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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
ACETAMINOPH-CAFF-DIHYDROCOD ACETAMINOPHEN-COD #2 TABLET ACETAMINOPHEN-COD #3 TABLET ACETAMINOPHEN-COD #4 TABLET ACETAMINOPHEN-CODEINE ELIXI ACETAMINOPHEN-CODEINE SOLUT ACTIQ 1,200 MCG LOZENGE ACTIQ 1,600 MCG LOZENGE ACTIQ 200 MCG LOZENGE ACTIQ 400 MCG LOZENGE ACTIQ 600 MCG LOZENGE ACTIQ 800 MCG LOZENGE ALA-HIST AC LIQUID ALAHIST DHC LIQUID ALLFEN CD TABLET ALLFEN CDX TABLET ALPRAZOLAM 0.25 MG TABLET ALPRAZOLAM 0.5 MG TABLET ALPRAZOLAM 1 MG TABLET ALPRAZOLAM 1 MG/ML ORAL CON ALPRAZOLAM 2 MG TABLET ALPRAZOLAM ER 0.5 MG TABLET
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
ALPRAZOLAM ER 1 MG TABLET ALPRAZOLAM ER 2 MG TABLET ALPRAZOLAM ER 3 MG TABLET ALPRAZOLAM ODT 0.25 MG TAB ALPRAZOLAM ODT 0.5 MG TAB ALPRAZOLAM ODT 1 MG TAB ALPRAZOLAM ODT 2 MG TAB ALPRAZOLAM XR 0.5 MG TABLET ALPRAZOLAM XR 1 MG TABLET ALPRAZOLAM XR 2 MG TABLET ALPRAZOLAM XR 3 MG TABLET AMBIEN 10 MG TABLET AMBIEN 5 MG TABLET AMBIEN CR 12.5 MG TABLET AMBIEN CR 6.25 MG TABLET AMBIFED CD TABLET AMBIFED CDX TABLET AMBIFED-G CD TABLET AMBIFED-G CDX TABLET ANADROL-50 TABLET ANDRODERM 2 MG/24HR PATCH ANDRODERM 4 MG/24HR PATCH
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
ANDROGEL 1% GEL PUMP ANDROGEL 1%(2.5G) GEL PACKE ANDROGEL 1%(5G) GEL PACKET ANDROGEL 1.62% GEL PUMP ANEXSIA 7.5/650 TABLET ASCOMP WITH CODEINE CAPSULE ATIVAN 0.5 MG TABLET ATIVAN 1 MG TABLET ATIVAN 2 MG TABLET ATIVAN 2 MG/ML VIAL ATIVAN 4 MG/ML VIAL AVINZA 120 MG CAPSULE AVINZA 30 MG CAPSULE AVINZA 45 MG CAPSULE AVINZA 60 MG CAPSULE AVINZA 75 MG CAPSULE AVINZA 90 MG CAPSULE AXIRON 30 MG/ACTUATION SOLN BALTUSSIN SYRUP BELLADONNA-OPIUM 16.2-30 SU BELLADONNA-OPIUM 16.2-60 SU BRONTEX LIQUID
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
BRONTEX TABLET BUPRENEX 0.3 MG/ML AMPUL BUPRENORPHINE 2 MG TABLET S BUPRENORPHINE 8 MG TABLET S BUTALB-CAFF-ACETAMINOPH-COD BUTALBITAL COMP-CODEINE #3 BUTALBITAL COMPOUND TABLET BUTALBITAL-ASA-CAFFEINE CAP BUTALBITAL-ASA-CAFFEINE TAB BUTORPHANOL 10 MG/ML SPRAY BUTRANS 10 MCG/HR PATCH BUTRANS 20 MCG/HR PATCH BUTRANS 5 MCG/HR PATCH CAPITAL WITH CODEINE SUSP CARISOPRODL-ASPIRIN 200-325 CARISOPRODOL 250 MG TABLET CARISOPRODOL 350 MG TABLET CARISOPRODOL COMPOUND TAB CARISOPRODOL CPD-CODEINE TA CHERATUSSIN AC SYRUP CHERATUSSIN DAC SYRUP CHLORAL HYDRATE 500 MG/5 ML
