USAMA

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Description
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BRAND NAMEGENERICPRIVATE INSPART DLIS DENIAL% OOP$ OOP MEDICAREFPLSUPPLYCOST
Novolin 70-30human insulin isophane suspension and 30% regular, human insulin injectionNOYESNONO1000YES30090 Day152
Auvi-Q InjectableepinephrineNOYESYES5NOYES250120 Day4500
CialistadalafilNOYESNONO1100YES300120 Day109.56
CymbaltaduloxetineNOYESNONO1100YES300120 Day502.63
EffientprasugrelNOYESNONO1100YES300120 Day416.93
EvistaraloxifeneNOYESNONO1100YES300120 Day53
Humaloginsulin lisproNOYESNONO1100YES300120 Day77.14
Humalog Mix50/50insulin lisproNOYESNONO1100YES300120 Day264.04
Humalog Mix75/25insulin lisproNOYESNONO1100YES300120 Day264.04
HumatropesomatropinåNOYESNONO1100YES300120 Day784.98
Humulin 70/30insulin humanNOYESNONO1100YES300120 Day138.35
Humulin Nnph human insulinNOYESNONO1100YES300120 Day138.35
Humulin Rregular insulin humanåNOYESNONO1100YES300120 Day138.35
ProzacfluoxetineNOYESNONO1100YES300120 Day435.36
Quinidine Gluconatequinidine gluconateNOYESNONO1100YES300120 Day23
StratteraatomoxetineNOYESNONO1100YES300120 Day428.88
Symbyaxolonzapine/fluoxetineNOYESNONO1100YES300120 Day698.24
ZyprexaolanzapineNOYESNONO1100YES300120 Day423.18
Zyprexa RelprevvolanzapineNOYESNONO1100YES300120 Day637.86
Zyprexa ZydisolanzapineNOYESNONO1100YES300120 Day670.99
Basaglarinsulin glargine injectionNOYESNONO1100YES300120 Day234.6
Humalog KwikPenrecombinantNOYESNONO1100YES300120 Day292.53
Humalog Mix 50/50recombinantNOYESNONO1100YES300120 Day292.53
Humalog Mix 50/50 KwikPenrecombinantNOYESNONO1100YES300120 Day292.53
Humalog Mix 50/50 PenrecombinantNOYESNONO1100YES300120 Day292.53
Humalog Mix 75/25recombinantNOYESNONO1100YES300120 Day292.53
Humalog Mix 75/25 PenrecombinantNOYESNONO1100YES300120 Day292.53
Humalog PenrecombinantNOYESNONO1100YES300120 Day292.53
Humalog U-200 KwikPenrecombinantNOYESNONO1100YES300120 Day292.53
Humulin R (U-100)insulin human isophane-human insulinNOYESNONO1100YES300120 Day179
Humulin R (U-500)insulin human isophane-human insulinNOYESNONO1100YES300120 Day179
TrulicityDulaglutide NOYESNONO1100YES300120 Day770
FiaspInsulin aspartNOYESNONO1000YES400120 Day 304.65
GlucaGen HypokitglucagonNOYESNONO1000YES400120 Day 286.39
Prozac WeeklyFluoxetineNOYESNONO1100YES300120 Days34.92
TaltzixekizumabNOYESNONO1100YES300120 Days4200
Alphanateantihemophilic factor humanYESNONONONOYES40030 Day608.49
AlphaNine SDcoagulation factor IX (humanYESNONONONONO40030 Day699.52
Duzalloallopurinol/lesinuradYESYESNONONOYES30030 Day387
Butrans TransdermalbuprenorphineNOYESNONONOYES13930 Day288
OxyContin TabletsoxycodoneNOYESNONONOYES13930 Day80.5
Analpram HChydrocortisone/pramoxineNOYESNONONODetermined case by case10030 Day46.19
SuboxoneBuprenorphineNONONONONO25030 Day151
BelviqlorcaserinYes if not listed in the formularyYESNONONOYES15030 Day 294.73
Auryxiaferric citrateNOYESNONONOYES40030 Day 1100
Aptiomeslicarbazepine acetateNONONONONONO25030 Day 945.55
AndroGeltestosteroneYESYESNONONOYES30090 Day4801.94
CreonpancrelipaseYESYESNONONOYES30090 Day481.89
Gengraf CapsulescyclosporineYESYESNONONOYES30090 Day165.3
HUMIRAadalimumabYESYESNONONOYES30090 Day2477.43
Lupronleuprolide acetate)YESYESNONONOYES30090 Day
Lupron Depotleuprolide acetate)YESYESNONONOYES30090 Day
Lupron Depot-PEDleuprolide acetate)YESYESNONONOYES30090 Day
NorvirritonavirYESYESNONONOYES30090 Day277
SynthroidlevothyroxineYESYESNONONOYES30090 Day34.58
KALETRAlopinavir/ritonavirYESYESNONONOYES50090 Day476.79
Compleraemtricitabine/rilpivirine/tenofovir disoproxil fumarateYESYESNONONOYES50090 Day2670
Zioptan Opthalmic SolutiontafluprostYESYESNONONOYES40090 Day200
Aerochamber Plus Flow-Vumedical deviceMust have no prescription coverageYESYESNONOYES40090 Day39.61
EstraceEstradiolYes if not listed in the formularyYESYESNONOYES40090 dAY337
ZenpeppancrelipaseYESYESYESNONOYES40090 Day544
Avycazceftazidime/avibactamNOYESYESNONOYES40090 Day359
CanasamesalamineNOYESYESNONOYES40090 Day1062
Armour Thyroidthyroid desiccatedYes if not listed in the formularyYESYESNONOYES40090 Day44
Bystolic TabletsnebivololYes if not listed in the formularyYESYESNONOYES40090 Day118.55
Fetzima ER CapsuleslevomilnacipranYes if not listed in the formularyYESYESNONOYES40090 Day323.36
Fetzima ER Capsules Titration PacklevomilnacipranYes if not listed in the formularyYESYESNONOYES40090 Day301.87
Linzess CapsuleslinaclotideYes if not listed in the formularyYESYESNONOYES40090 Day348.83
Namenda Oral SolutionmemantineYes if not listed in the formularyYESYESNONOYES40090 Day904.46
Namenda TabletsmemantineYes if not listed in the formularyYESYESNONOYES40090 Day468.08
Namenda Titration PakmemantineYes if not listed in the formularyYESYESNONOYES40090 Day234.5
Namenda XR ER Capsules Titration PackmemantineYes if not listed in the formularyYESYESNONOYES40090 Day387.08
Namenda XRER CapsulesmemantineYes if not listed in the formularyYESYESNONOYES40090 Day387.08
Namzaricmemantine-donepezilYes if not listed in the formularyYESYESNONOYES40090 Day449
Savella TabletsmilnaciprabYes if not listed in the formularyYESYESNONOYES40090 Day318.26
Savella Titration PackmilnaciprabYes if not listed in the formularyYESYESNONOYES40090 Day291.82
Viibryd Patient Starter KitvilazodoneYes if not listed in the formularyYESYESNONOYES40090 Day224.42
Viibryd TabletsvilazodoneYes if not listed in the formularyYESYESNONOYES40090 Day224.42
CorlanorivabradineYESYESNONONOYES50090 Day435
AmBisomeamphotericin B liposomeYESYESNONONOYES25090 Day
Cresembaisavuconazonium sulfateYESYESNONONOYES25090 Day304
Bydureon Vial ERexenatide syntheticNOYESNO3NOYES30090 Day613.83
Byetta InjectionexenatideNOYESNO3NOYES30090 Day658.59
Farxiga TabletdapagliflozinNOYESNO3NOYES30090 Day424.63
Kombiglyze XRTabletsaxagliptin/metforminNOYESNO3NOYES30090 Day190.49
Movantiknaloxegol oxalateNOYESNO3NOYES30090 Day362.04
Symlin Pen Injectionpramlintide acetateNOYESNO3NOYES30090 Day943.78
Daliresp TabletsroflumilastNOYESNO3NOYES30090 Day317.56
Kombiglyze XRMetformin,SaxagliptonNOYESNO3NOYES30090 Day411.06
LynparzaNO PROGRAM AVAILABLENOYESNO3NOYES30090 Day
Onglyzasaxagliptin)NOYESNO3NOYES30090 Day
Pulmicort FlexhalerbudesonideNOYESNO3NOYES30090 Day281
SymbicortNO PROGRAM AVAILABLENOYESNO3NOYES30090 Day241
Tudorza Pressairaclidinium bromideNOYESNO3NOYES30090 Day278.87
Arimidex TabletanastrozoleNOYESNO3NOYES30090 Day549.97
Bevespi Aerosphereglycopyrrolate/formoterol fumarateNOYESNO3NOYES30090 Day360
Brilinta TabletticagrelorNOYESNO3NOYES30090 Day170.89
Faslodex InjectionfulvestrantNOYESNO3NOYES30090 Day2013.52
Merrem InjectionmeropenemNOYESNO3NOYES30090 Day386.89
Pulmicort FlexhalerPowderbudesonideNOYESNO3NOYES30090 Day186.94
Pulmicort RespulesInhalationbudesonideNOYESNO3NOYES30090 Day354.88
Seroquel XR Tablet ERquetiapine fumarateNOYESNO3NOYES30090 Day485.95
Symbicort Inhalerbudesonide/formoterol fumarate dihydrateNOYESNO3NOYES30090 Day308.45
BenlystabelimumabNOYESNONONOYES40090 Day3380
Aptivus CapsuletipranavirYESYESNONONOYES40090 Day1519.72
Aptivus Oral SolutiontipranavirYESYESNONONOYES40090 Day507.22
Atrovent HFAAerosolipratropium bromide HFAYESYESNONONOYES40090 Day383
Combivent RespimatSprayipratropium bromide/albuterolYESYESNONONOYES40090 Day340.4
GlyxambiEmpagliflozin,LinagliptonYESYESNONONOYES40090 Day370.41
JardianceEmpagliflozinYESYESNONONOYES40090 Day466.53
JentaduetoLinaglipton,MetforminYESYESNONONOYES40090 Day438
Jentadueto XRLinaglipton,MetforminYESYESNONONOYES40090 Day438
Pradaxadabigatran etexilate)YESYESNONONOYES40090 Day370.41
Pradaxa Capsuledabigatran etexilateYESYESNONONOYES40090 Day370.41
Spiriva HandiHalertiotropium bromideYESYESNONONOYES40090 Day286
Spiriva HandiHaler Powdertiotropium bromideYESYESNONONOYES40090 Day1101.18
Spiriva Respimattiotropium bromideYESYESNONONOYES40090 Day286
