ( PROGRAM AVAIL )
Nutramigen with Enflora LGG	NO INFO ( PROGRAM AVAIL )
Nutramigen with Enflora LGG Toddler	NO INFO ( PROGRAM AVAIL )
Nutren 1.0 Fiber	NO INFO ( PROGRAM AVAIL )
Nutren 1.5	NO INFO ( PROGRAM AVAIL )
Nutren Junior	NO INFO ( PROGRAM AVAIL )
Nutren Junior Fiber	NO INFO ( PROGRAM AVAIL )
Nutrestore	NO INFO ( PROGRAM AVAIL )
Nutropin	NO INFO ( PROGRAM AVAIL )
Nutropin AQ	NO INFO ( PROGRAM AVAIL )
Nutropin AQ NuSpin	NO INFO ( PROGRAM AVAIL )
Nutropin AQ NuSpin Pen	NO INFO ( PROGRAM AVAIL )
Nutropin AQ Pen	NO INFO ( PROGRAM AVAIL )
Nuvail	NO INFO ( PROGRAM AVAIL )
Nuvaring	NO INFO ( PROGRAM AVAIL )
Nuvigil	armodafinil	YES	NO	300	Patient	1 Year	90 Day	$765.75	TevaCares
Nuwiq	NO INFO ( PROGRAM AVAIL )
Nyamyc	NO INFO ( PROGRAM AVAIL )
OA 1 Infant Formula	NO INFO ( PROGRAM AVAIL )
OA 2 Medical Food	NO INFO ( PROGRAM AVAIL )
Oasis	NO INFO ( PROGRAM AVAIL )
Oasis Tri-Layer	NO INFO ( PROGRAM AVAIL )
OB Complete One	NO INFO ( PROGRAM AVAIL )
OB Complete Petite	NO INFO ( PROGRAM AVAIL )
OB Complete Premier	NO INFO ( PROGRAM AVAIL )
Ocaliva	NO INFO ( PROGRAM AVAIL )
Ocrevus	NO INFO ( PROGRAM AVAIL )
Octagam	NO INFO ( PROGRAM AVAIL )
Ocuvite Adult 50 Eye Vitamins	NO INFO ( PROGRAM AVAIL )
Ocuvite Eye Health Formula	NO INFO ( PROGRAM AVAIL )
Ocuvite Eye+Multi	NO INFO ( PROGRAM AVAIL )
Ocuvite Lutien	NO INFO ( PROGRAM AVAIL )
Ocuvite Lutien and Zeaxanthin	NO INFO ( PROGRAM AVAIL )
Odefsey	NO INFO ( PROGRAM AVAIL )
Odomzo	NO INFO ( PROGRAM AVAIL )
Ofev	NO INFO ( PROGRAM AVAIL )
Ogen	NO INFO ( PROGRAM AVAIL )
Olux	NO INFO ( PROGRAM AVAIL )
Olux-E	NO INFO ( PROGRAM AVAIL )
Olysio	NO INFO ( PROGRAM AVAIL )
Olysio Capsule	simeprevir	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$76,315.20	J&J
Omeclamox-Pak	NO INFO ( PROGRAM AVAIL )
Omidria	NO INFO ( PROGRAM AVAIL )
Omnipred	NO INFO ( PROGRAM AVAIL )
Omnitrope	NO INFO ( PROGRAM AVAIL )
Oncaspar	NO INFO ( PROGRAM AVAIL )
Oncovin	NO INFO ( PROGRAM AVAIL )
One-A-Day Adult Multivitamin products	NO INFO ( PROGRAM AVAIL )
One-A-Day Kids Multivitamin products	NO INFO ( PROGRAM AVAIL )
One-A-Day Prenatal Multivitamin products	NO INFO ( PROGRAM AVAIL )
One-A-Day Teen Multivitamin products	NO INFO ( PROGRAM AVAIL )
OneTouch Verio	NO INFO ( PROGRAM AVAIL )
OneTouch Verio Flex	NO INFO ( PROGRAM AVAIL )
Onexton	NO INFO ( PROGRAM AVAIL )
Onfi	NO INFO ( PROGRAM AVAIL )
Onglyza	NO INFO ( PROGRAM AVAIL )
Onglyza Tablet	saxagliptin	NO + 3% OOP	NO	300	Patient	1 Year	Varies	$384.59	AZ&ME
Onivyde	NO INFO ( PROGRAM AVAIL )
Onmel	NO INFO ( PROGRAM AVAIL )
Ontak	NO INFO ( PROGRAM AVAIL )
Onxol	NO INFO ( PROGRAM AVAIL )
Onzetra Xsail	NO INFO ( PROGRAM AVAIL )
Opdivo	NO INFO ( PROGRAM AVAIL )
Opdivo Yervoy Regimen	NO INFO ( PROGRAM AVAIL )
Opsumit	NO INFO ( PROGRAM AVAIL )
Opti-Free Express Contact Lens Solution	NO INFO ( PROGRAM AVAIL )
Opti-Free Lubricant Eye Drops	NO INFO ( PROGRAM AVAIL )
Opti-Free PureMoist Contact Lens Solution	NO INFO ( PROGRAM AVAIL )
Opti-Free PureMoist Rewetting Drops	NO INFO ( PROGRAM AVAIL )
Opti-Free Replenish Contact Lens Solution	NO INFO ( PROGRAM AVAIL )
Optune	NO INFO ( PROGRAM AVAIL )
Oracea	NO INFO ( PROGRAM AVAIL )
Oralair	NO INFO ( PROGRAM AVAIL )
ORAP	pimozide	YES	NO	300	Patient	1 Year	90 Day	$134.03	TevaCares
Orapred	NO INFO ( PROGRAM AVAIL )
Orbactiv	NO INFO ( PROGRAM AVAIL )
Orencia	abatacept	YES + 3% OOP	YES	300	Doctor	1 Year	Varies	$4,403.86	Bristol-Myers
Orencia Container	NO INFO ( PROGRAM AVAIL )
Orenitram	NO INFO ( PROGRAM AVAIL )
Orkambi	NO INFO ( PROGRAM AVAIL )
Ortho Micronor	NO INFO ( PROGRAM AVAIL )
Ortho Tri-Cyclen	NO INFO ( PROGRAM AVAIL )
Ortho Tri-Cyclen Lo	NO INFO ( PROGRAM AVAIL )
Ortho-Cyclen	NO INFO ( PROGRAM AVAIL )
Orthoclone OKT3	NO INFO ( PROGRAM AVAIL )
Orthovisc	NO INFO ( PROGRAM AVAIL )
Orthovisc Injection	high molecular weight hyaluronan	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day		J&J
Oseni	algoliptin/pioglitazone	YES	YES	400	Patient	1 Year	90 Day	$431.48	Takeda
Osmolite 1.2 cal	NO INFO ( PROGRAM AVAIL )
Osphena	NO INFO ( PROGRAM AVAIL )
Ostaway x-Bag	NO INFO ( PROGRAM AVAIL )
Osteo Bi-Flex Products	NO INFO ( PROGRAM AVAIL )
Otezla	NO INFO ( PROGRAM AVAIL )
Otiprio	NO INFO ( PROGRAM AVAIL )
Otovel	NO INFO ( PROGRAM AVAIL )
Otrexup	NO INFO ( PROGRAM AVAIL )
Otrexup Container	NO INFO ( PROGRAM AVAIL )
Ovace Plus Products	NO INFO ( PROGRAM AVAIL )
Ovcon 35	NO INFO ( PROGRAM AVAIL )
Ovidrel	NO INFO ( PROGRAM AVAIL )
Oxandrin	NO INFO ( PROGRAM AVAIL )
Oxaydo	NO INFO ( PROGRAM AVAIL )
Oxistat	NO INFO ( PROGRAM AVAIL )
Oxsoralen	NO INFO ( PROGRAM AVAIL )
Oxtellar XR	NO INFO ( PROGRAM AVAIL )
OxyContin	NO INFO ( PROGRAM AVAIL )
OxyContin Tablets	oxycodone	NO	NO	139	Patient	1 Year	30 Day		Purdue
Ozempic	NO INFO ( PROGRAM AVAIL )
Ozurdex	NO INFO ( PROGRAM AVAIL )
Pacerone	NO INFO ( PROGRAM AVAIL )
Pamelor	NO INFO ( PROGRAM AVAIL )
Pancreaze	NO INFO ( PROGRAM AVAIL )
Pancreaze Capsule	pancrelipase	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$286.65	J&J
Pandel	NO INFO ( PROGRAM AVAIL )
Panhematin	NO INFO ( PROGRAM AVAIL )
Panretin	NO INFO ( PROGRAM AVAIL )
Parafon Forte DSC	NO INFO ( PROGRAM AVAIL )
Paraplatin	NO INFO ( PROGRAM AVAIL )
Parlodel	NO INFO ( PROGRAM AVAIL )
Parsabiv	NO INFO ( PROGRAM AVAIL )
Pataday	NO INFO ( PROGRAM AVAIL )
Patanase	NO INFO ( PROGRAM AVAIL )
Patanol	NO INFO ( PROGRAM AVAIL )
Paxil	NO INFO ( PROGRAM AVAIL )
Paxil CR	NO INFO ( PROGRAM AVAIL )
Pazeo	NO INFO ( PROGRAM AVAIL )
PCE	NO INFO ( PROGRAM AVAIL )
Pedia-Lax Products	NO INFO ( PROGRAM AVAIL )
PediaCare Allergy Products	NO INFO ( PROGRAM AVAIL )
PediaCare Cough & Cold Products	NO INFO ( PROGRAM AVAIL )
PediaCare Fever & Pain Relievers	NO INFO ( PROGRAM AVAIL )
PediaCare Gentle Vapors	NO INFO ( PROGRAM AVAIL )
PediaCare IB Products	NO INFO ( PROGRAM AVAIL )
PediaCare Infant Gas Relief Drops	NO INFO ( PROGRAM AVAIL )
Pediaderm HC	NO INFO ( PROGRAM AVAIL )
Pediaderm TA	NO INFO ( PROGRAM AVAIL )
Pedialyte-AdvancedCare Liters	NO INFO ( PROGRAM AVAIL )
Pedialyte-Freezer Pops	NO INFO ( PROGRAM AVAIL )
Pedialyte-Liters	NO INFO ( PROGRAM AVAIL )
Pedialyte-Powder Packs	NO INFO ( PROGRAM AVAIL )
Pediapred	NO INFO ( PROGRAM AVAIL )
PediaSure	NO INFO ( PROGRAM AVAIL )
PediaSure 1.5 cal	NO INFO ( PROGRAM AVAIL )
PediaSure Enteral Formula w-Fiber	NO INFO ( PROGRAM AVAIL )
PediaSure Peptide	NO INFO ( PROGRAM AVAIL )
PediaSure Products	NO INFO ( PROGRAM AVAIL )
PediaSure w/Fiber	NO INFO ( PROGRAM AVAIL )
Peganone	NO INFO ( PROGRAM AVAIL )
Pegasys	NO INFO ( PROGRAM AVAIL )
Pegasys ProClick	NO INFO ( PROGRAM AVAIL )
PegIntron	NO INFO ( PROGRAM AVAIL )
PegIntron-Rebetol	NO INFO ( PROGRAM AVAIL )
Pennsaid	NO INFO ( PROGRAM AVAIL )
Pentasa	mesalamine	YES	YES	300	Card	1 Year	90 Day		Shire Cares
Pepcid	NO INFO ( PROGRAM AVAIL )
Pepcid AC Maximum Strength	NO INFO ( PROGRAM AVAIL )
Pepcid AC Original Strength	NO INFO ( PROGRAM AVAIL )
Pepcid Complete	NO INFO ( PROGRAM AVAIL )
Peptamen	NO INFO ( PROGRAM AVAIL )
Peptamen 1.5	NO INFO ( PROGRAM AVAIL )
Peptamen Junior	NO INFO ( PROGRAM AVAIL )
Peptamen Junior 1.5	NO INFO ( PROGRAM AVAIL )
Peptamen Junior Fiber	NO INFO ( PROGRAM AVAIL )
Peptamen Junior HP	NO INFO ( PROGRAM AVAIL )
Peptamen Junior PreBio	NO INFO ( PROGRAM AVAIL )
Peptamen PreBio	NO INFO ( PROGRAM AVAIL )
Perative	NO INFO ( PROGRAM AVAIL )
Perforomist	NO INFO ( PROGRAM AVAIL )
