Prescription Drug Guide Comprehensive list of covered drugs

hydrocodone/ibuprofen...............1hydrocortisone ....................42, 50hydrocortisone butyrate ............42hydrocortisone lotn, tabs...........42hydrocortisone oint...................42hydrocortisone valerate.............42hydromorphone hcl inj 500mg/50ml................................................4hydromorphone hcl tabs .............4hydroxychloroquine sulfate ......19hydroxyurea..............................17hydroxyzine hcl ........................13hydroxyzine pamoate................13ibandronate sodium...................50ibuprofen susp.............................2ibuprofen tabs 400mg, 600mg, 800mg................................................2iclusig tabs 15mg......................17iclusig tabs 45mg......................17imipenem/cilastatin.....................7imipramine hcl..........................13imipramine pamoate caps 100mg,150mg, 75mg........................13imipramine pamoate caps 125mg13imiquimod.................................37imitrex soln...............................16Immune Suppressants...............47Immunizing Agents, Passive ....48Immunological Agents .............47Immunomodulators...................48imovax rabies (h.d.c.v.) ............49incivek ......................................24increlex .....................................42indapamide ...............................34indocin susp................................2indomethacin caps ......................2indomethacin er ..........................2infanrix .....................................49Inflammatory Bowel Disease Agents..............................................49inlyta.........................................18innopran xl................................31Insulins .....................................27intelence tabs 100mg ................22intelence tabs 200mg ................22intralipid ...................................57intron-a inj 6000000unit/ml......24intron-a w/diluent inj 10mu ......24introvale....................................44intuniv.......................................36invanz .........................................7invega sustenna inj 117mg/0.75ml,156mg/ml, 234mg/1.5ml......21Iinvega sustenna inj 39mg/0.25ml,78mg/0.5ml ..........................21invega tb24 1.5mg, 3mg ...........21invega tb24 6mg .......................21invega tb24 9mg .......................21invirase caps .............................23invirase tabs..............................23ionosol-b/dextrose 5% ..............57ipol inactivated ipv ...................49ipratropium bromide inhalation soln..............................................54ipratropium bromide nasal soln 54ipratropium bromide/albuterol sulfate..............................................55irbesartan ............................30, 32irbesartan/hydrochlorothiazide .32irinotecan inj 100mg/5ml..........18Irritable Bowel Syndrome Agents39isentress chew...........................23isentress tabs.............................23isolyte-p/dextrose 5% ...............57isoniazid tabs ............................16isordil titradose .........................35isosorbide dinitrate ...................35isosorbide dinitrate er ...............35isosorbide mononitrate er .........35isosorbide mononitrate tabs 10mg35isosorbide mononitrate tabs 20mg35isotonic gentamicin inj 0.8mg/ml, 0.9%................................................5isradipine ..................................31istalol ........................................52itraconazole...............................15ixempra kit inj 45mg.................18ixiaro.........................................49jakafi.........................................18jalyn ..........................................40jantoven ....................................28janumet .....................................27janumet xr.................................27januvia ......................................26jevtana.......................................18jinteli.........................................44jolivette.....................................46junel 1.5/30...............................44junel 1/20..................................44junel fe 1.5/30...........................44junel fe 1/20..............................45JKkaletra soln................................23kaletra tabs 100mg, 25mg.........23kaletra tabs 200mg, 50mg.........23kalydeco....................................55kanamycin sulfate.......................5kariva ........................................45kcl 0.075%/d5w/nacl 0.45%.....57kcl 0.15%/d5w/lr ......................57kcl 0.15%/d5w/nacl 0.2%.........57kcl 0.15%/d5w/nacl 0.9%.........57kcl 0.3%/d5w/nacl 0.45%.........57kcl 0.3%/d5w/nacl 0.9%...........57kelnor 1/35................................45kenalog .....................................42ketoconazole crea, sham, tabs...15ketoconazole foam....................15ketoprofen...................................2ketoprofen er...............................2ketorolac tromethamine ........2, 51ketorolac tromethamine inj 15mg/ml,30mg/ml .................................2ketorolac tromethamine tabs.......2kineret.......................................48kionex .......................................56klor-con 10................................56klor-con 8..................................56klor-con m15 ............................56klor-con m20 ............................56kombiglyze xr tb24 1000mg, 2.5mg..............................................27kombiglyze xr tb24 1000mg, 5mg,500mg, 5mg..........................27kristalose...................................39kuvan ........................................38labetalol hcl tabs.......................31laclotion ....................................37lactated ringers irrigation..........58lactated ringers viaflex..............58lactulose....................................39lamictal odt tbdp 100mg, 25mg 10lamictal odt tbdp 200mg...........10lamictal starter/not takingcarbamazepine......................10lamictal starter/takingcarbamazepine/not taking valproate..............................................10lamictal starter/taking valproate10lamictal xr kit 0.........................10lamictal xr tb24 100mg, 25mg, 50mg..............................................10lamictal xr tb24 200mg.............10lamictal xr tb24 250mg.............10lamivudine ................................22lamivudine/zidovudine .............22lamotrigine................................1066L