Stiolto Respimattiotropium bromide/olodaterolYESYESNONONOYES40090 Day370.41
Tradjenta TabletlinagliptinYESYESNONONOYES40090 Day375.9
Viramune XR Tablet ERnevirapineYESYESNONONOYES40090 Day861.06
BethkistobramycinYes if not listed in the formularyNONONONONO40090 Day5643
Azoramlodipine/olmesartan medoxmilYESNONONONOYES20090 day240
Benicar TabletsolmesartanNONONONONOYES20090 day320.2
SavaysaedoxabanNONONONONOYES20090 Day362.06
Welchol Oral SuspensioncolesevelamNONONONONOYES20090 Day576.32
Welchol TabletcolesevelamNONONONONOYES20090 day576.32
GocovriamantadineMust be uninsured or underinsuredNONONONOYES50090 Day2146.87
Advair Diskusfluticasone propionate/salmeterol xinafoateNOYESNONO600YES25090 Day296.83
Advair DiskusPowderfluticasone propionate/salmeterol xinafoateNOYESNONO600YES25090 Day296.83
Advair HFAfluticasone propionate/salmeterol xinafoateNOYESNONO600YES25090 Day360.95
Advair HFAAerosolfluticasone propionate/salmeterol xinafoateNOYESNONO600YES25090 Day360.95
Anoro Elliptaumeclidinium bromide/vilanterol trifenatateNOYESNONO600YES25090 Day345.27
Avandiarosiglitazone maleateNOYESNONO600YES25090 Day180
Avandia Tabletsrosiglitazon/glimepirideNOYESNONO600YES25090 Day161.72
AvandiaTabletrosiglitazone maleateNOYESNONO600YES25090 Day161.72
Avodart Soft Gelatin TabletsdutasterideNOYESNONO600YES25090 Day211.87
Avodart TabletdutasterideNOYESNONO600YES25090 Day211.87
Bactroban Creammupirocin calciumNOYESNONO600YES25090 Day222.17
Bactroban Cream2mupirocin calciumNOYESNONO600YES25090 Day222.17
Bactroban Nasal Ointmentmupirocin calciumNOYESNONO600YES25090 Day168.98
Bactroban Ointmentmupirocin calciumNOYESNONO600YES25090 Day168.98
Bactroban Ointment; Nasal2mupirocin calciumNOYESNONO600YES25090 Day168.98
Bactroban Ointment2mupirocin calciumNOYESNONO600YES25090 Day168.98
Beconase AQbeclomethasoneNOYESNONO600YES25090 Day314
Beconase AQSpray; Nasal0.042beclomethasoneNOYESNONO600YES25090 Day314
Breo Elliptafluticasone furoate/vilanterol trifenatateNOYESNONO600YES25090 Day317.59
Breo ElliptaInhalation Powderfluticasone furoate/vilanterol trifenatateNOYESNONO600YES25090 Day317.59
Coreg CRcarvedilol phosphateNOYESNONO600YES25090 Day317.76
Coreg CR Capsule ERcarvedilolNOYESNONO600YES25090 Day317.76
DuacGel1/5clindamycin phosphate/benzoyl peroxideNOYESNONO600YES25090 Day387.06
Epivir-HBVOral SolutionlamivudineNOYESNONO600YES25090 Day128.71
Epivir-HBVTabletlamivudineNOYESNONO600YES25090 Day479.31
Flovent Diskusfluticasone propionateNOYESNONO600YES25090 Day163.36
Flovent HFAfluticasone propionateNOYESNONO600YES25090 Day230.15
Imitrex Nasal SpraysumatriptanNOYESNONO600YES25090 Day521.31
Imitrex SpraysumatriptanNOYESNONO600YES25090 Day417.91
Incruse Elliptaumeclidinium bromideNOYESNONO600YES25090 Day12049
Jalyndutasteride/tamsulosinNOYESNONO600YES25090 Day12049
Jalyn Capsuledutasteride and tamsulosinNOYESNONO600YES25090 Day211.67
Lamictal ODTPatient Titration KitlamotrigineNOYESNONO600YES25090 Day719.23
Lamictal TabletlamotrigineNOYESNONO600YES25090 Day854.82
Lamictal XRPatient Titration KitlamotrigineNOYESNONO600YES25090 Day719.23
Lamictal XRTablet ERlamotrigineNOYESNONO600YES25090 Day854.82
Malarone Tabletatovaquone and proguanilNOYESNONO600YES25090 Day180
Mepron SuspensionatovaquoneNOYESNONO600YES25090 Day1564.26
Potiga TabletezogabineNOYESNONO600YES25090 Day1084.33
RelenzazanamivirNOYESNONO600YES25090 Day60.05
Requip XLropiniroleNOYESNONO600YES25090 Day555.11
Requip XL Tablet ERropiniroleNOYESNONO600YES25090 Day162.94
Rythmol SR Capsule ERpropafeNONOYESNONO600YES25090 Day800.84
Soriatane CapsuleacitretinNOYESNONO600YES25090 Day1621.74
Ventolin HFA Inhalantalbuterol sulfateNOYESNONO600YES25090 Day53.25
Veramyst Nasal Sprayfluticasone furoateNOYESNONO600YES25090 Day217.95
Veramyst Spray; Nasalfluticasone furoateNOYESNONO600YES25090 Day218.15
ConcertamethylphenidateYESYESNO4NOYES30090 Day354.66
DoxildoxorubicinYESYESNO4NOYES30090 Day1240.98
Duragesic CIIPatchfentanyl transdermal systemYESYESNO4NOYES30090 Day3375.36
EdurantrilpivirneYESYESNO4NOYES30090 Day992.24
Elmironpentosan polysulfate sodiumYESYESNO4NOYES30090 Day50
Haldol InjectionhaloperidolYESYESNO4NOYES30090 Day212.9
ImbruvicaibrutinibYESYESNO4NOYES30090 Day14397.38
IntelenceetravirineYESYESNO4NOYES30090 Day587.79
Invegapaliperidone palmitateYESYESNO4NOYES30090 Day1170.92
Invega Sustenna ERpaliperidone palmitateYESYESNO4NOYES30090 Day1147.07
Invokamet canagliflozin; metformin hydrochlorideYESYESNO4NOYES30090 Day438.62
Invokamet XR canagliflozin; metformin hydrochlorideYESYESNO4NOYES30090 Day438.62
InvokanacanagliflozinYESYESNO4NOYES30090 Day462.74
Olysio CapsulesimeprevirYESYESNO4NOYES30090 Day76315.2
Orthovisc Injectionhigh molecular weight hyaluronanYESYESNO4NOYES30090 Day592
Pancreaze CapsulepancrelipaseYESYESNO4NOYES30090 Day286.65
Prezista TabletdarunavirYESYESNO4NOYES30090 Day1096.99
Procrit Injectionepoetin alfaYESYESNO4NOYES30090 Day5724.17
Remicade VialinfliximabYESYESNO4NOYES30090 Day1136.9
Risperdal ConstaInjectionrisperidoneYESYESNO4NOYES30090 Day416.61
Risperdal M-TABrisperidoneYESYESNO4NOYES30090 Day634.76
Risperdal Oral SolutionrisperidoneYESYESNO4NOYES30090 Day380.32
Risperdal TabletrisperidoneYESYESNO4NOYES30090 Day340.49
SimponigolimumabYESYESNO4NOYES30090 Day4642.89
Simponi ARIAgolimumabYESYESNO4NOYES30090 Day1832.1
Sporanox CapsuleitraconazoleYESYESNO4NOYES30090 Day1677.28
Sporanox Oral SolutionitraconazoleYESYESNO4NOYES30090 Day341.37
StelaraustekinumabYESYESNO4NOYES30090 Day10970.59
SylvantsiltuximabYESYESNO4NOYES30090 Day860.63
Topamax CapsuletopiramateYESYESNO4NOYES30090 Day413.41
Topamax TablettopiramateYESYESNO4NOYES30090 Day720.73
TremfyaguselkumabYESYESNO4NOYES30090 Day10095
XareltorivroxabanYESYESNO4NOYES30090 Day388.25
YondelistrabectedinYESYESNO4NOYES30090 Day2679.46
Zytigaabiraterone acetateYESYESNO4NOYES30090 Day9138.7
ForteoteriparatideNOYESNONO1100YES30090 Day2947.07
Asmanex TwisthalerInhalationmometasoneYESYESNONONOYES40090 Day309.92
BelsomrasuvorexantYESYESNONONOYES40090 Day337
Crixivanindinavir sulfateYESYESNONONOYES40090 Day475
Diprolene Cream0.05betamethasoneYESYESNONONOYES40090 Day197.16
Diprolene Lotion0.05betamethasoneYESYESNONONOYES40090 Day199.41
Diprolene Ointment0.05betamethasoneYESYESNONONOYES40090 Day197.16
Dulera Aerosolmometasone furoate/formoterol fumarate dihydrateYESYESNONONOYES40090 Day299.19
JanumetMetformin,SitagliptonYESYESNONONOYES40090 Day457
Janumet Tabletmetformin/sitagliptin phosphateYESYESNONONOYES40090 Day391.89
Janumet XRMetformin,SitagliptonYESYESNONONOYES40090 Day457
Janumet XRTablet ERmetformin/sitagliptin phosphateYESYESNONONOYES40090 Day391.89
JanuviaSitagliptonYESYESNONONOYES40090 Day457
Januvia TabletsitagliptinYESYESNONONOYES40090 Day388.66
Lotrisone Creamclotrimazole/betamethasoneYESYESNONONOYES40090 Day123.16
Maxalt Tabletrizatriptan benzoateYESYESNONONOYES40090 Day226.29
Maxalt-MLTTabletrizatriptan benzoateYESYESNONONOYES40090 Day226.28
Nasonex Spraymometasone furoate monohydrateYESYESNONONOYES40090 Day244.58
Nitro-DurnitroglycerinYESYESNONONOYES40090 Day182.52
Proventilalbuterol sulfateYESYESNONONOYES40090 Day
Proventil HFAalbuterol sulfateYESYESNONONOYES40090 Day
Proventil HFA Aerosolalbuterol sulfateYESYESNONONOYES40090 Day88.06
Remeron TabletmirtazapineYESYESNONONOYES40090 Day173.59
SingulairMontelukast SodiumYESYESNONONOYES40090 Day246
Singulair Asthma Oral Granulesmontelukast sodiumYESYESNONONOYES40090 Day222.17
Stromectol TabletivermectinYESYESNONONOYES40090 Day15.71
Trusopt Ophthalmic SolutiondorzolamideYESYESNONONOYES40090 Day60
Vytorin Tabletezetimibe/simvastatinYESYESNONONOYES40090 Day319.95
ZetiaezetimibeYESYESNONONOYES40090 Day369
Zetia TabletezetimibeYESYESNONONOYES40090 Day323.02
EpiPen 2-PakInjectionepinephrineYESYESNONONONO40090 Day697
EpiPen Jr 2-PakNO PROGRAM AVAILABLEYESYESNONONONO40090 Day697