Peri-Colace	NO INFO ( PROGRAM AVAIL )
Perjeta	NO INFO ( PROGRAM AVAIL )
Pertzye	NO INFO ( PROGRAM AVAIL )
PFD 2 Medical Food	NO INFO ( PROGRAM AVAIL )
PFD Toddler Medical Food	NO INFO ( PROGRAM AVAIL )
Pfizerpen	NO INFO ( PROGRAM AVAIL )
Phenergan	NO INFO ( PROGRAM AVAIL )
Phenex	NO INFO ( PROGRAM AVAIL )
Phillips Fiber Supplements	NO INFO ( PROGRAM AVAIL )
Phillips Laxative Products	NO INFO ( PROGRAM AVAIL )
Phillips Probiotics Products	NO INFO ( PROGRAM AVAIL )
Phillips\' Stool Softner	NO INFO ( PROGRAM AVAIL )
Phoslo	NO INFO ( PROGRAM AVAIL )
Phoslyra	NO INFO ( PROGRAM AVAIL )
Phospholine Iodide	NO INFO ( PROGRAM AVAIL )
Photofrin	NO INFO ( PROGRAM AVAIL )
Picato	NO INFO ( PROGRAM AVAIL )
Pivot 1.5 cal	NO INFO ( PROGRAM AVAIL )
Plan B One-Step	NO INFO ( PROGRAM AVAIL )
Plaquenil	NO INFO ( PROGRAM AVAIL )
Platinol	NO INFO ( PROGRAM AVAIL )
Platinol-AQ	NO INFO ( PROGRAM AVAIL )
Plavix		YES + 3% OOP	YES	300	Doctor	1 Year	Varies		Bristol-Myers
Plegridy	NO INFO ( PROGRAM AVAIL )
Plendil	NO INFO ( PROGRAM AVAIL )
Pletal	NO INFO ( PROGRAM AVAIL )
Plexion	NO INFO ( PROGRAM AVAIL )
Pneumovax 23	NO INFO ( PROGRAM AVAIL )
Poise Products	NO INFO ( PROGRAM AVAIL )
Polident 3-Minute Anti-Bacterial Denture Cleanser	NO INFO ( PROGRAM AVAIL )
Polident Clean and Protect for Partials	NO INFO ( PROGRAM AVAIL )
Polident Dentu-Creme Cleanser	NO INFO ( PROGRAM AVAIL )
Polident Overnight Whitening	NO INFO ( PROGRAM AVAIL )
Polident Smokers	NO INFO ( PROGRAM AVAIL )
Pomalyst	NO INFO ( PROGRAM AVAIL )
Portrazza	NO INFO ( PROGRAM AVAIL )
Potaba	NO INFO ( PROGRAM AVAIL )
Potiga Tablet	ezogabine	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$1,084.33	BtA
Pradaxa	NO INFO ( PROGRAM AVAIL )
Pradaxa Capsule	dabigatran etexilate	YES	YES	200	Patient	1 Year	90 Day	$370.41	BIC
Praluent	NO INFO ( PROGRAM AVAIL )
Pramosone	NO INFO ( PROGRAM AVAIL )
Prandin	NO INFO ( PROGRAM AVAIL )
Pravachol	NO INFO ( PROGRAM AVAIL )
Precose	NO INFO ( PROGRAM AVAIL )
Pred Forte	NO INFO ( PROGRAM AVAIL )
Pred Mild	NO INFO ( PROGRAM AVAIL )
Pred-G	NO INFO ( PROGRAM AVAIL )
Prednisolone	NO INFO ( PROGRAM AVAIL )
Prefest	NO INFO ( PROGRAM AVAIL )
Pregestimil	NO INFO ( PROGRAM AVAIL )
Pregnyl	NO INFO ( PROGRAM AVAIL )
Prelone	NO INFO ( PROGRAM AVAIL )
Premarin	NO INFO ( PROGRAM AVAIL )
Premarin Cream	estrogens conjugated	YES	YES	400	Doctor	1 Year	90 Day	$345.75	Pfizer
Premarin Tablet	estrogens conjugated	YES	YES	400	Doctor	1 Year	90 Day	$156.78	Pfizer
Premphase	NO INFO ( PROGRAM AVAIL )
Premphase Tablet	estrogens conjugated/medroxyprogesterone acetate	YES	YES	400	Doctor	1 Year	90 Day		Pfizer
Prempro	NO INFO ( PROGRAM AVAIL )
Prena1 Chew	NO INFO ( PROGRAM AVAIL )
Prena1 Pearl	NO INFO ( PROGRAM AVAIL )
Prena1 True	NO INFO ( PROGRAM AVAIL )
Prenate AM	NO INFO ( PROGRAM AVAIL )
Prenate Chewables	NO INFO ( PROGRAM AVAIL )
Prenate DHA	NO INFO ( PROGRAM AVAIL )
Prenate Elite	NO INFO ( PROGRAM AVAIL )
Prenate Enhance	NO INFO ( PROGRAM AVAIL )
Prenate Essential with Quatrefolic	NO INFO ( PROGRAM AVAIL )
Prenate Mini	NO INFO ( PROGRAM AVAIL )
Prenate Pixie	NO INFO ( PROGRAM AVAIL )
Prenate Restore	NO INFO ( PROGRAM AVAIL )
Prenate Star	NO INFO ( PROGRAM AVAIL )
Preparation H Anti-inch Cream	NO INFO ( PROGRAM AVAIL )
Preparation H Cooling Gel	NO INFO ( PROGRAM AVAIL )
Preparation H Maximum Strength Pain Relief Cream	NO INFO ( PROGRAM AVAIL )
Preparation H Maximum Strength Pain Relief Wipes	NO INFO ( PROGRAM AVAIL )
Preparation H Suppositories	NO INFO ( PROGRAM AVAIL )
Preparation H Totables	NO INFO ( PROGRAM AVAIL )
Prepopik	NO INFO ( PROGRAM AVAIL )
PreserVision Eye Vitamin AREDS 2 Formula Soft Gels	NO INFO ( PROGRAM AVAIL )
PreserVision Eye Vitamin AREDS Lutien Formula	NO INFO ( PROGRAM AVAIL )
PreserVision Eye Vitamin AREDS Tablets	NO INFO ( PROGRAM AVAIL )
Prevacid	lansoprazole	YES	YES	400	Patient	1 Year	90 Day	$478.36	Takeda
Prevacid 24HR	NO INFO ( PROGRAM AVAIL )
Prevacid SoluTab	NO INFO ( PROGRAM AVAIL )
Prevalite	NO INFO ( PROGRAM AVAIL )
Prevnar 13	NO INFO ( PROGRAM AVAIL )
Prevymis	NO INFO ( PROGRAM AVAIL )
Prezcobix	NO INFO ( PROGRAM AVAIL )
Prezista	NO INFO ( PROGRAM AVAIL )
Prezista Tablet	darunavir	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$1,096.99	J&J
Prialt	NO INFO ( PROGRAM AVAIL )
Priftin	rifapentine	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$122.06	Sanofi
Prilosec	NO INFO ( PROGRAM AVAIL )
Prilosec OTC	NO INFO ( PROGRAM AVAIL )
Primaxin	NO INFO ( PROGRAM AVAIL )
Primlev	NO INFO ( PROGRAM AVAIL )
Prinivil	NO INFO ( PROGRAM AVAIL )
Prinzide	NO INFO ( PROGRAM AVAIL )
Pristiq	NO INFO ( PROGRAM AVAIL )
Pristiq Tablet ER	desvenlafaxine	YES	YES	400	Doctor	1 Year	90 Day	$319.10	Pfizer
Privigen	NO INFO ( PROGRAM AVAIL )
Pro-Phree	NO INFO ( PROGRAM AVAIL )
Proair HFA	albuterol sulfate	YES	NO	300	Patient	1 Year	90 Day	$56.30	TevaCares
Proair Respiclick	NO INFO ( PROGRAM AVAIL )
Probuphine	NO INFO ( PROGRAM AVAIL )
Procardia	NO INFO ( PROGRAM AVAIL )
Procardia Capsule	nifedipine	YES	YES	400	Patient	1 Year	90 Day	$238.51	Pfizer
Procardia XL	NO INFO ( PROGRAM AVAIL )
Procardia XL Tablet ER	nifedipine	YES	YES	400	Patient	1 Year	90 Day	$179.70	Pfizer
ProCort	NO INFO ( PROGRAM AVAIL )
Procrit	NO INFO ( PROGRAM AVAIL )
Procrit Injection	epoetin alfa	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day	$5,724.17	J&J
Procysbi	NO INFO ( PROGRAM AVAIL )
Proglycem	diazoxide	YES	NO	300	Patient	1 Year	90 Day	$305.26	TevaCares
Prograf	NO INFO ( PROGRAM AVAIL )
Prolastin C	NO INFO ( PROGRAM AVAIL )
Prolensa	NO INFO ( PROGRAM AVAIL )
Proleukin	NO INFO ( PROGRAM AVAIL )
Prolia	Denosumab	Varies	YES	500	Varies	Varies	Varies	$3,000.00	Amgen
Promacta	NO INFO ( PROGRAM AVAIL )
Promethegan	NO INFO ( PROGRAM AVAIL )
Promiseb Complete	NO INFO ( PROGRAM AVAIL )
Promiseb Topical Cream	NO INFO ( PROGRAM AVAIL )
Promogran	NO INFO ( PROGRAM AVAIL )
Promote	NO INFO ( PROGRAM AVAIL )
Promote with Fiber	NO INFO ( PROGRAM AVAIL )
Pronto Plus Complete Lice Removal System	NO INFO ( PROGRAM AVAIL )
Pronto Plus Lice Killing Mousse Shampoo	NO INFO ( PROGRAM AVAIL )
Propimex	NO INFO ( PROGRAM AVAIL )
Prosacea	NO INFO ( PROGRAM AVAIL )
Proscar	NO INFO ( PROGRAM AVAIL )
Prosigna	NO INFO ( PROGRAM AVAIL )
Prothelial	NO INFO ( PROGRAM AVAIL )
Protonix	NO INFO ( PROGRAM AVAIL )
Protopic	NO INFO ( PROGRAM AVAIL )
Provella	NO INFO ( PROGRAM AVAIL )
Provenge	NO INFO ( PROGRAM AVAIL )
Proventil	NO INFO ( PROGRAM AVAIL )
Proventil HFA	NO INFO ( PROGRAM AVAIL )
Proventil HFA Aerosol	albuterol sulfate	YES	YES	400	Patient	1 Year	90 Day	$88.06	Merck
Provera	NO INFO ( PROGRAM AVAIL )
Provida DHA	NO INFO ( PROGRAM AVAIL )
Provida OB	NO INFO ( PROGRAM AVAIL )
Provigil	NO INFO ( PROGRAM AVAIL )
ProViMin	NO INFO ( PROGRAM AVAIL )
Prozac	fluoxetine	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$435.36	Lilly Cares
Prozac Weekly	NO INFO ( PROGRAM AVAIL )
Psorcon	NO INFO ( PROGRAM AVAIL )
Psoriasin Products	NO INFO ( PROGRAM AVAIL )
Pulmicort	NO INFO ( PROGRAM AVAIL )
Pulmicort Flexhaler	NO INFO ( PROGRAM AVAIL )
Pulmicort FlexhalerPowder	budesonide	YES + LIS DENIAL + 3% OOP	YES	300	Patient	End Of Year	90 Day	$186.94	AZ&ME
Pulmicort Respules	NO INFO ( PROGRAM AVAIL )
Pulmicort RespulesInhalation	budesonide	YES + LIS DENIAL + 3% OOP	YES	300	Patient	End Of Year	90 Day	$354.88	AZ&ME
Pulmocare	NO INFO ( PROGRAM AVAIL )