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
CHLORDIAZEPOXIDE 10 MG CAPS CHLORDIAZEPOXIDE 25 MG CAPS CHLORDIAZEPOXIDE 5 MG CAPSU CHLORPHENIRAMINE-CODEINE LI CLORAZEPATE 15 MG TABLET CLORAZEPATE 3.75 MG TABLET CLORAZEPATE 7.5 MG TABLET COCET PLUS TABLET COCET TABLET CODEINE 10 MG-GUAI 300 MG L CODEINE SULFATE 30 MG TABLE CODEINE SULFATE 30 MG/5 ML CODEINE SULFATE 60 MG TABLE CO-GESIC 5-500 TABLET COLDCOUGH SYRUP COLDTUSS SYRUP COTAB A TABLET COTAB AX TABLET COTABFLU TABLET DELATESTRYL 200 MG/ML VIAL DEMEROL 100 MG TABLET DEMEROL 100 MG/ML AMPUL
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
DEMEROL 100 MG/ML VIAL DEMEROL 50 MG TABLET DEMEROL 50 MG/ML AMPUL DEMEROL 50 MG/ML VIAL DEMEROL 75 MG/1.5 ML AMPUL DEPO-TESTOSTERONE 100 MG/ML DEPO-TESTOSTERONE 200 MG/ML DEX-TUSS LIQUID DILAUDID 1 MG/ML LIQUID DILAUDID 2 MG TABLET DILAUDID 4 MG TABLET DILAUDID 8 MG TABLET DILAUDID-HP 10 MG/ML AMPUL DILAUDID-HP 10 MG/ML VIAL DILAUDID-HP 250 MG VIAL DOLOPHINE HCL 10 MG TABLET DONATUSS DC SYRUP DORAL 15 MG TABLET DUOHIST DH LIQUID DURAGESIC 100 MCG/HR PATCH DURAGESIC 12 MCG/HR PATCH DURAGESIC 25 MCG/HR PATCH
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
DURAGESIC 50 MCG/HR PATCH DURAGESIC 75 MCG/HR PATCH EDLUAR 10 MG SL TABLET EDLUAR 5 MG SL TABLET EMBEDA 100-4 MG CAPSULE EMBEDA 20-0.8 MG CAPSULE EMBEDA 30-1.2 MG CAPSULE EMBEDA 50-2 MG CAPSULE EMBEDA 60-2.4 MG CAPSULE EMBEDA 80-3.2 MG CAPSULE ENDACOF-C LIQUID ENDOCET 10-325 MG TABLET ENDOCET 10-650 MG TABLET ENDOCET 5-325 TABLET ENDOCET 7.5-325 MG TABLET ENDOCET 7.5-500 MG TABLET ENDODAN 4.83-325 MG TABLET ESTAZOLAM 1 MG TABLET ESTAZOLAM 2 MG TABLET EXALGO ER 12 MG TABLET EXALGO ER 16 MG TABLET EXALGO ER 32 MG TABLET
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
EXALGO ER 8 MG TABLET FENTANYL 100 MCG/HR PATCH FENTANYL 12 MCG/HR PATCH FENTANYL 25 MCG/HR PATCH FENTANYL 50 MCG/HR PATCH FENTANYL 75 MCG/HR PATCH FENTANYL CIT OTFC 1,200 MCG FENTANYL CIT OTFC 1,600 MCG FENTANYL CITRATE OTFC 200 M FENTANYL CITRATE OTFC 400 M FENTANYL CITRATE OTFC 600 M FENTANYL CITRATE OTFC 800 M FENTORA 100 MCG BUCCAL TABL FENTORA 200 MCG BUCCAL TABL FENTORA 400 MCG BUCCAL TABL FENTORA 600 MCG BUCCAL TABL FENTORA 800 MCG BUCCAL TABL FIORICET-COD 30-50-325-40 C FIORINAL 50-325-40 MG CAPSU FIORINAL-COD 30-50-325-40 C FLURAZEPAM 15 MG CAPSULE FLURAZEPAM 30 MG CAPSULE