EpiPen Jr 2-Pak InjectionepinephrineYESYESNONONONO40090 Day697
GleostinelomustineNONONONONOYES20090 Day350
NeoralcyclosporineYESNONONONOYES40090 Day75
TobitobramycinYESNONONONOYES40090 Day386
Tobi PodhalertobramycinYESNONONONOYES40090 Day386
AfinitoreverolimusYESNONONONOYES40090 Day3715.52
Afinitor DisperzeverolimusYESNONONONOYES40090 Day3715.52
ArzerraNO PROGRAM AVAILABLEYESNONONONOYES40090 Day20000
AZO Suspension/ DropsbrinzolamideYESNONONONOYES40090 Day292
AzoptbrinzolamideYESNONONONOYES40090 Day292
Ciprociprofloxacin/dexamethasone sterile otic suspensionYESNONONONOYES40090 Day257
Coartemartmether/lumefantrineYESNONONONOYES40090 Day130
DurezoldifluprednateYESNONONONOYES40090 Day180
Entrestosacubitril/valsartanYESNONONONOYES40090 Day468.57
ExjadedeferasiroxYESNONONONOYES40090 Day18644.58
Extaviainterferon beta-1bYESNONONONOYES40090 Day6268.54
Farydakpanobinostat lactateYESNONONONOYES40090 Day8011.48
GilenyafingolimodYESNONONONOYES40090 Day5412.92
Glatopaglatiramer acetateYESNONONONOYES40090 Day1953.29
GleevecimatinibYESNONONONOYES40090 Day1406.6
HycamtintopotecanYESNONONONOYES40090 Day75.95
Myforticmycophenolic acidYESNONONONOYES40090 Day292
PazeoolopatadineYESNONONONOYES40090 Day292
TegretolcarbamazepineYESNONONONOYES40090 Day
Tegretol XRcarbamazepineYes if not listed in the formularyNONONONOYES40090 Day
Gluca Gen HypokitInjectionglucagonNOYESNONO1000YES40090 Day257.57
Levemir FlexPenInjectioninsulin detemirNOYESNONO1000YES40090 Day411.59
Levemir Injectioninsulin detemirNOYESNONO1000YES40090 Day274.56
Novolin 70/30 VialInjectionhuman/insulin susp isophaneNOYESNONO1000YES40090 Day140.79
Novolin Ninsulin humanNOYESNONO1000YES40090 Day291.71
Novolin N VialInjectioninsulin humanNOYESNONO1000YES40090 Day140.79
Novolin Rinsulin humanNOYESNONO1000YES40090 Day291.71
Novolin R VialInjectioninsulin humanNOYESNONO1000YES40090 Day140.79
NovoLoginsulin humanNOYESNONO1000YES40090 Day291.71
NovoLog FlexPenInjectioninsulin aspartåNOYESNONO1000YES40090 Day542.72
NovoLog Injectioninsulin aspartåNOYESNONO1000YES40090 Day281.26
NovoLog Mix 70/30insulin humanNOYESNONO1000YES40090 Day291.71
NovoLog Mix 70/30 FlexPen Cartridgesinsulin aspart protamineNOYESNONO1000YES40090 Day291.71
NovoLog Mix 70/30Vialinsulin aspart protamineNOYESNONO1000YES40090 Day291.71
TresibaDegludecNOYESNONO1000YES40090 Day489.84
Tresiba FlexTouch PenDegludecNOYESNONO1000YES40090 Day489.84
Victoza InjectionliraglutideNOYESNONO1000YES40090 Day762.19
VictozaliraglutideNOYES NONO1000YES40090 Day872
Aromasin TabletexemestaneYESYESNONONOYES40090 Day1058.72
Arthrotec Tabletdiclofenac sodium/misoprostolYESYESNONONOYES40090 Day143
Bosulif TabletbosutinibYESYESNONONOYES40090 Day3196.96
Caduet Tabletsamlodipine besylate/atorvastatin calciumYESYESNONONOYES40090 Day408.15
Caverjec tInjectionalprostadilYESYESNONONOYES40090 Day595
Celebrex CapsulecelecoxibYESYESNONONOYES40090 Day761.35
Celontin CapsulemethsuximideYESYESNONONOYES40090 Day453
Chantix TabletvareniclineYESYESNONONOYES40090 Day369.34
Cleocin Capsuleclindamycin phosphateYESYESNONONOYES40090 Day248.61
Cleocin PediatricSolutionclindamycin phosphateYESYESNONONOYES40090 Day137.71
Cleocin PhosphateInjectionclindamycin phosphateYESYESNONONOYES40090 Day121.95
Cleocin Suppository; Vaginalclindamycin phosphateYESYESNONONOYES40090 Day170
Cleocin Swab1clindamycin phosphateYESYESNONONOYES40090 Day497
Colestid Granules; FlavoredcolestipolYESYESNONONOYES40090 Day385.12
Colestid TabletcolestipolYESYESNONONOYES40090 Day244.04
Cortef TablethydrocortisoneYESYESNONONOYES40090 Day97.55
Depo-EstradiolInjectionestradiol cypionateYESYESNONONOYES40090 Day92.6
Depo-MedrolInjectionmethylprednisolone acetateYESYESNONONOYES40090 Day1201.59
Depo-ProveraInjectionmedroxyprogesterone acetateYESYESNONONOYES40090 Day5012.83
Detrol Tablettolterodine tartrateYESYESNONONOYES40090 Day446.57
Dilantin CapsulephenytoinYESYESNONONOYES40090 Day93.8
Dilantin-125Oral SuspensionphenytoinYESYESNONONOYES40090 Day124.44
Effexor XRCapsule ERvenlafaxineYESYESNONONOYES40090 Day406.59
Ellence InjectionepirubicinYESYESNONONOYES40090 Day56
Emcyt Capsuleestramustine phosphate sodiumYESYESNONONOYES40090 Day2404.72
Estring Vaginal RingEstradiolYESYESNONONOYES40090 Day372.09
Feldene CapsulepiroxicamYESYESNONONOYES40090 Day814
Glyset TabletmiglitolYESYESNONONOYES40090 Day295
Idamycin PFSInjectionidarubicinYESYESNONONOYES40090 Day33
Inlyta TabletaxitinibYESYESNONONOYES40090 Day6561.79
Inspra TableteplereNOYESYESNONONOYES40090 Day365
Lincocin InjectionlincomycinYESYESNONONOYES40090 Day219
LyricaPregabalinYESYESNONONOYES40090 Day
Lyrica CapsulepregabalinYESYESNONONOYES40090 Day566.18
Lyrica Oral SolutionpregabalinYESYESNONONOYES40090 Day792.15
Mycobutin CapsulerifabutinYESYESNONONOYES40090 Day1829.65
Nicotrol Inhalation Systemnicotine cartridgeYESYESNONONOYES40090 Day443
Norpace Capsuledisopyramide phosphateYESYESNONONOYES40090 Day463.22
Norpace CRCapsule ERdisopyramide phosphateYESYESNONONOYES40090 Day603.92
Premarinconjugated estrogensYESYESNONONOYES40090 Day
Premarin Creamestrogens conjugatedYESYESNONONOYES40090 Day345.75
Premarin Tabletestrogens conjugatedYESYESNONONOYES40090 Day156.78
Premphase Tabletestrogens conjugated/medroxyprogesterone acetateYESYESNONONOYES40090 Day200
Pristiqdesvenlafaxine succinateYESYESNONONOYES40090 Day1128
Pristiq Tablet ERdesvenlafaxineYESYESNONONOYES40090 Day319.1
Procardia CapsulenifedipineYESYESNONONOYES40090 Day238.51
Procardia XL Tablet ERnifedipineYESYESNONONOYES40090 Day179.7
Quillichew ERmethylphenidateYESYESNONONOYES40090 Day1128
Quillivant XRmethylphenidateYESYESNONONOYES40090 Day311
Quillivant XR Suspension ERmethylphenidateYESYESNONONOYES40090 Day314
Rapamune SolutionsirolimusYESYESNONONOYES40090 Day1582.52
Rapamune TabletsirolimusYESYESNONONOYES40090 Day1582.54
Relpaxeletriptan hydrobromideYESYESNONONOYES40090 Day399
Relpax Tableteletriptan HBrYESYESNONONOYES40090 Day359.99
Revatio TabletsildenafilYESYESNONONOYES40090 Day4122.77
Skelaxin TabletmetaxaloneYESYESNONONOYES40090 Day879.75
Sutent Capsulesunitinib malateYESYESNONONOYES40090 Day16240.58
Synarel Spraynafarelin acetateYESYESNONONOYES40090 Day227.39
TikosyndofetilideYESYESNONONOYES40090 Day160
Tikosyn CapsuledofetilideYESYESNONONOYES40090 Day442
Toviaz Tablet ERfesoterodine fumarateYESYESNONONOYES40090 Day281.56
TrecatorethionamideYESYESNONONOYES40090 Day90
Trecator TabletethionamideYESYESNONONOYES40090 Day277.14
VFEND FilmtabvoriconazoleYESYESNONONOYES40090 Day1976.55
Viagrasildenafil citrateYESYESNONONOYES40090 Day90
Viagra Tabletsildenafil citrateYESYESNONONOYES40090 Day628.05
Xalatan Ophthalmic Drops0.005latanoprostYESYESNONONOYES40090 Day180.71
Xalkori CapsulecrizotinibYESYESNONONOYES40090 Day9600
XeljanztofacitinibYESYESNONONOYES40090 Day4284
ZarontinethosuximideYESYESNONONOYES40090 Day90
Zarontin CapsuleethosuximideYESYESNONONOYES40090 Day240
Zinecard InjectiondexrazoxaneYESYESNONONOYES40090 Day271.31
ZyvoxlinezolidYESYESNONONOYES40090 Day150
AdlyxinlixisenatideYESYESNO5NOYES25090 Day593.94
Apidrainsulin glulisine recombinantYESYESNO5NOYES25090 Day423.51
ClolarclofarabineYESYESNO5NOYES25090 Day1005
CarbatrolcarbamazepineDetermined case by caseYESNONONOYES30090 Day230
Fosrenollanthanum carbonateDetermined case by caseYESNONONOYES30090 Day1136
IntunivguanfacineDetermined case by caseYESNONONOYES30090 Day1022
LialdamesalamineDetermined case by caseYESNONONOYES30090 Day1181
PentasamesalamineDetermined case by caseYESNONONOYES30090 Day769
Vyvanselisdexamfetamine dimesylateDetermined case by caseYESNONONOYES30090 Day270
AmitizaLubiprostoneYESYESNO3NOYES30090 Day349.69
ColcryscolchicineYESYESNO3NOYES30090 Day234.84
DexilantdexlansoprazoleYESYESNO3NOYES30090 Day244.1
Kazanoalgoliptin/metformin hciYESYESNO3NOYES30090 Day431.48
NesinaalgoliptinYESYESNO3NOYES30090 Day431.48