PulmoSal	NO INFO ( PROGRAM AVAIL )
Pulmozyme	NO INFO ( PROGRAM AVAIL )
Puracyn	NO INFO ( PROGRAM AVAIL )
PurAmino	NO INFO ( PROGRAM AVAIL )
PuraPly	NO INFO ( PROGRAM AVAIL )
PuraPly AM	NO INFO ( PROGRAM AVAIL )
PureVision Contact Lenses by Bausch and Lomb	NO INFO ( PROGRAM AVAIL )
Purinethol	NO INFO ( PROGRAM AVAIL )
Pylera	NO INFO ( PROGRAM AVAIL )
Qbrelis	NO INFO ( PROGRAM AVAIL )
QNASL	beclomethasone dipropionate	YES	NO	300	Patient	1 Year	90 Day	$222.23	TevaCares
Qsymia	NO INFO ( PROGRAM AVAIL )
Quadramet	NO INFO ( PROGRAM AVAIL )
Qudexy XR	NO INFO ( PROGRAM AVAIL )
Questran	NO INFO ( PROGRAM AVAIL )
Quillichew ER	NO INFO ( PROGRAM AVAIL )
Quillivant XR	NO INFO ( PROGRAM AVAIL )
Quillivant XR Suspension ER	methylphenidate	YES	YES	400	Patient	1 Year	90 Day	$314.00	Pfizer
Quinidine Gluconate	quinidine gluconate	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day		Lilly Cares
Qutenza	NO INFO ( PROGRAM AVAIL )
QVAR	beclomethasone	YES	NO	300	Patient	1 Year	90 Day	$181.25	TevaCares
R-Gene 10	NO INFO ( PROGRAM AVAIL )
RabAvert	NO INFO ( PROGRAM AVAIL )
Radicava	NO INFO ( PROGRAM AVAIL )
Ragwitek	NO INFO ( PROGRAM AVAIL )
Ranexa	NO INFO ( PROGRAM AVAIL )
Rapaflo	NO INFO ( PROGRAM AVAIL )
Rapamune	NO INFO ( PROGRAM AVAIL )
Rapamune Solution	sirolimus	YES	YES	400	Doctor	1 Year	90 Day	$1,582.52	Pfizer
Rapamune Tablet	sirolimus	YES	YES	400	Doctor	1 Year	90 Day	$1,582.54	Pfizer
Rasuvo	NO INFO ( PROGRAM AVAIL )
Rasuvo Container	NO INFO ( PROGRAM AVAIL )
Ravicti	NO INFO ( PROGRAM AVAIL )
Rayaldee	NO INFO ( PROGRAM AVAIL )
Rayos	NO INFO ( PROGRAM AVAIL )
Razadyne	NO INFO ( PROGRAM AVAIL )
RCF (Ross Carbohydrate Free)	NO INFO ( PROGRAM AVAIL )
Rebetol	NO INFO ( PROGRAM AVAIL )
Rebif	NO INFO ( PROGRAM AVAIL )
Recedo	NO INFO ( PROGRAM AVAIL )
Reclast	NO INFO ( PROGRAM AVAIL )
Reclast Injectable; IV	zoledronic acid	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$1,247.60	Novartis
Recombinate rAHF	NO INFO ( PROGRAM AVAIL )
Recombivax HB	NO INFO ( PROGRAM AVAIL )
RectiCare	NO INFO ( PROGRAM AVAIL )
Rectiv	NO INFO ( PROGRAM AVAIL )
Refresh Classic Lubricant Eye Drops	NO INFO ( PROGRAM AVAIL )
Refresh Contact Lens Eye Drops	NO INFO ( PROGRAM AVAIL )
Refresh Moisturizing Relief Products	NO INFO ( PROGRAM AVAIL )
Refresh Nighttime Protective Ointments	NO INFO ( PROGRAM AVAIL )
Refresh Optive Advanced Products	NO INFO ( PROGRAM AVAIL )
Refresh Optive Products	NO INFO ( PROGRAM AVAIL )
Refresh Soothing Gel Eye Drops	NO INFO ( PROGRAM AVAIL )
Reglan	NO INFO ( PROGRAM AVAIL )
Regranex	NO INFO ( PROGRAM AVAIL )
Relenza	zanamivir	NO	NO	250	Patient	1 Year	90 Day	$60.05	BtA
Relistor	NO INFO ( PROGRAM AVAIL )
Relistor Injection	NO INFO ( PROGRAM AVAIL )
Relistor Tablets	NO INFO ( PROGRAM AVAIL )
Relizorb	NO INFO ( PROGRAM AVAIL )
Relpax	NO INFO ( PROGRAM AVAIL )
Relpax Tablet	eletriptan HBr	YES	YES	400	Doctor	1 Year	90 Day	$359.99	Pfizer
Rembrandt Canker Sore Toothpaste	NO INFO ( PROGRAM AVAIL )
Rembrandt Deeply White 2hr Whitening Kit	NO INFO ( PROGRAM AVAIL )
Rembrandt Deeply White Peroxide Fresh Mint Toothpaste	NO INFO ( PROGRAM AVAIL )
Rembrandt Deeply White+Peroxide Whitening Mouthwash	NO INFO ( PROGRAM AVAIL )
Rembrandt Intense Stain Toothpaste	NO INFO ( PROGRAM AVAIL )
Remeron	NO INFO ( PROGRAM AVAIL )
Remeron Tablet	mirtazapine	YES	YES	400	Patient	1 Year	90 Day	$173.59	Merck
Remicade	NO INFO ( PROGRAM AVAIL )
Remicade Vial	infliximab	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day	$1,136.90	J&J
Remodulin	NO INFO ( PROGRAM AVAIL )
Renagel	NO INFO ( PROGRAM AVAIL )
Renflexis	NO INFO ( PROGRAM AVAIL )
Renova	NO INFO ( PROGRAM AVAIL )
Renvela	NO INFO ( PROGRAM AVAIL )
Repatha	NO INFO ( PROGRAM AVAIL )
Repatha Sureclick	NO INFO ( PROGRAM AVAIL )
RepHresh	NO INFO ( PROGRAM AVAIL )
RepHresh Pro-B	NO INFO ( PROGRAM AVAIL )
Replens	NO INFO ( PROGRAM AVAIL )
Replesta	NO INFO ( PROGRAM AVAIL )
Replesta Childrens	NO INFO ( PROGRAM AVAIL )
Replesta NX	NO INFO ( PROGRAM AVAIL )
Requip	NO INFO ( PROGRAM AVAIL )
Requip XL	ropinirole	NO	NO	250	Patient	1 Year	90 Day	$555.11	BtA
Requip XL Tablet ER	ropinirole	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$162.94	BtA
Rescriptor	NO INFO ( PROGRAM AVAIL )
Restasis	NO INFO ( PROGRAM AVAIL )
Restasis Multidose	NO INFO ( PROGRAM AVAIL )
Restora	NO INFO ( PROGRAM AVAIL )
Restora RX	NO INFO ( PROGRAM AVAIL )
Restora Sprinkles	NO INFO ( PROGRAM AVAIL )
Restoril	NO INFO ( PROGRAM AVAIL )
Restylane	NO INFO ( PROGRAM AVAIL )
Restylane Defyne	NO INFO ( PROGRAM AVAIL )
Restylane Lyft	NO INFO ( PROGRAM AVAIL )
Restylane Refyne	NO INFO ( PROGRAM AVAIL )
Restylane Silk	NO INFO ( PROGRAM AVAIL )
Retin-A MICRO	NO INFO ( PROGRAM AVAIL )
Retisert	NO INFO ( PROGRAM AVAIL )
Retrovir	NO INFO ( PROGRAM AVAIL )
Revatio	NO INFO ( PROGRAM AVAIL )
Revatio Tablet	sildenafil	YES	YES	400	Doctor	1 Year	90 Day	$4,122.77	Pfizer
Revlimid	NO INFO ( PROGRAM AVAIL )
Rexulti	NO INFO ( PROGRAM AVAIL )
Reyataz	NO INFO ( PROGRAM AVAIL )
Rheumatrex	NO INFO ( PROGRAM AVAIL )
Rheumatrex Dose Pack	NO INFO ( PROGRAM AVAIL )
Rhinocort	NO INFO ( PROGRAM AVAIL )
Rhofade	NO INFO ( PROGRAM AVAIL )
Rhophylac	NO INFO ( PROGRAM AVAIL )
RiaSTAP	NO INFO ( PROGRAM AVAIL )
Riax Foam	NO INFO ( PROGRAM AVAIL )
Ribasphere	NO INFO ( PROGRAM AVAIL )
Ribasphere RibaPak	NO INFO ( PROGRAM AVAIL )
Ribatab	NO INFO ( PROGRAM AVAIL )
RID Home Lice, Bedbug and Dust Mite Spray Kit	NO INFO ( PROGRAM AVAIL )
RID Lice and Egg Comb-Out Kit	NO INFO ( PROGRAM AVAIL )
Ridaura	NO INFO ( PROGRAM AVAIL )
Risperdal	NO INFO ( PROGRAM AVAIL )
Risperdal Consta	NO INFO ( PROGRAM AVAIL )
Risperdal ConstaInjection	risperidone	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$416.61	J&J
Risperdal M-TAB	risperidone	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$634.76	J&J
Risperdal Oral Solution	risperidone	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$380.32	J&J
Risperdal Tablet	risperidone	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$340.49	J&J
Ritalin	NO INFO ( PROGRAM AVAIL )
Ritalin LA	NO INFO ( PROGRAM AVAIL )
Rituxan	NO INFO ( PROGRAM AVAIL )
Rituxan Hycela	NO INFO ( PROGRAM AVAIL )
Rixubis	NO INFO ( PROGRAM AVAIL )
Robaxin	NO INFO ( PROGRAM AVAIL )
Robitussin 12 Hour Cough Relief	NO INFO ( PROGRAM AVAIL )
Robitussin Children\'s Cough and Chest Congestion DM	NO INFO ( PROGRAM AVAIL )
Robitussin Children\'s Cough and Cold CF	NO INFO ( PROGRAM AVAIL )
Robitussin Children\'s Cough and Cold Long-Acting	NO INFO ( PROGRAM AVAIL )
Robitussin Children\'s Cough Long-Acting	NO INFO ( PROGRAM AVAIL )
Robitussin Cold Nasal Relief	NO INFO ( PROGRAM AVAIL )
Robitussin Cold Nighttime Nasal Relief	NO INFO ( PROGRAM AVAIL )
Robitussin Cough plus Chest Congestion DM	NO INFO ( PROGRAM AVAIL )
Robitussin Daytime Cold plus Flu	NO INFO ( PROGRAM AVAIL )
Robitussin Long-Acting Cough	NO INFO ( PROGRAM AVAIL )
Robitussin Long-Acting CoughGels	NO INFO ( PROGRAM AVAIL )
Robitussin Maximum Nighttime Strength Cough DM	NO INFO ( PROGRAM AVAIL )
Robitussin Maximum Strength Cough+Chest Congestion DM Capsules	NO INFO ( PROGRAM AVAIL )
Robitussin Maximum Strength Cough+Chest Congestion DM Syrup	NO INFO ( PROGRAM AVAIL )
Robitussin Maximum Strength Multi-Symptom Cold CF	NO INFO ( PROGRAM AVAIL )
Robitussin Medi-Soothers DM	NO INFO ( PROGRAM AVAIL )
Robitussin Mucus+Chest Congestion	NO INFO ( PROGRAM AVAIL )