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
FORTESTA 10 MG GEL PUMP GANI-TUSS NR LIQUID GUAIATUSSIN AC LIQUID GUAIFENESIN AC COUGH SYRUP GUAIFENESIN-CODEINE SYRUP GUAIFENESIN-CODEINE TABLET HALCION 0.25 MG TABLET HYCET 7.5 MG-325 MG/15 ML S HYDROCODON-ACETAMIN 7.5-325 HYDROCODON-ACETAMIN 7.5-500 HYDROCODON-ACETAMINOPH 2.5HYDROCODON-ACETAMINOPH 7.5HYDROCODON-ACETAMINOPHEN 5HYDROCODON-ACETAMINOPHN 10HYDROCODONE-ACETAMINOPHEN S HYDROCODONE-CHLORPHENIRAM S HYDROCODONE-HOMATROPINE SYR HYDROCODONE-HOMATROPINE TAB HYDROCODONE-IBUPROFEN 10-20 HYDROCODONE-IBUPROFEN 2.5-2 HYDROCODONE-IBUPROFEN 5-200 HYDROCODONE-IBUPROFEN 7.5-2
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
HYDROGESIC 5-500 MG CAPSULE HYDROMET SYRUP HYDROMORPHONE 1 MG/ML SOLUT HYDROMORPHONE 10 MG/ML VIAL HYDROMORPHONE 2 MG TABLET HYDROMORPHONE 3 MG SUPPOS HYDROMORPHONE 4 MG TABLET HYDROMORPHONE 50 MG/5 ML VI HYDROMORPHONE 8 MG TABLET IBUDONE 10-200 MG TABLET IBUDONE 5-200 MG TABLET INFUMORPH 10 MG/ML AMPUL PINFUMORPH 25 MG/ML AMPUL PINTERMEZZO 1.75 MG TAB SUBL INTERMEZZO 3.5 MG TAB SUBLI IOPHEN-C NR LIQUID J-COF DHC LIQUID J-MAX DHC LIQUID KADIAN ER 10 MG CAPSULE KADIAN ER 100 MG CAPSULE KADIAN ER 130 MG CAPSULE KADIAN ER 150 MG CAPSULE
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
KADIAN ER 20 MG CAPSULE KADIAN ER 200 MG CAPSULE KADIAN ER 30 MG CAPSULE KADIAN ER 40 MG CAPSULE KADIAN ER 50 MG CAPSULE KADIAN ER 60 MG CAPSULE KADIAN ER 70 MG CAPSULE KADIAN ER 80 MG CAPSULE KLONOPIN 0.5 MG TABLET KLONOPIN 1 MG TABLET KLONOPIN 2 MG TABLET LEVORPHANOL 2 MG TABLET LEXUSS 210 LIQUID LIQUICET 10-500 MG/15 ML SO LORAZEPAM 0.5 MG TABLET LORAZEPAM 1 MG TABLET LORAZEPAM 2 MG TABLET LORAZEPAM 2 MG/ML ORAL CONC LORAZEPAM 2 MG/ML VIAL LORAZEPAM 4 MG/ML VIAL LORAZEPAM INTENSOL 2 MG/ML LORCET 10-650 TABLET
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
LORCET PLUS TABLET LORTAB 10-500 TABLET LORTAB 5-500 TABLET LORTAB 7.5-500 MG/15 ML ELI LORTAB 7.5-500 TABLET LORTUSS EX LIQUID LUNESTA 1 MG TABLET LUNESTA 2 MG TABLET LUNESTA 3 MG TABLET LYRICA 100 MG CAPSULE LYRICA 150 MG CAPSULE LYRICA 200 MG CAPSULE LYRICA 225 MG CAPSULE LYRICA 25 MG CAPSULE LYRICA 300 MG CAPSULE LYRICA 50 MG CAPSULE LYRICA 75 MG CAPSULE MAXIFED CD TABLET MAXIFED CDX TABLET MAXIFED-G CD TABLET MAXIFED-G CDX TABLET MAXIFLU CD TABLET