Osenialgoliptin/pioglitazoneYESYESNO3NOYES30090 Day431.48
PrevacidlansoprazoleYESYESNO3NOYES30090 Day478.36
RozeremramelteonYESYESNO3NOYES30090 Day478.36
TrintellixvortioxetineYESYESNO3NOYES30090 Day346.4
UloricfebuxostatYESYESNO3NOYES30090 Day285.02
GabitriltiagabineYESNONONONOYES30090 Day270.56
NuvigilarmodafinilYESNONONONOYES30090 Day765.75
ORAPpimozideYESNONONONOYES30090 Day134.03
Proair HFAalbuterol sulfateYESNONONONOYES30090 Day56.3
Proair RespiclickalbuterolYESNONONONOYES30090 Day56.3
ProglycemdiazoxideYESNONONONOYES30090 Day305.26
QNASLbeclomethasone dipropionateYESNONONONOYES30090 Day222.23
QVARbeclomethasoneYESNONONONOYES30090 Day181.25
NeuprorotigotineYESYESNONONOYES30090 Day$858.30 
Keppra Oral SolutionlevetiracetamYESYESNONONOYES30090 Day562.6
Keppra TabletlevetiracetamYESYESNONONOYES30090 Day122.46
Keppra XR TabletlevetiracetamYESYESNONONOYES30090 Day122.46
VimpatLacosamideYESYESNONONOYES30090 Day858.3
GengrafcyclosporineYes if not listed in the formularyYESNONONOYES30090 Day 22
Humira ContaineradalimumabYes if not listed in the formularyYESNONONOYES30090 Day 4976.48
Descovyemtricitabine/tenofovir alafenamideYESYESNONONOYES45090 Day 1672
Genvoyaelvitegravir/cobicistat/emtricitabine/tenofovir alafenamideYESYESNONONOYES45090 Day 2933.58
EmtrivaemtricitabineYESYESNONONOYES45090 Day 554
Hepseraadefovir dipivoxilYESYESNONONOYES45090 Day 346.62
Alphagan Pbrimonidine tartrateNOYESYESNONOYES40090 Day 159.94
BystolicnebivololNOYESYESNONOYES40090 Day 139.35
Byvalsonnebivolol/valsartanNOYESYESNONOYES40090 Day 128.01
CriNOprogesterone vaginalNOYESYESNONOYES40090 Day 550
DalvancedalbavancinNOYESYESNONOYES40090 Day 3056
DelzicolmesalamineNOYESYESNONOYES40090 Day 660
FetzimalevomilnacipranNOYESYESNONOYES40090 Day 375.39
Fetzima Titration PacklevomilnacipranNOYESYESNONOYES40090 Day 375.39
Gelniqueoxybutynin chlorideNOYESYESNONOYES40090 Day 394.09
Combiganbrimonidine tartrate/timolol maleate)NOYESNONONOYES40090 Day
Aranespdarbepoetin alfaYESYESNONONOYES50090 Day 1270.16
EnbreletanerceptYESYESNONONOYES50090 Day 4976
Epogenepoetin alfaYESYESNONONOYES50090 Day 38.02
BlincytoblinatumomabYESYESNONONOYES50090 Day 178000
Bydureonexenatide syntheticNOYESNO3NOYES 25090 Day 664.09
Bydureon BCiseexenatideNOYESNO3NOYES 25090 Day 664.09
Bydureon Penexenatide syntheticNOYESNO3NOYES 25090 Day 664.09
ByettaexenatideNOYESNO3NOYES 25090 Day 732.05
CalquenceacalabrutinibNOYESNO3NOYES25090 Day 13974
DaliresproflumilastNOYESNO3NOYES 25090 Day 367
FarxigadapagliflozinNOYESNO3NOYES 25090 Day 469.84
FasenrabenralizumabNOYESNO3NOYES 25090 Day 2833
FaslodexfulvestrantNOYESNO3NOYES 25090 Day 1955
BrilintaticagrelorNOYESNO3NOYES 25090 Day 360
Alrexloteprednol etabonateNOYESNONONOYES40090 Day 225.48
AncobonflucytosineNOYESNONONOYES40090 Day
AndroidmethyltestosteroneNOYESNONONOYES40090 Day
AprisomesalamineNOYESNONONOYES40090 Day
Bepreve bepotastine besilateNOYESNONONOYES40090 Day
Besivance besifloxacinNOYESNONONOYES40090 Day
CaracfluorouracilNOYESNONONOYES40090 Day
ClindagelclindamycinNOYESNONONOYES40090 Day
CupriminepenicillamineNOYESNONONOYES40090 Day
CyclosetbromocriptineNOYESNONONOYES40090 Day
DemsermetyrosineNOYESNONONOYES40090 Day
ElidelpimecrolimusNOYESNONONOYES40090 Day
JubliaefinaconazoleNOYESNONONOYES40090 Day
Lacrisert hydroxypropyl celluloseNOYESNONONOYES40090 Day
Locoid hydrocortisone butyrateNOYESNONONOYES40090 Day
LodosyncarbidopaNOYESNONONOYES40090 Day
Lotemax loteprednol etabonateNOYESNONONOYES40090 Day
LuzululiconazoleNOYESNONONOYES40090 Day
Macugen pegaptanib sodiumNOYESNONONOYES40090 Day
MephytonphytonadioneNOYESNONONOYES40090 Day
MoviPrep sodium/ascorbic acidNOYESNONONOYES40090 Day
NoritatemetronidazoleNOYESNONONOYES40090 Day
Onexton clindamycin/benzoyl peroxideNOYESNONONOYES40090 Day
OxsoralenmethoxsalenNOYESNONONOYES40090 Day
Prolensa bromfenac sodiumNOYESNONONOYES40090 Day
Relistor methylnaltrexone bromideNOYESNONONOYES40090 Day
RenovatretinoinNOYESNONONOYES40090 Day
Retin-A MICRO tretinoinNOYESNONONOYES40090 Day
Retisert fluocinolone acetonideNOYESNONONOYES40090 Day
SolodynminocyclineNOYESNONONOYES40090 Day
SyprinetrientineNOYESNONONOYES40090 Day
TargretinbexaroteneNOYESNONONOYES40090 Day
TasmartolcaponeNOYESNONONOYES40090 Day
Timoptic in Ocudose ophthalmic solution/drops timolol maleateNOYESNONONOYES40090 Day
UcerisbudesonideNOYESNONONOYES40090 Day
VisudyneverteporfinNOYESNONONOYES40090 Day
Vyzulta latanoprostene bunodNOYESNONONOYES40090 Day
XifaxanrifaximinNOYESNONONOYES40090 Day
ZelaparselegilineNOYESNONONOYES40090 Day
ZirganganciclovirNOYESNONONOYES40090 Day
ZyclaraimiquimodNOYESNONONOYES40090 Day
Zylet loteprednol etabonate/tobramycinNOYESNONONOYES40090 Day
Atroventipratropium bromideYESYESNONONOYES40090 Day 376.04
AptivustipranavirNOYESNONONOYES40090 Day 409.45
Atrovent HFAipratropium bromideYESYESNONONOYES40090 Day 376.04
Combiventpratropium bromide/albuterolYESYESNONONOYES40090 Day
Combivent Respimatpratropium bromide/albuterolYESYESNONONOYES40090 Day
GilotrifafatinibYESYESNONONOYES40090 Day 8324.85
Synjardyempagliflozin/metforminYESYESNONONOYES40090 Day 250
TradjentalinagliptinYESYESNONONOYES40090 Day 250
DroxiahydroxyureaNOYESNONONOYES40090 Day 85
EliquisapixabanNOYESNO3NOYES40090 Day 440
EmplicitielotuzumabNOYESNONONOYES40090 Day 10000
EtopophosetoposideNOYESNONONOYES 40090 Day 145
Evotazatazanavir sulfate/cobicistatNOYESNO3NOYES40090 Day 1647
GranixTBO-filgrastimNONONONONONO40090 Day 859.33
BendekabendamustineNO NONONONONO40090 Day 50
ExalgohydromorphoneNOYESNONONOYES 20090 Day 217.62
BanzelrufinamideYes if not listed in the formularyYESNONONOYES30090 Day 1600
EquetrocarbamazepineNONONONONOYES20090 Day 252.48
LamictallamotrigineNOYESNONO600YES25090 Day
Lamictal CDlamotrigineNOYESNONO600YES25090 Day
Lamictal ODTlamotrigineNOYESNONO600YES25090 Day
Lamictal XRlamotrigineNOYESNONO600YES25090 Day
Arnuity Elliptafluticasone furoateNOYESNONO600YES25090 Day
Floventfluticasone propionateNOYESNONO600YES25090 Day 241.48
Havrixhepatitis A vaccine inactivatedNOYESNONO600YES25090 Day 74.28
Duacbenzoyl peroxide/clindamycinNOYESNONO600YES25090 Day 72.83
Engerix-Bhepatitis B vaccine recombinantNOYESNONO600YES25090 Day 61.98
Akynzeonetupitant/palonosetronYESYESNONONOYES40090 Day 2189.18
CinvantiaprepitantYESNONONONONO50090 Day 1286
Hymovishigh molecular weight viscoelastic hyaluronanNOYESNONONONO25090 Day 4559.31
EmvermmebendazoleYESYESNONONOYES30090 Day 1951
DarzalexdaratumumabYESYESNO4NOYES30090 Day 5850
ErleadaapalutamideYESYESNO4NOYES30090 Day 10852
HaldolhaloperidolYESYESNO4NOYES30090 Day 26
Haldol DecanoatehaloperidolYESYESNO4NOYES30090 Day 26
LipitorpitavastatinNOYESNONONOYES15090 Day
LivalopitavastatinNOYESNONONOYES15090 Day
DificidfidaxomicinYESYESNONONOYES40090 Day 3664
Duleraformoterol fumarate/mometasone furoateYESYESNONONOYES40090 Day 317
Eloconmometasone furoateYESYESNONONOYES40090 Day 28
EmendaprepitantYESYESNONONOYES40090 Day 41.38
AubagioteriflunomideNONONONONOYES25090 Day 6500
EMSAMselegilineNONONONONONO40090 Day 1692
EpiPenepinephrineNONONONONOYES40090 Day 141.22
EpiPen 2-PakepinephrineNONONONONOYES40090 Day 141.22
ArranonnelarabineYESNONONONOYES40090 Day
CyramzaramucirumabNONONONONOYES25090 Day 33066
AlimtapemetrexedNOYESNONONOYES25090 Day 697.04
AromasinexemestaneYESYESNONONOYES40090 Day
Caduetamlodipine besylate/atorvastatin calciumYESYESNONONOYES40090 Day 80
CamptosaririnotecanYESYESNONONOYES40090 Day 35
Caverject ImpulsealprostadilYESYESNONONOYES40090 Day 595
CelebrexcelecoxibYESYESNONONOYES40090 Day 201
CelontinmethsuximideYESYESNONONOYES40090 Day 127
Chantixvarenicline tartrateYESYESNONONOYES40090 Day 406
CleocinclindamycinYESYESNONONOYES40090 Day 85
Detroltolterodine tartrateYESYESNONONOYES40090 Day 50.48
Detrol LAtolterodine tartrateYESYESNONONOYES40090 Day 50.48
Dilantinphenytoin sodiumYESYESNONONOYES40090 Day 25.34