Robitussin Multi-Symptom Cold CF	NO INFO ( PROGRAM AVAIL )
Robitussin Nighttime Cold plus Flu	NO INFO ( PROGRAM AVAIL )
Robitussin Severe Multi-Symptom Cough Cold Flu	NO INFO ( PROGRAM AVAIL )
Robitussin Sugar-Free Cough+Chest Congestion DM	NO INFO ( PROGRAM AVAIL )
Rocaltrol	NO INFO ( PROGRAM AVAIL )
Roferon-A	NO INFO ( PROGRAM AVAIL )
Rogaine for Men Products	NO INFO ( PROGRAM AVAIL )
Rogaine for Women Products	NO INFO ( PROGRAM AVAIL )
Rowasa	NO INFO ( PROGRAM AVAIL )
Roxicodone	NO INFO ( PROGRAM AVAIL )
Rozerem	ramelteon	YES	YES	400	Patient	1 Year	90 Day	$478.36	Takeda
Rubraca	NO INFO ( PROGRAM AVAIL )
Ruconest	NO INFO ( PROGRAM AVAIL )
Rydapt	NO INFO ( PROGRAM AVAIL )
Rytary	NO INFO ( PROGRAM AVAIL )
Rythmol	NO INFO ( PROGRAM AVAIL )
Rythmol SR	NO INFO ( PROGRAM AVAIL )
Rythmol SR Capsule ER	propafenone	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$800.84	BtA
Sabadil	NO INFO ( PROGRAM AVAIL )
Sabril	NO INFO ( PROGRAM AVAIL )
Safyral	NO INFO ( PROGRAM AVAIL )
Saizen	NO INFO ( PROGRAM AVAIL )
Samsca	NO INFO ( PROGRAM AVAIL )
Sancuso	NO INFO ( PROGRAM AVAIL )
Sandimmune	NO INFO ( PROGRAM AVAIL )
Sandimmune Capsule, Gel	cyclosporine	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$917.87	Novartis
Sandimmune Oral Solution	cyclosporine	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$644.40	Novartis
Sandostatin	NO INFO ( PROGRAM AVAIL )
Sandostatin LAR	NO INFO ( PROGRAM AVAIL )
Santyl	NO INFO ( PROGRAM AVAIL )
Saphris	NO INFO ( PROGRAM AVAIL )
Savaysa	edoxaban	NO RX COVERAGE	NO	200	Doctor	1 Year	90 Day	$362.06	Daiichi Sankyo
Savella	NO INFO ( PROGRAM AVAIL )
Savella Tablets	milnaciprab	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$318.26	Allergan
Savella Titration Pack	milnaciprab	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$291.82	Allergan
Saxenda	NO INFO ( PROGRAM AVAIL )
Scalacort	NO INFO ( PROGRAM AVAIL )
Sculptra	NO INFO ( PROGRAM AVAIL )
Sectral	NO INFO ( PROGRAM AVAIL )
Seebri	NO INFO ( PROGRAM AVAIL )
Segluromet	NO INFO ( PROGRAM AVAIL )
Select-OB	NO INFO ( PROGRAM AVAIL )
Select-OB DHA	NO INFO ( PROGRAM AVAIL )
SelRx Shampoo	NO INFO ( PROGRAM AVAIL )
Selzentry	NO INFO ( PROGRAM AVAIL )
Senokot	NO INFO ( PROGRAM AVAIL )
Senokot TO GO	NO INFO ( PROGRAM AVAIL )
Senokot-S	NO INFO ( PROGRAM AVAIL )
SenokotXTRA	NO INFO ( PROGRAM AVAIL )
Sensipar	NO INFO ( PROGRAM AVAIL )
Sensodyne Iso-Active	NO INFO ( PROGRAM AVAIL )
Sensodyne ProNamel	NO INFO ( PROGRAM AVAIL )
Sensodyne Toothpaste	NO INFO ( PROGRAM AVAIL )
SenSura-Colostomy Pouches	NO INFO ( PROGRAM AVAIL )
SenSura-Ileostomy Pouches	NO INFO ( PROGRAM AVAIL )
SenSura-Urostomy Pouches	NO INFO ( PROGRAM AVAIL )
Septra	NO INFO ( PROGRAM AVAIL )
Serevent	NO INFO ( PROGRAM AVAIL )
Serevent Diskus	NO INFO ( PROGRAM AVAIL )
Sernivo	NO INFO ( PROGRAM AVAIL )
Seroquel	NO INFO ( PROGRAM AVAIL )
Seroquel XR Tablet ER	quetiapine fumarate	YES + LIS DENIAL + 3% OOP	YES	300	Patient	End Of Year	90 Day	$485.95	AZ&ME
Seroquel XR	NO INFO ( PROGRAM AVAIL )
Serostim	NO INFO ( PROGRAM AVAIL )
Sfrowasa	NO INFO ( PROGRAM AVAIL )
Shingrix	NO INFO ( PROGRAM AVAIL )
Signifor	NO INFO ( PROGRAM AVAIL )
Signifor LAR	NO INFO ( PROGRAM AVAIL )
Silenor	NO INFO ( PROGRAM AVAIL )
Siliq	NO INFO ( PROGRAM AVAIL )
Silphen	NO INFO ( PROGRAM AVAIL )
Simbrinza	NO INFO ( PROGRAM AVAIL )
Simcor	NO INFO ( PROGRAM AVAIL )
Similac	NO INFO ( PROGRAM AVAIL )
Simponi	golimumab	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day	$4,642.89	J&J
Simponi ARIA	golimumab	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day	$1,832.10	J&J
Simponi Container	NO INFO ( PROGRAM AVAIL )
Simulect	NO INFO ( PROGRAM AVAIL )
Sinemet	NO INFO ( PROGRAM AVAIL )
Sinemet CR	NO INFO ( PROGRAM AVAIL )
Singulair	NO INFO ( PROGRAM AVAIL )
Singulair Asthma Oral Granules	montelukast sodium	YES	YES	400	Patient	1 Year	90 Day	$222.17	Merck
Sinus Buster Nasal Spray	NO INFO ( PROGRAM AVAIL )
Sinusalia	NO INFO ( PROGRAM AVAIL )
Sirturo	NO INFO ( PROGRAM AVAIL )
Sitavig	NO INFO ( PROGRAM AVAIL )
Sivextro	NO INFO ( PROGRAM AVAIL )
Skelaxin	NO INFO ( PROGRAM AVAIL )
Skelaxin Tablet	metaxalone	YES	YES	400	Doctor	1 Year	90 Day	$879.75	Pfizer
Sklice	NO INFO ( PROGRAM AVAIL )
Skyla	NO INFO ( PROGRAM AVAIL )
Slow-Mag	NO INFO ( PROGRAM AVAIL )
SofLens Daily Disposables by Bausch and Lomb	NO INFO ( PROGRAM AVAIL )
Soliqua	NO INFO ( PROGRAM AVAIL )
Soliris	NO INFO ( PROGRAM AVAIL )
Solodyn	NO INFO ( PROGRAM AVAIL )
Soltamox	NO INFO ( PROGRAM AVAIL )
Solu-Medrol	NO INFO ( PROGRAM AVAIL )
SoluCortef	NO INFO ( PROGRAM AVAIL )
Somatuline Depot	NO INFO ( PROGRAM AVAIL )
Somavert	NO INFO ( PROGRAM AVAIL )
Sonata	NO INFO ( PROGRAM AVAIL )
Soolantra	NO INFO ( PROGRAM AVAIL )
Soriatane	NO INFO ( PROGRAM AVAIL )
Soriatane Capsule	acitretin	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$1,621.74	BtA
Sorilux	NO INFO ( PROGRAM AVAIL )
Sorine	NO INFO ( PROGRAM AVAIL )
Sotret	NO INFO ( PROGRAM AVAIL )
Sotylize	NO INFO ( PROGRAM AVAIL )
Sovaldi	NO INFO ( PROGRAM AVAIL )
SpeediCath Compact for Women	NO INFO ( PROGRAM AVAIL )
SpeediCath Straight Tip for Men	NO INFO ( PROGRAM AVAIL )
Spinraza	NO INFO ( PROGRAM AVAIL )
Spiriva HandiHaler	NO INFO ( PROGRAM AVAIL )
Spiriva HandiHaler Powder	tiotropium bromide	YES	YES	200	Patient	1 Year	90 Day	$1,101.18	BIC
Spiriva Respimat	NO INFO ( PROGRAM AVAIL )
Sporanox	NO INFO ( PROGRAM AVAIL )
Sporanox Capsule	itraconazole	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$1,677.28	J&J
Sporanox Oral Solution	itraconazole	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$341.37	J&J
Spritam	NO INFO ( PROGRAM AVAIL )
Sprix	NO INFO ( PROGRAM AVAIL )
Sprycel	dasatinib	NO RX COVERAGE	YES	300	Doctor	1 Year	Varies		BMS Access
Sps	NO INFO ( PROGRAM AVAIL )
SSKI	NO INFO ( PROGRAM AVAIL )
Stalevo	NO INFO ( PROGRAM AVAIL )
Steglatro	NO INFO ( PROGRAM AVAIL )
Steglujan	NO INFO ( PROGRAM AVAIL )
Stelara	ustekinumab	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day	$10,970.59	J&J
Stendra	NO INFO ( PROGRAM AVAIL )
Stimate	NO INFO ( PROGRAM AVAIL )
Stiolto Respimat	NO INFO ( PROGRAM AVAIL )
Stivarga	NO INFO ( PROGRAM AVAIL )
Stopain Cold Extra Strength Roll-On	NO INFO ( PROGRAM AVAIL )
Stopain Cold Extra Strength Spray	NO INFO ( PROGRAM AVAIL )
Stopain Cold Pain Relieving Gel	NO INFO ( PROGRAM AVAIL )
Strattera	atomoxetine	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$428.88	Lilly Cares
Strensiq	NO INFO ( PROGRAM AVAIL )
Stribild	NO INFO ( PROGRAM AVAIL )
Striverdi Respimat	NO INFO ( PROGRAM AVAIL )
Stromectol	NO INFO ( PROGRAM AVAIL )
Stromectol Tablet	ivermectin	YES	YES	400	Patient	1 Year	90 Day	$15.71	Merck
Sublocade	NO INFO ( PROGRAM AVAIL )
Suboxone	Buprenorphine	NO	NO	250	Card	1 Year	30 Day		Suboxone
Subsys	NO INFO ( PROGRAM AVAIL )
Sucraid	NO INFO ( PROGRAM AVAIL )
Sudafed Cold+Cough	NO INFO ( PROGRAM AVAIL )
Sudafed Congestion	NO INFO ( PROGRAM AVAIL )
Sudafed PE Pressure+Pain	NO INFO ( PROGRAM AVAIL )
Sudafed PE Sinus plus Allergy	NO INFO ( PROGRAM AVAIL )
Sundown Naturals-Nutritional Supplements and Vitamins	NO INFO ( PROGRAM AVAIL )
Supartz	NO INFO ( PROGRAM AVAIL )
Super Poligrip Comfort Seal Strip	NO INFO ( PROGRAM AVAIL )
Super Poligrip Extra Care	NO INFO ( PROGRAM AVAIL )
Super Poligrip Extra Strength Powder	NO INFO ( PROGRAM AVAIL )
Super Poligrip Free	NO INFO ( PROGRAM AVAIL )