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
MAXIFLU CDX TABLET MAXIPHEN CD TABLET MAXIPHEN CDX TABLET M-CLEAR CAPSULE M-CLEAR WC LIQUID MEBARAL 100 MG TABLET M-END MAX D LIQUID M-END WC LIQUID MEPERIDINE 100 MG TABLET MEPERIDINE 100 MG/ML VIAL MEPERIDINE 25 MG/ML VIAL MEPERIDINE 50 MG TABLET MEPERIDINE 50 MG/5 ML SOLUT MEPERIDINE 50 MG/ML VIAL MEPERITAB 100 MG TABLET MEPROBAMATE 200 MG TABLET MEPROBAMATE 400 MG TABLET METHADONE 10 MG/5 ML SOLUTI METHADONE 10 MG/ML ORAL CON METHADONE 40 MG TABLET DISP METHADONE 5 MG/5 ML SOLUTIO METHADONE HCL 10 MG TABLET
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
METHADONE HCL 5 MG TABLET METHADONE INTENSOL 10 MG/ML METHADOSE 10 MG TABLET METHADOSE 10 MG/ML ORAL CON METHADOSE 40 MG TABLET DISP METHADOSE 5 MG TABLET METHITEST 10 MG TABLET MODAFINIL 100 MG TABLET MODAFINIL 200 MG TABLET MORPHINE 10 MG/ML CARPUJECT MORPHINE 10 MG/ML VIAL MORPHINE 100 MG/10 ML VIAL MORPHINE 15 MG/ML CARPUJECT MORPHINE 15 MG/ML VIAL MORPHINE 2 MG/ML CARPUJECT MORPHINE 300 MG/20 ML VIAL MORPHINE 4 MG/ML CARPUJECT MORPHINE 5 MG/ML VIAL MORPHINE 8 MG/ML SYRINGE MORPHINE 8 MG/ML VIAL MORPHINE SULF 10 MG/5 ML SO MORPHINE SULF 100 MG/5 ML S
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
MORPHINE SULF 20 MG/5 ML SO MORPHINE SULF ER 100 MG TAB MORPHINE SULF ER 15 MG TABL MORPHINE SULF ER 200 MG TAB MORPHINE SULF ER 30 MG TABL MORPHINE SULF ER 60 MG TABL MORPHINE SULFATE 50 MG/ML V MORPHINE SULFATE ER 100 MG MORPHINE SULFATE ER 20 MG C MORPHINE SULFATE ER 30 MG C MORPHINE SULFATE ER 50 MG C MORPHINE SULFATE ER 60 MG C MORPHINE SULFATE ER 80 MG C MORPHINE SULFATE IR 15 MG T MORPHINE SULFATE IR 30 MG T MS CONTIN 100 MG TABLET MS CONTIN 15 MG TABLET MS CONTIN 200 MG TABLET MS CONTIN 60 MG TABLET MS CONTIN CR 30 MG TABLET NASOTUSS LIQUID NEO AC SYRUP
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
NIRAVAM 0.25 MG ODT NIRAVAM 0.5 MG ODT NIRAVAM 1 MG ODT NIRAVAM 2 MG ODT NORCO 10-325 TABLET NUCYNTA 100 MG TABLET NUCYNTA 50 MG TABLET NUCYNTA 75 MG TABLET NUCYNTA ER 100 MG TABLET NUCYNTA ER 150 MG TABLET NUCYNTA ER 200 MG TABLET NUCYNTA ER 250 MG TABLET NUCYNTA ER 50 MG TABLET NUVIGIL 150 MG TABLET NUVIGIL 250 MG TABLET NUVIGIL 50 MG TABLET ONFI 10 MG TABLET ONFI 20 MG TABLET ONFI 5 MG TABLET ONSOLIS 1,200 MCG SOLUBLE F ONSOLIS 200 MCG SOLUBLE FIL ONSOLIS 400 MCG SOLUBLE FIL