Duaveebazedoxifene acetate/conjugated estrogensYESYESNONONOYES40090 Day 158.77
Elelysotaliglucerase alfaYESYESNONONOYES40090 Day 782.54
EllenceepirubicinYESYESNONONOYES40090 Day 421
Emcytestramustine phosphate sodiumYESYESNONONOYES40090 Day 1841
EstringestradiolYESYESNONONOYES40090 Day 436
EucrisacrisaboroleYESYESNONONOYES40090 Day 636
FeldenepiroxicamYESYESNONONOYES40090 Day 32.5
Flector Patchdiclofenac epolamineYESYESNONONOYES40090 Day 672.31
FragmindalteparinYESYESNONONOYES40090 Day 4530
Genotropinsomatropin recombinantYESYESNONONOYES40090 Day 522.29
GlysetmiglitolYESYESNONONOYES40090 Day 67.3
HeparinsodiumYESYESNONONOYES40090 Day 53.15
IbranceNO PROGRAM AVAILABLEYESYESNONONOYES40090 Day 11966.61
Benefixfactor IXYes if not listed in the formularyYESNONONOYES40090 Day 2700
Arthrotecdiclofenac sodium/misoprostolYESYESNONONOYES40090 Day 55
Besponsainotuzumab ozogamicinYes if not listed in the formularyYESNONONOYES40090 Day 168300
Bosulifbosutinib monohydrateYes if not listed in the formularyYESNONONOYES40090 Day 14124
Adaceltetanus toxoid-reduced diptheria toxoid-acellular pertussisYESYESNO5NOYES25090 Day 49.32
ElitekrasburicaseYESYESNO5NOYES25090 Day 2601
FentorafentanylYESYESNONONOYES30090 Day 15052
Galzinzinc acetateYESYESNONONOYES30090 Day 255.01
BriviactbrivaracetamYESYESNONONOYES30090 Day 1071
EpivirlamivudineNOYESNONONOYES50090 Day 55.12
Epivir-HBVlamivudineNOYESNONONOYES50090 Day 55.12
Epzicomabacavir sulfate/lamivudineNOYESNONONOYES50090 Day 55.12
TrelstartriptorelinYESYESYESNONOYES40090 Days850
RestasiscyclosporineNOYESYESNONOYES40090 DAYS514.32
TagrissoosimertinibNONONONONOYES25090 Days14522
Trelegy Elliptafluticasone furoate/umeclidinium/vilanterolNOYESNONO600YES25090 Days266
Julucadolutegravir/rilpivirineContact ProgramYESNONONOYES50090 Days2569.5
EMSAM TransdermalselegilineNONONONONOYES20090 Dya493
AlbenzaalbendazoleYESYESNONONOYES300Amount Requested is sent 152.97
Strensiq disposal container container for strensiq sharps YESYESNONONOYES400Re-application
Nutropin AQ NuSpin Pen pen somatropin NOYESNONONOYES400Refill Process
Nutropin AQ Pen pen somatropin NOYESNONONOYES400Refill Process
Phoslyra oral solution calcium acetate YESUNKNOWNMay have insuranceYes, but contact program for detailsNot disclosedPatient's home400
Equetro capsule; extended release carbamazepine NOYESNONONOYES200
Kepivance palifermin YESYESNONONOYES400
Orfadin nitisinone YESYESNONONOYES400
Aldurazyme laronidase YESYESNONONOYES400
Cerezyme imiglucerase YESYESNONONOYES400
Lumizyme alglucosidase alfa YESYESNONONOYES400
Fabrazyme agalsidase beta YESYESNONONOYES400
Cystadane powder betaine anhydrous YESYESNONONOPatient's home400
Cholbam capsule cholic acid YESYESNONONOPatient's home400
Thiola tablet tiopronin YESYESNONONODoctor's office or patient's home400
HepaGam B immune globulin; intravenous YESYESNONONOYES200
Varizig immune globulin; human varicella zoster YESYESNONONOYES200
Lioresal injectable; intrathecal baclofen NOYESNONONOYES400
Analpram HC cream hydrocortisone/pramoxine YESYESNONONOYES150
Eligard injection leuprolide acetate YESYESNONONOYES500
Keveyis tablet dichlorphenamide YESYESNONONOYES400
Episil concentrated oral liquid wound dressing oral YESYESNONONODoctor's office or patient's home400
Alinia tablet nitazoxanide NOYESNONONOPatient's home, doctor's office, or the advocate's facility400
Arestin powder; extended release minocycline NONONONONOYES400
Trulance plecanatide YESYESNONONOYES400
Otrexup Container disposal container container for otrexup sharps YESYESNONONOYES400
Haegarda C1 esterase inhibitor YESYESNONONOYES400
Kristalose oral solution lactulose YESYESNONONOYES400
Berinert vial; single-use C1 esterase inhibitor YESYESNONONOYES400
Nityr nitisinone YESYESNONONOYES400
Boost Kid Essentials nutritional supplement NOYESNONONOYES250
Boost Kid Essentials 1.5 nutritional supplement NOYESNONONOYES250
Boost Kid Essentials 1.5 Fiber nutritional supplement NOYESNONONOYES250
Boost Original nutritional supplement NOYESNONONOYES250
Boost Plus nutritional supplement NOYESNONONOYES250
Boost VHC nutritional supplement NOYESNONONOYES250
Alfamino Infant medical food NOYESNONONOYES250
Alfamino Junior medical food NOYESNONONOYES250
Compleat medical food NOYESNONONOYES250
Compleat Pediatric medical food NOYESNONONOYES250
Compleat Pediatric Reduced Calorie medical food NOYESNONONOYES250
Diabetisource AC medical food NOYESNONONOYES250
Glytrol medical food NOYESNONONOYES250
Impact Peptide 1.5 medical food NOYESNONONOYES250
Nutren 1.0 Fiber medical food NOYESNONONOYES250
Nutren 1.5 medical food NOYESNONONOYES250
Nutren Junior medical food NOYESNONONOYES250
Nutren Junior Fiber medical food NOYESNONONOYES250
Peptamen medical food NOYESNONONOYES250
Peptamen 1.5 medical food NOYESNONONOYES250
Peptamen Junior medical food NOYESNONONOYES250
Peptamen Junior 1.5 medical food NOYESNONONOYES250
Peptamen Junior Fiber medical food NOYESNONONOYES250
Peptamen Junior PreBio medical food NOYESNONONOYES250
Peptamen PreBio medical food NOYESNONONOYES250
Tolerex medical food NOYESNONONOYES250
Vivonex Pediatric medical food NOYESNONONOYES250
Vivonex Plus medical food NOYESNONONOYES250
Vivonex RTF medical food NOYESNONONOYES250
Vivonex TEN medical food NOYESNONONOYES250
Pulmocare nutritional supplement YESYESNONONOYES400
Calcilo XD medical food YESYESNONONOYES400
Cyclinex medical food YESYESNONONOYES400
EleCare medical food YESYESNONONOYES400
EleCare Jr. medical food YESYESNONONOYES400
Ensure Original medical food YESYESNONONOYES400
Ensure Plus medical food YESYESNONONOYES400
Glucerna 1.2 medical food YESYESNONONOYES400
Glucerna Shake medical food YESYESNONONOYES400
Glutarex medical food YESYESNONONOYES400
Hi-Cal medical food YESYESNONONOYES400
Hominex medical food YESYESNONONOYES400
I-Valex medical food YESYESNONONOYES400
Jevity 1.2 Cal medical food YESYESNONONOYES400
Ketonex medical food YESYESNONONOYES400
Nepro with Carb Steady medical food YESYESNONONOYES400
Osmolite 1.2 cal medical food YESYESNONONOYES400
PediaSure medical food YESYESNONONOYES400
PediaSure 1.5 cal medical food YESYESNONONOYES400
PediaSure Enteral Formula w-Fiber medical food YESYESNONONOYES400
PediaSure Peptide medical food YESYESNONONOYES400
Perative medical food YESYESNONONOYES400
Phenex medical food YESYESNONONOYES400
Promote medical food YESYESNONONOYES400
Promote with Fiber medical food YESYESNONONOYES400
Propimex medical food YESYESNONONOYES400
ProViMin medical food YESYESNONONOYES400
Suplena medical food YESYESNONONOYES400
TwoCal medical food YESYESNONONOYES400
Tyrex medical food YESYESNONONOYES400
Vital AF 1.2 cal medical food YESYESNONONOYES400
Vital High Protein medical food YESYESNONONOYES400
Pivot 1.5 cal medical drink YESYESNONONOYES400
Uptravi selexipag YESYESNONONOYES400
Opsumit tablet macitentan YESYESNONONOYES400
Ventavis solution; inhalation iloprost YESYESNONONOYES400
Veletri injection epoprostenol sodium YESYESNONONOYES400
Tracleer tablet bosentan YESYESNONONOYES400
Gocovri capsule; extended release amantadine YESYESNONONOYES400
Kanuma sebelipase alfa YESYESNONONOYES400
Soliris injectable; iv eculizumab YESYESNONONOYES400
Strensiq injection asfotase alfa YESYESNONONOYES400
Iluvien implant fluocinolone acetonide YESYESNONONOYES400
Adempas riociguat NOYESNONONOYES400
Aliqopa copanlisib NOYESNONONOYES400
Kogenate FS antihemophilic factor recombinant NOYESNONONOYES400
Kovaltry antihemophilic factor NOYESNONONOYES400
Provenge autologous cellular immunotherapy sipuleucel-T YESYESNONONOYES400
Halaven eribulin YESUNKNOWN*See Additional Information section belowNot specifiedDetermined case by caseNot specified400
Truvada emtricitabine/tenofovir disoproxil fumarate YESYESNONONOYES400
Descovy emtricitabine/tenofovir alafenamide YESYESNONONOYES400
Complera emtricitabine/rilpivirine/tenofovir disoproxil fumarate YESYESNONONOYES400