Super Poligrip Original	NO INFO ( PROGRAM AVAIL )
Super Poligrip Ultra Fresh	NO INFO ( PROGRAM AVAIL )
Suplena	NO INFO ( PROGRAM AVAIL )
Supprelin LA	NO INFO ( PROGRAM AVAIL )
Suprax Product Family	NO INFO ( PROGRAM AVAIL )
Suprep Bowel Prep Kit	NO INFO ( PROGRAM AVAIL )
Surmontil	NO INFO ( PROGRAM AVAIL )
Sustiva	NO INFO ( PROGRAM AVAIL )
Sustol	NO INFO ( PROGRAM AVAIL )
Sutent	NO INFO ( PROGRAM AVAIL )
Sutent Capsule	sunitinib malate	YES	YES	400	Doctor	1 Year	90 Day	$16,240.58	Pfizer
Sylatron	NO INFO ( PROGRAM AVAIL )
Sylvant	siltuximab	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day	$860.63	J&J
Symbicort	NO INFO ( PROGRAM AVAIL )
Symbicort Inhaler	budesonide/formoterol fumarate dihydrate	YES + LIS DENIAL + 3% OOP	YES	300	Patient	End Of Year	90 Day	$308.45	AZ&ME
Symbyax	olonzapine/fluoxetine	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$698.24	Lilly Cares
Symdeko	NO INFO ( PROGRAM AVAIL )
Symlin	NO INFO ( PROGRAM AVAIL )
Symlin Pen Injection	pramlintide acetate	YES + 3% OOP	YES	300	Patient	1 Year	90 Day	$943.78	AZ&ME
Symproic	NO INFO ( PROGRAM AVAIL )
Synagis	NO INFO ( PROGRAM AVAIL )
Synalar	NO INFO ( PROGRAM AVAIL )
Synarel	NO INFO ( PROGRAM AVAIL )
Synarel Spray	nafarelin acetate	YES	YES	400	Doctor	1 Year	90 Day	$227.39	Pfizer
Syndros	NO INFO ( PROGRAM AVAIL )
Synjardy	NO INFO ( PROGRAM AVAIL )
Synribo	NO INFO ( PROGRAM AVAIL )
Synthroid	levothyroxine	YES	YES	300	Doctor	1 Year	90 Day	$34.58	AbbVie
Synvisc	NO INFO ( PROGRAM AVAIL )
Synvisc-One	NO INFO ( PROGRAM AVAIL )
Syprine	NO INFO ( PROGRAM AVAIL )
Systane Balance	NO INFO ( PROGRAM AVAIL )
Systane Contacts Lubricant Eye Drops	NO INFO ( PROGRAM AVAIL )
Systane Gel Eye Drops	NO INFO ( PROGRAM AVAIL )
Systane Lid Wipes	NO INFO ( PROGRAM AVAIL )
Systane Lubricant Eye Drops	NO INFO ( PROGRAM AVAIL )
Systane Nighttime Ointment	NO INFO ( PROGRAM AVAIL )
Systane Preservative-Free Formula	NO INFO ( PROGRAM AVAIL )
Systane Ultra	NO INFO ( PROGRAM AVAIL )
Systane Ultra Preservative-Free	NO INFO ( PROGRAM AVAIL )
Systane Vitamin Omega-3 Supplement	NO INFO ( PROGRAM AVAIL )
Taclonex	NO INFO ( PROGRAM AVAIL )
Tafinlar	NO INFO ( PROGRAM AVAIL )
Tagamet	NO INFO ( PROGRAM AVAIL )
Tagrisso	NO INFO ( PROGRAM AVAIL )
Taltz	NO INFO ( PROGRAM AVAIL )
Talymed	NO INFO ( PROGRAM AVAIL )
Tambocor	NO INFO ( PROGRAM AVAIL )
Tanzeum	NO INFO ( PROGRAM AVAIL )
Tapazole	NO INFO ( PROGRAM AVAIL )
Tarceva	NO INFO ( PROGRAM AVAIL )
Targretin	NO INFO ( PROGRAM AVAIL )
Tarka	NO INFO ( PROGRAM AVAIL )
Tasigna	NO INFO ( PROGRAM AVAIL )
Tasmar	NO INFO ( PROGRAM AVAIL )
Taxol	NO INFO ( PROGRAM AVAIL )
Taxotere	NO INFO ( PROGRAM AVAIL )
Taytulla	NO INFO ( PROGRAM AVAIL )
Tazorac	NO INFO ( PROGRAM AVAIL )
Taztia	NO INFO ( PROGRAM AVAIL )
Tecentriq	NO INFO ( PROGRAM AVAIL )
Tecfidera	NO INFO ( PROGRAM AVAIL )
Technivie	NO INFO ( PROGRAM AVAIL )
Teflaro	NO INFO ( PROGRAM AVAIL )
Tegretol	NO INFO ( PROGRAM AVAIL )
Tegretol XR	NO INFO ( PROGRAM AVAIL )
Tegretol XR Tablet	carbamazepine	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$162.88	Novartis
Tekturna	NO INFO ( PROGRAM AVAIL )
Tekturna HCT	NO INFO ( PROGRAM AVAIL )
Temodar	NO INFO ( PROGRAM AVAIL )
Temovate	NO INFO ( PROGRAM AVAIL )
Tena Personal Care Products	NO INFO ( PROGRAM AVAIL )
Tenex	NO INFO ( PROGRAM AVAIL )
Tenivac	NO INFO ( PROGRAM AVAIL )
Tenivac Injection	tetanus and diphtheria toxoids adsorbed	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$319.96	Sanofi
Tenoretic	NO INFO ( PROGRAM AVAIL )
Tenormin	NO INFO ( PROGRAM AVAIL )
Tessalon	NO INFO ( PROGRAM AVAIL )
Testopel	NO INFO ( PROGRAM AVAIL )
Tev-Tropin	NO INFO ( PROGRAM AVAIL )
Teveten	NO INFO ( PROGRAM AVAIL )
Teveten HCT	NO INFO ( PROGRAM AVAIL )
Texacort	NO INFO ( PROGRAM AVAIL )
Thalomid	NO INFO ( PROGRAM AVAIL )
Theo-24	NO INFO ( PROGRAM AVAIL )
Theochron	NO INFO ( PROGRAM AVAIL )
TheraCys	NO INFO ( PROGRAM AVAIL )
TheraSkin	NO INFO ( PROGRAM AVAIL )
ThermaCare Cold Wraps	NO INFO ( PROGRAM AVAIL )
ThermaCare Heat Wraps	NO INFO ( PROGRAM AVAIL )
Thiola	NO INFO ( PROGRAM AVAIL )
Thymoglobulin	NO INFO ( PROGRAM AVAIL )
Thymoglobulin Vial	anti-thymocyte globulin (rabbit)	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$815.90	Sanofi
Thyrogen	NO INFO ( PROGRAM AVAIL )
Tiazac	NO INFO ( PROGRAM AVAIL )
TICE BCG	NO INFO ( PROGRAM AVAIL )
Tikosyn	NO INFO ( PROGRAM AVAIL )
Tikosyn Capsule	dofetilide	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Timentin	NO INFO ( PROGRAM AVAIL )
Timoptic in Ocudose	NO INFO ( PROGRAM AVAIL )
Tinactin Athlete\'s Foot Cream	NO INFO ( PROGRAM AVAIL )
Tinactin Deodorant Powder Spray	NO INFO ( PROGRAM AVAIL )
Tinactin Jock Itch Cream	NO INFO ( PROGRAM AVAIL )
Tinactin Jock Itch Powder Spray	NO INFO ( PROGRAM AVAIL )
Tinactin Liquid Spray	NO INFO ( PROGRAM AVAIL )
Tinactin Powder Spray	NO INFO ( PROGRAM AVAIL )
Tindamax	NO INFO ( PROGRAM AVAIL )
Tirosint	NO INFO ( PROGRAM AVAIL )
Tivicay	NO INFO ( PROGRAM AVAIL )
Tivorbex	NO INFO ( PROGRAM AVAIL )
TNKase	NO INFO ( PROGRAM AVAIL )
Tobi	NO INFO ( PROGRAM AVAIL )
TOBI Inhalation Solution	tobramycin	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$8,439.59	Novartis
Tobi Podhaler	NO INFO ( PROGRAM AVAIL )
TOBI Podhaler Powder	tobramycin	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$9,300.99	Novartis
Tobradex	NO INFO ( PROGRAM AVAIL )
Tobradex ST	NO INFO ( PROGRAM AVAIL )
Tofranil	NO INFO ( PROGRAM AVAIL )
Tolerex	NO INFO ( PROGRAM AVAIL )
Topamax	NO INFO ( PROGRAM AVAIL )
Topamax Capsule	topiramate	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$413.41	J&J
Topamax Tablet	topiramate	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$720.73	J&J
Topicort	NO INFO ( PROGRAM AVAIL )
Toposar	NO INFO ( PROGRAM AVAIL )
Toprol XL	NO INFO ( PROGRAM AVAIL )
Torisel	NO INFO ( PROGRAM AVAIL )
Toujeo	NO INFO ( PROGRAM AVAIL )
Toujeo Solostar	insulin glargine	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$335.14	Sanofi
Toviaz	NO INFO ( PROGRAM AVAIL )
Toviaz Tablet ER	fesoterodine fumarate	YES	YES	400	Patient	1 Year	90 Day	$281.56	Pfizer
Tracleer	NO INFO ( PROGRAM AVAIL )
Tradjenta	NO INFO ( PROGRAM AVAIL )
Tradjenta Tablet	linagliptin	YES	YES	200	Patient	1 Year	90 Day	$375.90	BIC
Trandate	NO INFO ( PROGRAM AVAIL )
Tranxene	NO INFO ( PROGRAM AVAIL )
Travatan Z	travoprost	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$156.71	Novartis
Treanda	NO INFO ( PROGRAM AVAIL )
Trecator	NO INFO ( PROGRAM AVAIL )
Trecator Tablet	ethionamide	YES	YES	400	Doctor	1 Year	90 Day	$277.14	Pfizer
Trelegy Ellipta	NO INFO ( PROGRAM AVAIL )
Trelstar	NO INFO ( PROGRAM AVAIL )
Tremfya	NO INFO ( PROGRAM AVAIL )
Trental	NO INFO ( PROGRAM AVAIL )
Tresiba	NO INFO ( PROGRAM AVAIL )
Tresiba FlexTouch Pen	NO INFO ( PROGRAM AVAIL )
Tretin-X	NO INFO ( PROGRAM AVAIL )
Tretten	NO INFO ( PROGRAM AVAIL )
Trexall	NO INFO ( PROGRAM AVAIL )
Treximet	NO INFO ( PROGRAM AVAIL )
Treximet Tablet	sumatriptan and naproxen sodium	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day		Pernix
Trezix	NO INFO ( PROGRAM AVAIL )
Tri-Luma	NO INFO ( PROGRAM AVAIL )
Triaminic Chest and Nasal Congestion	NO INFO ( PROGRAM AVAIL )
Triaminic Cold and Allergy	NO INFO ( PROGRAM AVAIL )
Triaminic Cold and Sore Throat	NO INFO ( PROGRAM AVAIL )
Triaminic Cough and Cold Thin Strip	NO INFO ( PROGRAM AVAIL )
Triaminic Day Time Cold and Cough	NO INFO ( PROGRAM AVAIL )