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
ONSOLIS 600 MCG SOLUBLE FIL ONSOLIS 800 MCG SOLUBLE FIL OPANA 10 MG TABLET OPANA 5 MG TABLET OPANA ER 10 MG TABLET OPANA ER 15 MG TABLET OPANA ER 20 MG TABLET OPANA ER 30 MG TABLET OPANA ER 40 MG TABLET OPANA ER 5 MG TABLET OPANA ER 7.5 MG TABLET OXANDRIN 10 MG TABLET OXANDRIN 2.5 MG TABLET OXANDROLONE 10 MG TABLET OXANDROLONE 2.5 MG TABLET OXAZEPAM 10 MG CAPSULE OXAZEPAM 15 MG CAPSULE OXAZEPAM 30 MG CAPSULE OXYCODON-ACETAMINOPHEN 2.5OXYCODON-ACETAMINOPHEN 7.5OXYCODONE HCL 10 MG TABLET
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
OXYCODONE HCL 100 MG/5 ML S OXYCODONE HCL 15 MG TABLET OXYCODONE HCL 20 MG TABLET OXYCODONE HCL 30 MG TABLET OXYCODONE HCL 5 MG CAPSULE OXYCODONE HCL 5 MG TABLET OXYCODONE HCL 5 MG/5 ML SOL OXYCODONE-ACETAMINOPHEN 10OXYCODONE-ACETAMINOPHEN 5-3 OXYCODONE-ACETAMINOPHEN 5-5 OXYCODONE-ASPIRIN 4.83-325 OXYCODONE-IBUPROFEN 5-400 T OXYCONTIN 10 MG TABLET OXYCONTIN 15 MG TABLET OXYCONTIN 20 MG TABLET OXYCONTIN 30 MG TABLET OXYCONTIN 40 MG TABLET OXYCONTIN 60 MG TABLET OXYCONTIN 80 MG TABLET OXYMORPHONE HCL 10 MG TABLE OXYMORPHONE HCL 5 MG TABLET OXYMORPHONE HCL ER 10 MG TA
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
OXYMORPHONE HCL ER 15 MG TA OXYMORPHONE HCL ER 20 MG TA OXYMORPHONE HCL ER 30 MG TA OXYMORPHONE HCL ER 40 MG TA OXYMORPHONE HCL ER 5 MG TAB OXYMORPHONE HCL ER 7.5 MG T PENTAZOCIN-ACETAMINOPHN 25PENTAZOCINE-NALOXONE TABLET PERCOCET 10-325 MG TABLET PERCOCET 10-650 MG TABLET PERCOCET 2.5-325 MG TABLET PERCOCET 5-325 MG TABLET PERCOCET 7.5-325 MG TABLET PERCOCET 7.5-500 MG TABLET PERCODAN TABLET PERCOLONE 5 MG TABLET PHENFLU CD TABLET PHENFLU CDX TABLET PHENYLHISTINE DH LIQUID POLY HIST DHC LIQUID POLY HIST NC LIQUID POLYGESIC 5/500 CAPSULE
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
POLY-TUSSIN AC LIQUID POLY-TUSSIN DHC LIQUID POLY-TUSSIN EX LIQUID PRO-CLEAR AC SYRUP PROMETHAZINE VC-CODEINE SYR PROMETHAZINE-CODEINE SYRUP PROVIGIL 100 MG TABLET PROVIGIL 200 MG TABLET PSEUDOEPHEDRINE-CODEINE LIQ REPREXAIN 10-200 MG TABLET REPREXAIN 2.5-200 MG TABLET REPREXAIN 5-200 MG TABLET REPREXAIN 7.5-200 MG TABLET RESTORIL 15 MG CAPSULE RESTORIL 22.5 MG CAPSULE RESTORIL 30 MG CAPSULE RESTORIL 7.5 MG CAPSULE REZIRA SOLUTION ROXICET 5-325 ORAL SOLUTION ROXICET 5-325 TABLET ROXICODONE 15 MG TABLET SOMA 250 MG TABLET