Odefsey emtricitabine/rilpivirine/tenofovir alafenamide YESYESNONONOYES400
Emtriva emtricitabine YESYESNONONOYES400
Stribild elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate YESYESNONONOYES400
Genvoya elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide YESYESNONONOYES400
Atripla efavirenz/emtricitabine/tenofovir disoproxil fumarate YESYESNONONOYES400
Tybost cobicistat YESYESNONONOYES400
Biktarvy bictegravir/emtricitabine/tenofovir alafenamide YESYESNONONOYES400
Revatio sildenafil citrate NONONONONOYES400
Ibrance palbociclib NONONONONOYES400
Lonsurf trifluridine and tipiracil YESNONONONOYES400
Orenitram treprostinil diolamine YESNONONONOYES400
Remodulin treprostinil YESNONONONOYES400
Mekinist trametinib dimethyl sulfoxide YESNONONONOYES400
Fareston toremifene citrate YESNONONONOYES400
Thalomid thalidomide YESNONONONOYES400
Aubagio teriflunomide YESNONONONOYES400
Viread tenofovir disoproxil fumarate YESNONONONOYES400
Adcirca tadalafil YESNONONONOYES400
Zanosar streptozocin YESNONONONOYES400
Serostim somatropin YESNONONONOYES400
Zorbtive somatropin YESNONONONOYES400
Pomalyst pomalidomide YESNONONONOYES400
Vectibix panitumumab YESNONONONOYES400
Eloxatin oxaliplatin YESNONONONOYES400
Synribo omacetaxine mepesuccinate YESNONONONOYES400
Opdivo nivolumab YESNONONONOYES400
Korlym mifepristone YESNONONONOYES400
Purinethol mercaptopurine YESNONONONOYES400
Revlimid lenalidomide YESNONONONOYES400
Ixempra ixabepilone YESNONONONOYES400
Isordil isosorbide dinitrate YESNONONONOYES400
Yervoy ipilimumab YESNONONONOYES400
Actimmune interferon gamma-1b YESNONONONOYES400
Avonex interferon beta-1a YESNONONONOYES400
Infergen interferon alfacon-1 YESNONONONOYES400
Intron A interferon alfa-2b YESNONONONOYES400
Droxia hydroxyurea YESNONONONOYES400
Glatopa glatiramer acetate YESNONONONOYES400
Gilenya fingolimod YESNONONONOYES400
Afinitor everolimus YESNONONONOYES400
Flolan epoprostenol sodium YESNONONONOYES400
Empliciti elotuzumab YESNONONONOYES400
Firmagon degarelix acetate YESNONONONOYES400
Desferal deferoxamine YESNONONONOYES400
Ferriprox deferiprone YESNONONONOYES400
Darzalex daratumumab YESNONONONOYES400
Tafinlar dabrafenib YESNONONONOYES400
Clolar clofarabine YESNONONONOYES400
Zykadia ceritinib YESNONONONOYES400
Blincyto blinatumomab YESNONONONOYES400
Vidaza azacitidine YESNONONONOYES400
Agrylin anagrelide YESNONONONOYES400
Lemtrada alemtuzumab YESNONONONOYES400
Gilotrif afatinib YESNONONONOYES400
Ninlaro ixazomib YESNONONONOYES400
Hydrea hydroxyurea YESNONONONOYES400
Dacogen decitabine YESNONONONOYES400
Xeloda capecitabine YESNONONONOYES400
Alunbrig brigatinib YESNONONONOYES400
Arimidex anastrozole YESNONONONOYES400
Flebogamma DIF immune globulin; iv YESYESNONONOYES400
Actonel risedronate sodium YESYESNONONOYES400
Nucala mepolizumab YESYESNONONOYES400
Xopenex levalbuterol YESYESNONONOYES400
Femara letrozole YESYESNONONOYES400
Somatuline Depot lanreotide acetate YESYESNONONOYES400
Colcrys colchicine YESYESNONONOYES400
Imuran azathioprine YESYESNONONOYES400
Hexalen altretamine YESYESNONONOYES400
Fosamax alendronate sodium YESYESNONONOYES400
DuoNeb albuterol sulfate/ipratropium bromide YESYESNONONOYES400
Hycamtin topotecan YESYESNONONOYES400
Mozobil plerixafor YESYESNONONOYES400
Sylatron peginterferon alfa-2b YESYESNONONOYES400
Votrient pazopanib YESYESNONONOYES400
Signifor LAR pasireotide YESYESNONONOYES400
Creon pancrelipase YESYESNONONOYES400
Pancreaze pancrelipase YESYESNONONOYES400
Pertzye pancrelipase YESYESNONONOYES400
Arzerra ofatumumab YESYESNONONOYES400
Sandostatin LAR octreotide acetate YESYESNONONOYES400
Zejula niraparib YESYESNONONOYES400
Ofev nintedanib esylate YESYESNONONOYES400
Arranon nelarabine YESYESNONONOYES400
Gammagard immune globulin YESYESNONONOYES400
Zydelig idelalisib YESYESNONONOYES400
Imbruvica ibrutinib YESYESNONONOYES400
Haldol haloperidol YESYESNONONOYES400
Etopophos etoposide YESYESNONONOYES400
Procrit epoetin alfa YESYESNONONOYES400
Promacta eltrombopag YESYESNONONOYES400
Doxil doxorubicin YESYESNONONOYES400
Neoral cyclosporine YESYESNONONOYES400
Sandimmune cyclosporine YESYESNONONOYES400
Ilaris canakinumab YESYESNONONOYES400
Rayaldee calcifediol YESYESNONONOYES400
Proventil HFA albuterol sulfate YESYESNONONOYES400
Ventolin HFA albuterol YESYESNONONOYES400
Reclast zoledronic acid YESYESNONONOYES400
Evista raloxifene NOYESNONONOYES400
Akynzeo netupitant/palonosetron YESYESNONONOYES400
Sustol granisetron YESYESNONONOYES400
Cinvanti aprepitant YESYESNONONOYES400
Jakafi tablet ruxolitinib YESYESNONONOYES400
Onivyde injection irinotecan liposome YESYESNONONOYES400
Sabril oral solution vigabatrin YESYESNONONOYES400
Galzin zinc acetate YESNONONONOYES400
Zyflo zileuton YESNONONONOYES400
AlloDerm wound matrix YESNONONONOYES400
AlloSkin wound matrix YESNONONONOYES400
AlloWrap wound matrix YESNONONONOYES400
ArthroFlex wound matrix YESNONONONOYES400
BioDFence wound matrix YESNONONONOYES400
Cymetra wound matrix YESNONONONOYES400
Helicoll wound matrix YESNONONONOYES400
Integra wound matrix YESNONONONOYES400
Integra Flowable wound matrix YESNONONONOYES400
Oasis wound matrix YESNONONONOYES400
Promogran wound matrix YESNONONONOYES400
Talymed wound matrix YESNONONONOYES400
TheraSkin wound matrix YESNONONONOYES400
Unite Biomatrix wound matrix YESNONONONOYES400
Fortaderm wound dressing YESNONONONOYES400
Wilate von willebrand factor/coagulation factor Vlll complex YESNONONONOYES400
Ocuvite Lutien vitamin/mineral supplement YESNONONONOYES400
AquaSol A vitamin A supplement YESNONONONOYES400
Marqibo vincristine YESNONONONOYES400
Verelan verapamil YESNONONONOYES400
Entyvio vedolizumab YESNONONONOYES400
Trelstar triptorelin YESNONONONOYES400
Syprine trientine YESNONONONOYES400
Trianex triamcinolone acetonide YESNONONONOYES400
Triderm triamcinolone acetonide YESNONONONOYES400
Cyklokapron tranexamic acid YESNONONONOYES400
Demadex torsemide YESNONONONOYES400
Tasmar tolcapone YESNONONONOYES400
Tobradex tobramycin/dexamethasone YESNONONONOYES400
DermaCell tissue; human allograft YESNONONONOYES400
Kymriah tisagenlecleucel YESNONONONOYES400
Thyrogen thyrotropin alfa YESNONONONOYES400
Elixophyllin theophylline YESNONONONOYES400
Theo-24 theophylline YESNONONONOYES400
Theochron theophylline YESNONONONOYES400
Gattex teduglutide YESNONONONOYES400
Tazorac tazarotene YESNONONONOYES400
Astagraf XL tacrolimus YESNONONONOYES400
Envarsus XR tacrolimus YESNONONONOYES400
Hecoria tacrolimus YESNONONONOYES400
Protopic tacrolimus YESNONONONOYES400
Azulfidine sulfasalazine YESNONONONOYES400
Blephamide S.O.P. sulfacetamide sodium/prednisolone acetate YESNONONONOYES400
Velphoro sucroferric oxyhydroxide YESNONONONOYES400
Chemet succimer YESNONONONOYES400
Zerit stavudine YESNONONONOYES400
Aldactazide spironolactone/hydrochlorothiazide YESNONONONOYES400
Carospir spironolactone YESNONONONOYES400
Sotylize sotalol YESNONONONOYES400
Odomzo sonidegib YESNONONONOYES400
Kayexalate sodium polystyrene sulfonate YESNONONONOYES400
Sps sodium polystyrene sulfonate YESNONONONOYES400
Renagel sevelamer YESNONONONOYES400
Eldepryl selegiline YESNONONONOYES400
Zelapar selegiline YESNONONONOYES400
Serevent salmeterol xinafoate YESNONONONOYES400
Scalacort salicylic acid/sulfur/hydrocortisone YESNONONONOYES400
Xadago safinamide YESNONONONOYES400
Istodax romidepsin YESNONONONOYES400
Varubi rolapitant YESNONONONOYES400
Vexol rimexolone YESNONONONOYES400
Xifaxan rifaximin YESNONONONOYES400
Ribatab ribavirin YESNONONONOYES400
Cinqair reslizumab YESNONONONOYES400
Hemangeol propranolol YESNONONONOYES400
Inderal LA propranolol YESNONONONOYES400
InnoPran XL propranolol YESNONONONOYES400
Phenergan promethazine YESNONONONOYES400
Promethegan promethazine YESNONONONOYES400
Compazine prochlorperazine YESNONONONOYES400
Compro prochlorperazine YESNONONONOYES400
Veripred prednisolone sodium phosphate YESNONONONOYES400