Triaminic Fever Reducer Pain Reliever	NO INFO ( PROGRAM AVAIL )
Triaminic Long Acting Cough	NO INFO ( PROGRAM AVAIL )
Triaminic Multi-Symptom Fever	NO INFO ( PROGRAM AVAIL )
Triaminic Night Time Cold and Cough	NO INFO ( PROGRAM AVAIL )
Trianex	NO INFO ( PROGRAM AVAIL )
Trianex 430-grams Jar	NO INFO ( PROGRAM AVAIL )
Tribenzor	NO INFO ( PROGRAM AVAIL )
Tricor	NO INFO ( PROGRAM AVAIL )
Triderm	NO INFO ( PROGRAM AVAIL )
Tridesilon	NO INFO ( PROGRAM AVAIL )
Triesence	NO INFO ( PROGRAM AVAIL )
Triglide	NO INFO ( PROGRAM AVAIL )
Trileptal	NO INFO ( PROGRAM AVAIL )
Trileptal Tablet	oxcarbazepine	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$293.62	Novartis
Trilipix	NO INFO ( PROGRAM AVAIL )
Trintellix	vortioxetine	YES	YES	400	Patient	1 Year	90 Day	$346.40	Takeda
Trisenox	NO INFO ( PROGRAM AVAIL )
Triumeq	NO INFO ( PROGRAM AVAIL )
Trizivir	NO INFO ( PROGRAM AVAIL )
Trojan Brand Condoms	NO INFO ( PROGRAM AVAIL )
Trokendi XR	NO INFO ( PROGRAM AVAIL )
TruBiotics	NO INFO ( PROGRAM AVAIL )
TRUE Meters and Test Strip	NO INFO ( PROGRAM AVAIL )
TRUE Sharps	NO INFO ( PROGRAM AVAIL )
TRUEmanager-Diabetes Management Software	NO INFO ( PROGRAM AVAIL )
TRUEplus Nutrition Products	NO INFO ( PROGRAM AVAIL )
Trulance	NO INFO ( PROGRAM AVAIL )
Trulicity	NO INFO ( PROGRAM AVAIL )
Trulicity Container	NO INFO ( PROGRAM AVAIL )
Trumenba	NO INFO ( PROGRAM AVAIL )
Trusopt	NO INFO ( PROGRAM AVAIL )
Trusopt Ophthalmic Solution	dorzolamide	YES	YES	400	Patient	1 Year	90 Day		Merck
Truvada	NO INFO ( PROGRAM AVAIL )
Tudorza Pressair	aclidinium bromide	YES + 3% OOP	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$278.87	AZ&ME
TUMS Products	NO INFO ( PROGRAM AVAIL )
Tuzistra XR	NO INFO ( PROGRAM AVAIL )
TwoCal	NO INFO ( PROGRAM AVAIL )
Tybost	NO INFO ( PROGRAM AVAIL )
Tygacil	NO INFO ( PROGRAM AVAIL )
Tykerb	NO INFO ( PROGRAM AVAIL )
Tymlos	NO INFO ( PROGRAM AVAIL )
Tyrex	NO INFO ( PROGRAM AVAIL )
Tyros 1 Medical Food	NO INFO ( PROGRAM AVAIL )
Tyros 2 Medical Food	NO INFO ( PROGRAM AVAIL )
Tysabri	NO INFO ( PROGRAM AVAIL )
Tyvaso	NO INFO ( PROGRAM AVAIL )
Tyzeka	NO INFO ( PROGRAM AVAIL )
U-Cort	NO INFO ( PROGRAM AVAIL )
Uceris	NO INFO ( PROGRAM AVAIL )
Ulesfia	NO INFO ( PROGRAM AVAIL )
Uloric	febuxostat	YES	YES	400	Patient	1 Year	90 Day	$285.02	Takeda
Ultracet	NO INFO ( PROGRAM AVAIL )
Ultram	NO INFO ( PROGRAM AVAIL )
Ultram ER	NO INFO ( PROGRAM AVAIL )
Ultravate	NO INFO ( PROGRAM AVAIL )
Ultresa	NO INFO ( PROGRAM AVAIL )
Uniretic	NO INFO ( PROGRAM AVAIL )
Unite Biomatrix	NO INFO ( PROGRAM AVAIL )
Unithroid	NO INFO ( PROGRAM AVAIL )
Univasc	NO INFO ( PROGRAM AVAIL )
Uptravi	NO INFO ( PROGRAM AVAIL )
Urecholine	NO INFO ( PROGRAM AVAIL )
Uribel	NO INFO ( PROGRAM AVAIL )
Uricalm	NO INFO ( PROGRAM AVAIL )
Uricalm Max	NO INFO ( PROGRAM AVAIL )
Uristat Pain Relief Tablets	NO INFO ( PROGRAM AVAIL )
Uristat Relief Pak	NO INFO ( PROGRAM AVAIL )
Urocit-K	NO INFO ( PROGRAM AVAIL )
Urogesic Blue	NO INFO ( PROGRAM AVAIL )
UroXatral	NO INFO ( PROGRAM AVAIL )
Utibron	NO INFO ( PROGRAM AVAIL )
Utira-C	NO INFO ( PROGRAM AVAIL )
Utopic Cream	NO INFO ( PROGRAM AVAIL )
Vagifem 18	NO INFO ( PROGRAM AVAIL )
Vaginal Contraceptive Film (VCF)	NO INFO ( PROGRAM AVAIL )
Valchlor	NO INFO ( PROGRAM AVAIL )
Valcyte	NO INFO ( PROGRAM AVAIL )
Valium	NO INFO ( PROGRAM AVAIL )
Valtrex	NO INFO ( PROGRAM AVAIL )
Valtropin	NO INFO ( PROGRAM AVAIL )
Vancocin	NO INFO ( PROGRAM AVAIL )
Vaniqa	NO INFO ( PROGRAM AVAIL )
Vanos	NO INFO ( PROGRAM AVAIL )
Vanquish	NO INFO ( PROGRAM AVAIL )
Vantas	NO INFO ( PROGRAM AVAIL )
Vaqta	NO INFO ( PROGRAM AVAIL )
Varivax	NO INFO ( PROGRAM AVAIL )
Varizig	NO INFO ( PROGRAM AVAIL )
Varubi	NO INFO ( PROGRAM AVAIL )
Vascepa	NO INFO ( PROGRAM AVAIL )
Vasculera	NO INFO ( PROGRAM AVAIL )
Vaseretic	NO INFO ( PROGRAM AVAIL )
Vasotec	NO INFO ( PROGRAM AVAIL )
Vectibix	NO INFO ( PROGRAM AVAIL )
Vectical	NO INFO ( PROGRAM AVAIL )
Vectra DA	NO INFO ( PROGRAM AVAIL )
Velban	NO INFO ( PROGRAM AVAIL )
Velcade	NO INFO ( PROGRAM AVAIL )
Veletri	NO INFO ( PROGRAM AVAIL )
Velphoro	NO INFO ( PROGRAM AVAIL )
Veltassa	NO INFO ( PROGRAM AVAIL )
Veltin	NO INFO ( PROGRAM AVAIL )
Vemlidy	NO INFO ( PROGRAM AVAIL )
Venclexta	NO INFO ( PROGRAM AVAIL )
Venofer	NO INFO ( PROGRAM AVAIL )
Ventavis	NO INFO ( PROGRAM AVAIL )
Ventolin HFA	NO INFO ( PROGRAM AVAIL )
Ventolin HFA Inhalant	albuterol sulfate	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$53.25	BtA
Vepesid	NO INFO ( PROGRAM AVAIL )
Veramyst Nasal Spray	fluticasone furoate	NO	NO	250	Patient	1 Year	90 Day	$217.95	BtA
Veramyst Spray; Nasal	fluticasone furoate	YES (LIS Denial)	YES + $600 OOP	250	Patient	1 Year	90 Day	$218.15	BtA
Verdeso	NO INFO ( PROGRAM AVAIL )
Verdeso Foam	NO INFO ( PROGRAM AVAIL )
Verelan	NO INFO ( PROGRAM AVAIL )
VergenixWD	NO INFO ( PROGRAM AVAIL )
Veripred	NO INFO ( PROGRAM AVAIL )
Verzenio	NO INFO ( PROGRAM AVAIL )
VESIcare	NO INFO ( PROGRAM AVAIL )
Vexol	NO INFO ( PROGRAM AVAIL )
Vfend	NO INFO ( PROGRAM AVAIL )
VFEND Filmtab	voriconazole	YES	YES	400	Varies	1 Year	90 Day		Pfizer
VGo	NO INFO ( PROGRAM AVAIL )
Viagra	NO INFO ( PROGRAM AVAIL )
Viagra Tablet	sildenafil citrate	YES	YES	400	Doctor	1 Year	90 Day	$628.05	Pfizer
Vibativ	NO INFO ( PROGRAM AVAIL )
Viberzi	NO INFO ( PROGRAM AVAIL )
VICKS Air Purifier	NO INFO ( PROGRAM AVAIL )
VICKS Children\'s Products	NO INFO ( PROGRAM AVAIL )
VICKS DayQuil Products	NO INFO ( PROGRAM AVAIL )
VICKS Formula 44 Products	NO INFO ( PROGRAM AVAIL )
VICKS Humidifiers	NO INFO ( PROGRAM AVAIL )
VICKS Nature Fusion Products	NO INFO ( PROGRAM AVAIL )
VICKS NyQuil Products	NO INFO ( PROGRAM AVAIL )
VICKS Products	NO INFO ( PROGRAM AVAIL )
VICKS Sinex Products	NO INFO ( PROGRAM AVAIL )
VICKS Steam Inhalers	NO INFO ( PROGRAM AVAIL )
VICKS Thermometers	NO INFO ( PROGRAM AVAIL )
VICKS Vapo Family Products, The	NO INFO ( PROGRAM AVAIL )
Victoza	NO INFO ( PROGRAM AVAIL )
Victoza Injection	liraglutide	YES + $1100 OOP	YES	400	Doctor	1 Year	90 Day	$762.19	Novo Nordisk
Victrelis	NO INFO ( PROGRAM AVAIL )
Vidaza	NO INFO ( PROGRAM AVAIL )
Videx	NO INFO ( PROGRAM AVAIL )
Viekira Pak	NO INFO ( PROGRAM AVAIL )
Viekira XR	NO INFO ( PROGRAM AVAIL )
Vigamox	NO INFO ( PROGRAM AVAIL )
Viibryd	NO INFO ( PROGRAM AVAIL )
Viibryd Patient Starter Kit	vilazodone	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$224.42	Allergan
Viibryd Tablets	vilazodone	YES	Must have a LIS Denial Letter	300	Doctor	3 Month	90 Day	$224.42	Allergan
Vimovo	NO INFO ( PROGRAM AVAIL )
Vimpat	Lacosamide	YES/No Coverage	YES	300	Doctor	6 Months	90 Day		UCBCares
Vincasar PFS	NO INFO ( PROGRAM AVAIL )
Viokace	NO INFO ( PROGRAM AVAIL )
Viracept	NO INFO ( PROGRAM AVAIL )
Viramune	NO INFO ( PROGRAM AVAIL )
Viramune XR	NO INFO ( PROGRAM AVAIL )
Viramune XR Tablet ER	nevirapine	YES	YES	200	Patient	1 Year	90 Day	$861.06	BIC
Virasal	NO INFO ( PROGRAM AVAIL )
Virazole	NO INFO ( PROGRAM AVAIL )
Viread	NO INFO ( PROGRAM AVAIL )
Virilon	NO INFO ( PROGRAM AVAIL )
Visine Products	NO INFO ( PROGRAM AVAIL )
Vistaril	NO INFO ( PROGRAM AVAIL )
Vistide	NO INFO ( PROGRAM AVAIL )
Vistogard	NO INFO ( PROGRAM AVAIL )
Visudyne	NO INFO ( PROGRAM AVAIL )
Vitafol Fe plus	NO INFO ( PROGRAM AVAIL )
Vitafol Gummies	NO INFO ( PROGRAM AVAIL )
Vitafol Nano	NO INFO ( PROGRAM AVAIL )
Vitafol One	NO INFO ( PROGRAM AVAIL )
Vitafol Ultra	NO INFO ( PROGRAM AVAIL )
Vital 1.5 cal	NO INFO ( PROGRAM AVAIL )