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
SOMA 350 MG TABLET SOMNOTE 500 MG SOFTGEL SONATA 10 MG CAPSULE SONATA 5 MG CAPSULE SUBOXONE 12 MG-3 MG SL FILM SUBOXONE 2 MG-0.5 MG SL FIL SUBOXONE 2 MG-0.5 MG TABLET SUBOXONE 4 MG-1 MG SL FILM SUBOXONE 8 MG-2 MG SL FILM SUBOXONE 8 MG-2 MG TABLET S TALWIN NX TABLET TEMAZEPAM 15 MG CAPSULE TEMAZEPAM 22.5 MG CAPSULE TEMAZEPAM 30 MG CAPSULE TEMAZEPAM 7.5 MG CAPSULE TESTIM 1% (50MG) GEL TESTOSTERONE CYP 100 MG/ML TESTOSTERONE CYP 200 MG/ML TESTOSTERONE ENAN 200 MG/ML TESTRED 10 MG CAPSULE TL-HIST CD LIQUID TL-HIST CM LIQUID
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
TRAMADOL ER 100 MG TABLET TRAMADOL ER 200 MG TABLET TRAMADOL ER 300 MG TABLET TRAMADOL HCL 50 MG TABLET TRAMADOL HCL ER 100 MG TABLET TRAMADOL HCL ER 200 MG TABLET TRAMADOL HCL ER 300 MG TABLET TRAMADOL-ACETAMINOPHN 37.5-325 TRANXENE SD 11.25 MG TABLET TRANXENE SD 22.5 MG TAB TRANXENE T-TAB 15 MG TRANXENE T-TAB 3.75 MG TRANXENE T-TAB 7.5 MG TRIAZOLAM 0.125 MG TABLET TRIAZOLAM 0.25 MG TABLET TUSSCOUGH DHC SYRUP TUSSICAPS 10 MG-8 MG CAPSUL TUSSIONEX PENNKINETIC SUSP TUSSO-C SYRUP VANACOF CD LIQUID VICODIN 5-300 MG TABLET VICODIN 5-500 TABLET
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
VICODIN ES 7.5-300 MG TABLE VICODIN ES 7.5-750 MG TABLE VICODIN HP 10-300 MG TABLET VICODIN HP 10-660 MG TABLET VICOPROFEN 200-7.5 MG TAB XANAX 0.25 MG TABLET XANAX 0.5 MG TABLET XANAX 1 MG TABLET XANAX 2 MG TABLET XANAX XR 0.5 MG TABLET XANAX XR 1 MG TABLET XANAX XR 2 MG TABLET XANAX XR 3 MG TABLET XODOL 10-300 TABLET XODOL 5-300 TABLET ZALEPLON 10 MG CAPSULE ZALEPLON 5 MG CAPSULE ZAMICET 10-325 MG/15 ML SOL ZOLPIDEM TART ER 12.5 MG TA ZOLPIDEM TART ER 6.25 MG TA ZOLPIDEM TARTRATE 10 MG TAB ZOLPIDEM TARTRATE 5 MG TABL
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Vendor Drug Program 90% Utilization Drug List

DRUG NAME
ZOLPIMIST 5 MG ORAL SPRAY ZOTEX-C SYRUP ZUTRIPRO SOLUTION ZYDONE 10-400 MG TABLET ZYDONE 5-400 MG TABLET ZYDONE 7.5-400 MG TABLET

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Last Update: November 2013