Flo-Pred prednisolone acetate YESNONONONOYES400
Omnipred prednisolone acetate YESNONONONOYES400
Pred Mild prednisolone acetate YESNONONONOYES400
Prelone prednisolone YESNONONONOYES400
Dermatop prednicarbate YESNONONONOYES400
Grafix CORE placental membrane allograft YESNONONONOYES400
Grafix PRIME placental membrane allograft YESNONONONOYES400
Livalo pitavastatin YESNONONONOYES400
Elidel pimecrolimus YESNONONONOYES400
Nuplazid pimavanserin YESNONONONOYES400
Mephyton phytonadione YESNONONONOYES400
Aceon perindopril erbumine YESNONONONOYES400
Cuprimine penicillamine YESNONONONOYES400
Depen penicillamine YESNONONONOYES400
Oncaspar pegaspargase YESNONONONOYES400
Aloxi palonosetron YESNONONONOYES400
Daypro oxaprozin YESNONONONOYES400
Zuplenz ondansetron YESNONONONOYES400
Dipentum olsalazine sodium YESNONONONOYES400
Adalat CC nifedipine YESNONONONOYES400
Simcor niacin-simvastatin YESNONONONOYES400
Niacor niacin YESNONONONOYES400
Viramune nevirapine YESNONONONOYES400
Nerlynx neratinib maleate YESNONONONOYES400
Neosporin neomycin sulfate/polymyxin B sulfate YESNONONONOYES400
Bystolic nebivolol YESNONONONOYES400
Aleve naproxen sodium YESNONONONOYES400
Anaprox naproxen sodium YESNONONONOYES400
Naprelan naproxen sodium YESNONONONOYES400
Corzide nadolol/bendroflumethiazide YESNONONONOYES400
Corgard nadolol YESNONONONOYES400
Asmanex mometasone YESNONONONOYES400
Univasc moexipril YESNONONONOYES400
Lysodren mitotane YESNONONONOYES400
Kynamro mipomersen sodium YESNONONONOYES400
Zavesca miglustat YESNONONONOYES400
Mifeprex mifepristone YESNONONONOYES400
Demser metyrosine YESNONONONOYES400
Metopirone metyrapone YESNONONONOYES400
Lopressor HCT metoprolol tartrate/hydrochlorothiazide YESNONONONOYES400
Metozolv tablet; orally disintegrating metoclopramide YESNONONONOYES400
A-Methapred methylprednisolone sodium succinate YESNONONONOYES400
8-MOP methoxsalen YESNONONONOYES400
Oxsoralen methoxsalen YESNONONONOYES400
Apriso mesalamine YESNONONONOYES400
Asacol HD mesalamine YESNONONONOYES400
Canasa mesalamine YESNONONONOYES400
Delzicol mesalamine YESNONONONOYES400
Lialda mesalamine YESNONONONOYES400
Pentasa mesalamine YESNONONONOYES400
Rowasa mesalamine YESNONONONOYES400
Sfrowasa mesalamine YESNONONONOYES400
Namzaric memantine-donepezil YESNONONONOYES400
Replesta medical food YESNONONONOYES400
DermaPure matrix; tissue wound YESNONONONOYES400
Graftjacket matrix; regenerative tissue YESNONONONOYES400
MatriStem Burn Matrix matrix; lyophilized extracellular YESNONONONOYES400
MatriStem MicroMatrix matrix; lyophilized extracellular YESNONONONOYES400
DermaVest matrix; human placental tissue YESNONONONOYES400
PuraPly matrix-wound YESNONONONOYES400
Advicor lovastatin niacin YESNONONONOYES400
Altoprev lovastatin YESNONONONOYES400
Mevacor lovastatin YESNONONONOYES400
Juxtapid lomitapide YESNONONONOYES400
Qbrelis lisinopril YESNONONONOYES400
Levo-T levothyroxine sodium YESNONONONOYES400
Tirosint levothyroxine YESNONONONOYES400
Unithroid levothyroxine YESNONONONOYES400
Fusilev levoleucovorin calcium YESNONONONOYES400
Trandate labetalol YESNONONONOYES400
Corlanor ivabradine YESNONONONOYES400
Absorica isotretinoin YESNONONONOYES400
Amnesteem isotretinoin YESNONONONOYES400
Claravis isotretinoin YESNONONONOYES400
Myorisan isotretinoin YESNONONONOYES400
Zenatane isotretinoin YESNONONONOYES400
BiDil isosorbide dinitrate/hydralazine YESNONONONOYES400
Dilatrate SR isosorbide dinitrate YESNONONONOYES400
Renflexis infliximab-ABDA YESNONONONOYES400
Tivorbex indomethacin YESNONONONOYES400
Atgam immune globulin; lymphocyte YESNONONONOYES400
Bivigam immune globulin; intravenous YESNONONONOYES400
Carimune NF immune globulin; intravenous YESNONONONOYES400
Gammaked immune globulin; intravenous YESNONONONOYES400
Aldara imiquimod YESNONONONOYES400
Corvert ibutilide fumarate YESNONONONOYES400
Texacort hydrocortizone YESNONONONOYES400
Cortisporin hydrocortisone/neomycin/polymyxin b sulfate YESNONONONOYES400
Westcort hydrocortisone valerate YESNONONONOYES400
A-Hydrocort hydrocortisone sodium succinate YESNONONONOYES400
Pandel hydrocortisone probutate YESNONONONOYES400
U-Cort hydrocortisone acetate/urea YESNONONONOYES400
MiCort HC hydrocortisone acetate YESNONONONOYES400
Nucort hydrocortisone acetate YESNONONONOYES400
Pediaderm HC hydrocortisone YESNONONONOYES400
GammaGraft human skin allograft YESNONONONOYES400
ClarixFlo human amniotic membrane YESNONONONOYES400
Vantas histrelin YESNONONONOYES400
Halog halcinonide YESNONONONOYES400
Granisol granisetron YESNONONONOYES400
Sancuso granisetron YESNONONONOYES400
Zoladex goserelin acetate YESNONONONOYES400
Nutrestore glutamine YESNONONONOYES400
Pred-G gentamicin sulfate/prednisolone acetate YESNONONONOYES400
Foradil formoterol fumarate YESNONONONOYES400
Perforomist formoterol fumarate YESNONONONOYES400
Lescol fluvastatin YESNONONONOYES400
Cutivate fluticasone propionate YESNONONONOYES400
Cordran flurandrenolide YESNONONONOYES400
Androxy fluoxymesterone YESNONONONOYES400
Flarex fluorometholone acetate YESNONONONOYES400
FML fluorometholone YESNONONONOYES400
Vanos fluocinonide YESNONONONOYES400
Derma-Smoothe fluocinolone acetonisde YESNONONONOYES400
Neo-Synalar fluocinolone acetonide/neomycin sulfate YESNONONONOYES400
Tri-Luma fluocinolone acetonide/hydroquinone/tretinoin YESNONONONOYES400
Capex fluocinolone acetonide YESNONONONOYES400
Synalar fluocinolone acetonide YESNONONONOYES400
Tambocor flecainide YESNONONONOYES400
Auryxia ferric citrate YESNONONONOYES400
Nalfon fenoprofen calcium YESNONONONOYES400
Fenoglide fenofibric acid YESNONONONOYES400
Antara fenofibrate YESNONONONOYES400
Lipofen fenofibrate YESNONONONOYES400
TUMS Products famotidine/calcium carbonate/magnesium hydroxide YESNONONONOYES400
Advate factor VIII YESNONONONOYES400
Mononine factor IX YESNONONONOYES400
Liptruzet ezetimibe/atorvastatin YESNONONONOYES400
Amidate etomidate YESNONONONOYES400
Lodine etodolac YESNONONONOYES400
Enbrel etanercept YESNONONONOYES400
Divigel estradiol YESNONONONOYES400
Elestrin estradiol YESNONONONOYES400
Estrasorb estradiol YESNONONONOYES400
Evamist estradiol YESNONONONOYES400
Minivelle estradiol YESNONONONOYES400
Brevibloc esmolol YESNONONONOYES400
Teveten HCT eprosartan/hydrochlorothiazide YESNONONONOYES400
Teveten eprosartan YESNONONONOYES400
Comtan entacapone YESNONONONOYES400
Epaned enalapril maleate YESNONONONOYES400
Vitekta elvitegravir YESNONONONOYES400
Cerdelga eliglustat tartrate YESNONONONOYES400
Lufyllin dyphylline YESNONONONOYES400
Dupixent dupilumab YESNONONONOYES400
Anzemet dolasetron YESNONONONOYES400
Diphen diphenhydramine YESNONONONOYES400
Silphen diphenhydramine YESNONONONOYES400
Cardizem LA diltiazem YESNONONONOYES400
Cartia XT diltiazem YESNONONONOYES400
Dilt-CD diltiazem YESNONONONOYES400
Diltzac diltiazem YESNONONONOYES400
Matzim diltiazem YESNONONONOYES400
Taztia diltiazem YESNONONONOYES400
Tiazac diltiazem YESNONONONOYES400
Psorcon diflorasone diacetate YESNONONONOYES400
ApexiCon E diflorasone YESNONONONOYES400
Videx didanosine YESNONONONOYES400
Zipsor diclofenac potassium YESNONONONOYES400
Cambia diclofenac YESNONONONOYES400
Cataflam diclofenac YESNONONONOYES400
Zorvolex diclofenac YESNONONONOYES400
Proglycem diazoxide YESNONONONOYES400
Maxitrol dexamethasone/neomycin/polymyxin B YESNONONONOYES400
Topicort desoximetasone YESNONONONOYES400
Desonate desonide YESNONONONOYES400
DesOwen desonide YESNONONONOYES400
Tridesilon desonide YESNONONONOYES400
Verdeso desonide YESNONONONOYES400
Stimate desmopressin acetate YESNONONONOYES400
Dermagraft dermal substitute YESNONONONOYES400
EZ Derm dermal substitute YESNONONONOYES400
Restasis Multidose cyclosporine YESNONONONOYES400
Cyclogyl cyclopentolate YESNONONONOYES400
Acthrel corticoreline ovine triflutate YESNONONONOYES400
Enjuvia conjugated synthetic b estrogens YESNONONONOYES400