Vital AF 1.2 cal	NO INFO ( PROGRAM AVAIL )
Vital High Protein	NO INFO ( PROGRAM AVAIL )
vitaMedMD - One Rx	NO INFO ( PROGRAM AVAIL )
vitaMedMD - RediChew Rx	NO INFO ( PROGRAM AVAIL )
vitaPearl	NO INFO ( PROGRAM AVAIL )
vitaTrue	NO INFO ( PROGRAM AVAIL )
Vitekta	NO INFO ( PROGRAM AVAIL )
Vivarin	NO INFO ( PROGRAM AVAIL )
Vivelle	NO INFO ( PROGRAM AVAIL )
Vivelle-Dot	NO INFO ( PROGRAM AVAIL )
Vivitrol	NO INFO ( PROGRAM AVAIL )
Vivlodex	NO INFO ( PROGRAM AVAIL )
Vivonex Pediatric	NO INFO ( PROGRAM AVAIL )
Vivonex Plus	NO INFO ( PROGRAM AVAIL )
Vivonex RTF	NO INFO ( PROGRAM AVAIL )
Vivonex TEN	NO INFO ( PROGRAM AVAIL )
Vivotif	NO INFO ( PROGRAM AVAIL )
Vogelxo	NO INFO ( PROGRAM AVAIL )
Voltaren	NO INFO ( PROGRAM AVAIL )
Voltaren XR	NO INFO ( PROGRAM AVAIL )
Vonvendi	NO INFO ( PROGRAM AVAIL )
Vosevi	NO INFO ( PROGRAM AVAIL )
Vospire ER	NO INFO ( PROGRAM AVAIL )
Votrient	NO INFO ( PROGRAM AVAIL )
VPRIV	NO INFO ( PROGRAM AVAIL )
Vraylar	NO INFO ( PROGRAM AVAIL )
Vumon	NO INFO ( PROGRAM AVAIL )
Vytone Cream	NO INFO ( PROGRAM AVAIL )
Vytorin	NO INFO ( PROGRAM AVAIL )
Vytorin Tablet	ezetimibe/simvastatin	YES	YES	400	Patient	1 Year	90 Day	$319.95	Merck
Vyvanse	lisdexamfetamine dimesylate	YES	YES	300	Card	1 Year	90 Day		Shire Cares
Vyxeos	NO INFO ( PROGRAM AVAIL )
Vyzulta	NO INFO ( PROGRAM AVAIL )
Welchol	NO INFO ( PROGRAM AVAIL )
Welchol Oral Suspension	colesevelam	NO	NO	200	Doctor	1 Year	90 Day	$576.32	Daiichi Sankyo
Welchol Tablet	colesevelam	NO	NO	200	Doctor	1 Year	90 day	$576.32	Daiichi Sankyo
Wellbutrin	NO INFO ( PROGRAM AVAIL )
Wellbutrin SR	NO INFO ( PROGRAM AVAIL )
Wellbutrin XL	NO INFO ( PROGRAM AVAIL )
Westcort	NO INFO ( PROGRAM AVAIL )
Wilate	NO INFO ( PROGRAM AVAIL )
WinRho SDF	NO INFO ( PROGRAM AVAIL )
WND 1 Infant Formula	NO INFO ( PROGRAM AVAIL )
WND 2 Medical Food	NO INFO ( PROGRAM AVAIL )
Woulgan	NO INFO ( PROGRAM AVAIL )
WoundSeal MD	NO INFO ( PROGRAM AVAIL )
Xadago	NO INFO ( PROGRAM AVAIL )
Xalatan	NO INFO ( PROGRAM AVAIL )
Xalatan Ophthalmic Drops0.005	latanoprost	YES	YES	400	Doctor	1 Year	90 Day	$180.71	Pfizer
Xalkori	NO INFO ( PROGRAM AVAIL )
Xalkori Capsule	crizotinib	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Xanax	NO INFO ( PROGRAM AVAIL )
Xanax XR	NO INFO ( PROGRAM AVAIL )
Xarelto	rivroxaban	YES + 4% OOP	YES	300	Card/Doctor	1 Year	90 Day	$388.25	J&J
Xatmep	NO INFO ( PROGRAM AVAIL )
Xeljanz	tofacitinib	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Xeloda	NO INFO ( PROGRAM AVAIL )
Xenazine	NO INFO ( PROGRAM AVAIL )
Xeomin	NO INFO ( PROGRAM AVAIL )
Xerese	NO INFO ( PROGRAM AVAIL )
Xermelo	NO INFO ( PROGRAM AVAIL )
Xgeva	NO INFO ( PROGRAM AVAIL )
Xiaflex	NO INFO ( PROGRAM AVAIL )
Xifaxan	NO INFO ( PROGRAM AVAIL )
Xifaxan 550	NO INFO ( PROGRAM AVAIL )
Xigduo XR	NO INFO ( PROGRAM AVAIL )
Xiidra	NO INFO ( PROGRAM AVAIL )
Xofigo	NO INFO ( PROGRAM AVAIL )
Xolair	NO INFO ( PROGRAM AVAIL )
Xolegel	NO INFO ( PROGRAM AVAIL )
Xopenex	NO INFO ( PROGRAM AVAIL )
Xopenex HFA	NO INFO ( PROGRAM AVAIL )
Xtampza ER	NO INFO ( PROGRAM AVAIL )
Xtandi	NO INFO ( PROGRAM AVAIL )
Xultophy	NO INFO ( PROGRAM AVAIL )
Xyntha Solofuse	NO INFO ( PROGRAM AVAIL )
Xyrem	NO INFO ( PROGRAM AVAIL )
Xyzal	NO INFO ( PROGRAM AVAIL )
Yervoy	ipilimumab	No	YES	300	Doctor	1 Year	Varies		BMS Access
Yondelis	trabectedin	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day	$2,679.46	J&J
Yosprala	NO INFO ( PROGRAM AVAIL )
Zaditor	NO INFO ( PROGRAM AVAIL )
Zaltrap	NO INFO ( PROGRAM AVAIL )
Zaltrap IV	ziv-aflibercept	LIS DENIAL + 5% OOP	YES	250	Doctor	1 Year	Varies	$1,792.00	Sanofi
Zanaflex	NO INFO ( PROGRAM AVAIL )
Zanosar	NO INFO ( PROGRAM AVAIL )
Zantac	NO INFO ( PROGRAM AVAIL )
Zantac 150	NO INFO ( PROGRAM AVAIL )
Zantac 75	NO INFO ( PROGRAM AVAIL )
Zarontin	NO INFO ( PROGRAM AVAIL )
Zarontin Capsule	ethosuximide	YES	YES	400	Varies	1 Year	90 Day		Pfizer
Zaroxolyn	NO INFO ( PROGRAM AVAIL )
Zarxio	NO INFO ( PROGRAM AVAIL )
Zavesca	NO INFO ( PROGRAM AVAIL )
Zebeta	NO INFO ( PROGRAM AVAIL )
Zegerid OTC	NO INFO ( PROGRAM AVAIL )
Zejula	NO INFO ( PROGRAM AVAIL )
Zelapar	NO INFO ( PROGRAM AVAIL )
Zelboraf	NO INFO ( PROGRAM AVAIL )
Zemaira	NO INFO ( PROGRAM AVAIL )
Zembrace SymTouch	NO INFO ( PROGRAM AVAIL )
Zemplar	NO INFO ( PROGRAM AVAIL )
Zenapax	NO INFO ( PROGRAM AVAIL )
Zenatane	NO INFO ( PROGRAM AVAIL )
Zenpep	NO INFO ( PROGRAM AVAIL )
Zenzedi	NO INFO ( PROGRAM AVAIL )
Zepatier	NO INFO ( PROGRAM AVAIL )
Zerbaxa	NO INFO ( PROGRAM AVAIL )
Zerit	NO INFO ( PROGRAM AVAIL )
Zestoretic	NO INFO ( PROGRAM AVAIL )
Zestril	NO INFO ( PROGRAM AVAIL )
Zetia	NO INFO ( PROGRAM AVAIL )
Zetia Tablet	ezetimibe	YES	YES	400	Patient	1 Year	90 Day	$323.02	Merck
Zevalin	NO INFO ( PROGRAM AVAIL )
Ziac	NO INFO ( PROGRAM AVAIL )
Ziagen	NO INFO ( PROGRAM AVAIL )
Ziana	NO INFO ( PROGRAM AVAIL )
Zicam Allergy Relief Nasal Gel	NO INFO ( PROGRAM AVAIL )
Zicam Extreme Congestion Relief	NO INFO ( PROGRAM AVAIL )
Zicam Intense Sinus Relief Nasal Gel	NO INFO ( PROGRAM AVAIL )
Zicam Naturals Cough Suppressant	NO INFO ( PROGRAM AVAIL )
Zicam Original	NO INFO ( PROGRAM AVAIL )
Zicam Ultra Cold Remedy Products	NO INFO ( PROGRAM AVAIL )
Zilretta	NO INFO ( PROGRAM AVAIL )
Zinecard	NO INFO ( PROGRAM AVAIL )
Zinecard Injection	dexrazoxane	YES	YES	400	Doctor	1 Year	90 Day	$271.31	Pfizer
Zinplava	NO INFO ( PROGRAM AVAIL )
Zioptan	NO INFO ( PROGRAM AVAIL )
Zioptan Opthalmic Solution	tafluprost	Determined case by case	YES	400	Patient	1 Year	90 Day		Akorn
Zipsor	NO INFO ( PROGRAM AVAIL )
Zirgan	NO INFO ( PROGRAM AVAIL )
Zithranol Shampoo	NO INFO ( PROGRAM AVAIL )
Zithranol-RR	NO INFO ( PROGRAM AVAIL )
Zithromax	NO INFO ( PROGRAM AVAIL )
Zmax	NO INFO ( PROGRAM AVAIL )
Zocor	NO INFO ( PROGRAM AVAIL )
Zofran	NO INFO ( PROGRAM AVAIL )
Zofran ODT	NO INFO ( PROGRAM AVAIL )
Zohydro ER	NO INFO ( PROGRAM AVAIL )
Zoladex	NO INFO ( PROGRAM AVAIL )
Zolinza	NO INFO ( PROGRAM AVAIL )
Zoloft	NO INFO ( PROGRAM AVAIL )
Zomacton	NO INFO ( PROGRAM AVAIL )
Zometa	NO INFO ( PROGRAM AVAIL )
Zomig	NO INFO ( PROGRAM AVAIL )
Zomig Nasal Spray	NO INFO ( PROGRAM AVAIL )
Zomig-ZMT	NO INFO ( PROGRAM AVAIL )
Zonegran	NO INFO ( PROGRAM AVAIL )
Zontivity	NO INFO ( PROGRAM AVAIL )
Zorbtive	NO INFO ( PROGRAM AVAIL )
Zortress	NO INFO ( PROGRAM AVAIL )
Zortress Tablet	everolimus	NO RX COVERAGE	NO	250	Card	1 Year	Varies	$1,432.97	Novartis
Zorvolex	NO INFO ( PROGRAM AVAIL )
Zostavax	NO INFO ( PROGRAM AVAIL )
Zovirax	NO INFO ( PROGRAM AVAIL )
Zubsolv	NO INFO ( PROGRAM AVAIL )
Zuplenz	NO INFO ( PROGRAM AVAIL )
Zurampic	NO INFO ( PROGRAM AVAIL )
Zyclara	NO INFO ( PROGRAM AVAIL )
Zydelig	NO INFO ( PROGRAM AVAIL )
Zyflo	NO INFO ( PROGRAM AVAIL )
Zyflo CR	NO INFO ( PROGRAM AVAIL )
Zykadia	NO INFO ( PROGRAM AVAIL )
Zylet	NO INFO ( PROGRAM AVAIL )
Zyloprim	NO INFO ( PROGRAM AVAIL )
Zyprexa	olanzapine	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$423.18	Lilly Cares
Zyprexa Relprevv	olanzapine	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$637.86	Lilly Cares
Zyprexa Zydis	olanzapine	YES + $1100 OOP	YES	300	Doctor	1 Year	120 Day	$670.99	Lilly Cares
Zyrtec	NO INFO ( PROGRAM AVAIL )
Zyrtec Allergy-Children\'s	NO INFO ( PROGRAM AVAIL )
Zyrtec-D	NO INFO ( PROGRAM AVAIL )
Zytiga	abiraterone acetate	YES + 4% OOP	YES	400	Card/Doctor	1 Year	90 Day	$9,138.70	J&J
Zyvox	NO INFO ( PROGRAM AVAIL )
ZzzQuil Products	NO INFO ( PROGRAM AVAIL )

MEDICATION(S) DETAILS
Enter Medication
1. MEDICATION NAME
1. MEDICATION DOSAGE
INCOME FPL

Monthly FPL Guidelines

Household	100%	150%	200%	250%	300%	350%	400%	450%
1	$972.50	$1,458.75	$1,945.00	$2,431.25	$2,917.50	$3,403.75	$3,890.00	$4,376.25
2	$1,310.83	$1,966.25	$2,621.66	$3,277.08	$3,932.49	$4,587.91	$5,243.32	$5,898.74
3	$1,649.17	$2,473.76	$3,298.34	$4,122.93	$4,947.51	$5,772.10	$6,596.68	$7,421.27
4	$1,987.50	$2,981.25	$3,975.00	$4,968.75	$5,962.50	$6,956.25	$7,950.00	$8,943.75
5	$2,325.83	$3,488.75	$4,651.66	$5,814.58	$6,977.49	$8,140.41	$9,303.32	$10,466.24
6	$2,664.17	$3,996.26	$5,328.34	$6,660.43	$7,992.51	$9,324.60	$10,656.68	$11,988.77
7	$3,002.50	$4,503.75	$6,005.00	$7,506.25	$9,007.50	$10,508.75	$12,010.00	$13,511.25
8	$3,340.83	$5,011.25	$6,681.66	$8,352.08	$10,022.49	$11,692.91	$13,363.32	$15,033.74

MONTHLY HOUSEHOLD INCOME
HOUSEHOLD COUNT

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APPLICANT INFORMATION
FIRST NAME
LAST NAME
GENDER
DATE OF BIRTH
EMAIL

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CONTACT INFORMATION
MOBILE PHONE
HOME PHONE
MAILING ADDRESS
Street Address Address Line 2 City State ZIP Code

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PHYSICIAN(S) DETAILS
PHYSICIAN(S) INFORMATION
DR. NAME PHONE ADDRESS
INCOME DETAILS

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ELIGIBLE PROGRAM SERVICES
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Categories: Patient Support Single Medication, Prescription Medication Product ID: 5133

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MEDICATION(S) DETAILS

INCOME FPL

Monthly FPL Guidelines

APPLICANT INFORMATION

CONTACT INFORMATION

PHYSICIAN(S) DETAILS

INCOME DETAILS

ELIGIBLE PROGRAM SERVICES

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