Cenestin conjugated synthetic A estrogens YESNONONONOYES400
Santyl collagenase YESNONONONOYES400
Mitigare colchicine YESNONONONOYES400
Alprolix coagulation factor IX YESNONONONOYES400
Idelvion coagulation factor IX YESNONONONOYES400
Cloderm clocortolone pivalate YESNONONONOYES400
Clobex clobetasol propionate YESNONONONOYES400
Clodan clobetasol propionate YESNONONONOYES400
Cormax clobetasol propionate YESNONONONOYES400
Temovate clobetasol propionate YESNONONONOYES400
Alvesco ciclesonide YESNONONONOYES400
Questran cholestyramine YESNONONONOYES400
Diuril chlorothiazide YESNONONONOYES400
Duopa carbidopa/levodopa YESNONONONOYES400
Lodosyn carbidopa YESNONONONOYES400
Eliphos calcium acetate YESNONONONOYES400
Phoslyra calcium acetate YESNONONONOYES400
Taclonex calcipotriene hydrate/betamethasone dipropionate YESNONONONOYES400
Calcitrene calcipotriene YESNONONONOYES400
Dovonex calcipotriene YESNONONONOYES400
Sorilux calcipotriene YESNONONONOYES400
Busulfex busulfan YESNONONONOYES400
Myleran busulfan YESNONONONOYES400
Pulmicort budesonide YESNONONONOYES400
Uceris budesonide YESNONONONOYES400
Parlodel bromocriptine YESNONONONOYES400
Siliq brodalumab YESNONONONOYES400
Excellagen bovine collagen YESNONONONOYES400
Zebeta bisoprolol fumarate YESNONONONOYES400
Apligraf bilayered skin substitute YESNONONONOYES400
Luxiq betamethasone valerate YESNONONONOYES400
Enstilar betamethasone dipropionate and calcipotriol YESNONONONOYES400
Sernivo betamethasone dipropionate YESNONONONOYES400
Cogentin benztropine YESNONONONOYES400
Beleodaq belinostat YESNONONONOYES400
Benlysta belimumab YESNONONONOYES400
QVAR beclomethasone dipropionate YESNONONONOYES400
Regranex becaplermin YESNONONONOYES400
TheraCys BCG YESNONONONOYES400
TICE BCG BCG YESNONONONOYES400
Giazo balsalazide disodium YESNONONONOYES400
Gablofen baclofen YESNONONONOYES400
Lioresal baclofen YESNONONONOYES400
Edarbi azilsartan medoxomil YESNONONONOYES400
Edarbyclor azilsartan kamedoxomil/chlorthalidone YESNONONONOYES400
Isopto Atropine atropine sulfate YESNONONONOYES400
Evotaz atazanavir sulfate/cobicistat YESNONONONOYES400
Erwinaze asparaginase erwinia chrysanthemi YESNONONONOYES400
Otezla apremilast YESNONONONOYES400
Apokyn apomorphine YESNONONONOYES400
Humate-P antihemophilic factor-von Willebrand factor complex human YESNONONONOYES400
Xyntha Solofuse antihemophilic factor recombinant YESNONONONOYES400
Afstyla antihemophilic factor YESNONONONOYES400
Helixate FS vial antihemophilic factor YESNONONONOYES400
Eloctate antihemophilic factor YESNONONONOYES400
Adynovate antihemophilic factor YESNONONONOYES400
Koate DVI injection antihemophilic factor YESNONONONOYES400
Monoclate-P vial; single-use antihemophilic factor YESNONONONOYES400
Zithranol-RR anthralin YESNONONONOYES400
BioVance amniotic membrane allograft YESNONONONOYES400
EpiFix amiotic membrane allograft YESNONONONOYES400
Cordarone amiodarone YESNONONONOYES400
Nexterone amiodarone YESNONONONOYES400
Amicar aminocaproic acid YESNONONONOYES400
Niravam alprazolam YESNONONONOYES400
Campath alemtuzumab YESNONONONOYES400
Xerese acyclovir hydrocortisone YESNONONONOYES400
Sectral acebutolol YESNONONONOYES400
Verzenio abemaciclib YESNONONONOYES400
Taltz ixekizumab NONONONOYES400
Bosulif bosutinib monohydrate YESNONONONOYES400
Elelyso taliglucerase alfa YESNONONONOYES400
Besponsa inotuzumab ozogamicin YESNONONONOYES400
Eucrisa crisaborole YESNONONONOYES400
Premarin conjugated estrogens NONONONONOYES400
Rapamune sirolimus NONONONONOYES400
Feldene piroxicam NONONONONOYES400
Menest estrogens/esterified NONONONONOYES400
Depo-Estradiol estradiol cypionate NONONONONOYES400
Inspra eplerenone NONONONONOYES400
Tikosyn dofetilide NONONONONOYES400
Norpace CR disopyramide NONONONONOYES400
Arthrotec diclofenac sodium/misoprostol NONONONONOYES400
Duavee bazedoxifene acetate/conjugated estrogens NONONONONOYES400
Caduet amlodipine besylate/atorvastatin calcium NONONONONOYES400
Inflectra infliximab-dyyb NONONONONOYES400
Benefix factor IX NONONONONOYES400
Zyprexa Zydis olanzapine NONONONONOYES400
Orenitram tablet; extended release treprostinil diolamine YESYESNONONOYES400
Remodulin injection treprostinil YESYESNONONOYES400
Adcirca tablet tadalafil YESYESNONONOYES400
Livalo tablet pitavastatin NOYESNONONOYES150
Myalept injection metreleptin YESYESNONONOYES400
Primlev tablet oxycodone and acetaminophen NOYESNONONOYES400
Nuedexta dextromethorpan hydrobromide/quinidine YESUNKNOWNNONONOYES400
Nexavar sorafenib NOYESNONONOYES400
Menostar estradiol NOYESNONONOYES400
Thalomid capsule thalidomide YESYESNONONOYES400
Pomalyst capsule pomalidomide YESYESNONONOYES400
Abraxane paclitaxel YESYESNONONOYES400
Revlimid capsule lenalidomide YESYESNONONOYES400
Idhifa enasidenib YESYESNONONOYES400
Vidaza injectable; subcutaneous azacitidine YESYESNONONOYES400
Bethkis solution; inhalation tobramycin YESYESNONONOYES400
Pertzye capsule; delayed release pancrelipase YESYESNONONOYES400
Xiaflex collagenase clostridium histolyticum YESUNKNOWNMay have insuranceYesVaries400
Cabometyx cabozantinib s-malate YESUNKNOWNMay have insuranceMust be uninsured or underinsuredNoAmount requested is sent400
Tecentriq atezolizumab YESYESNONONOYES400
Cellcept mycophenolate mofetil YESYESNONONOYES400
Zydelig tablet idelalisib YESYESNONONOYES400
Visudyne verteporfin YESNONONONOYES400
Soltamox tamoxifen citrate YESNONONONOYES400
Epclusa sofosbuvir/velpatasvir YESNONONONOYES400
Sovaldi sofosbuvir YESNONONONOYES400
Buphenyl sodium phenylbutyrate YESNONONONOYES400
Olysio simeprevir sodium YESNONONONOYES400
Moderiba ribavirin YESNONONONOYES400
Rebetol ribavirin YESNONONONOYES400
Ribasphere ribavirin YESNONONONOYES400
Cyramza ramucirumab YESNONONONOYES400
Matulane procarbazine YESNONONONOYES400
Alimta pemetrexed YESNONONONOYES400
Keytruda pembrolizumab YESNONONONOYES400
Plegridy peginterferon beta-1a YESNONONONOYES400
PegIntron peginterferon alfa-2b YESNONONONOYES400
Pegasys peginterferon alfa-2a YESNONONONOYES400
Macugen pegaptanib sodium YESNONONONOYES400
Taxol paclitaxel YESNONONONOYES400
Viekira Pak ombitasvir/paritaprevir/ritonavir and dasabuvir YESNONONONOYES400
Portrazza necitumumab YESNONONONOYES400
Tysabri natalizumab YESNONONONOYES400
Harvoni ledipasvir/sofosbuvir YESNONONONOYES400
Rebif interferon beta-1a YESNONONONOYES400
Roferon-A interferon alfa-2a YESNONONONOYES400
Ravicti glycerol phenylbutyrate YESNONONONOYES400
Copaxone glatiramer acetate YESNONONONOYES400
Gemzar gemcitabine YESNONONONOYES400
Zepatier elbasvir/grazoprevir YESNONONONOYES400
Adriamycin doxorubicin YESNONONONOYES400
Docefrez docetaxel YESNONONONOYES400
Taxotere docetaxel YESNONONONOYES400
Tecfidera dimethyl fumarate YESNONONONOYES400
Ozurdex dexamethasone YESNONONONOYES400
Daklinza daclatasvir YESNONONONOYES400
DTIC-Dome dacarbazine YESNONONONOYES400
Cytoxan cyclophosphamide YESNONONONOYES400
Erbitux cetuximab YESNONONONOYES400
Kyprolis carfilzomib YESNONONONOYES400
Cometriq cabozantinib s-malate YESNONONONOYES400
Adcetris brentuximab vedotin YESNONONONOYES400
Velcade bortezomib YESNONONONOYES400
Victrelis boceprevir YESNONONONOYES400
Proleukin aldesleukin YESNONONONOYES400
Navelbine vinorelbine tartrate YESNONONONOYES400
Sutent sunitinib malate YESNONONONOYES400
Camptosar irinotecan YESNONONONOYES400
Aromasin exemestane YESNONONONOYES400
Xalkori crizotinib YESNONONONOYES400
Gamunex-C immune globulin; intravenous YESYESNONONOYES400
Forteo teriparatide YESYESNONONOYES400
Torisel temsirolimus YESYESNONONOYES400
Somavert pegvisomant YESYESNONONOYES400
Idamycin PFS idarubicin YESYESNONONOYES400
Mylotarg gemtuzumab ozogamicin YESYESNONONOYES400
Ellence epirubicin YESYESNONONOYES400
Premarin cream; vaginal conjugated estrogens YESYESNONONOYES400
Inlyta axitinib YESYESNONONOYES400
Ingrezza valbenazine YESYESNONONOYES400
Kenalog triamcinolone acetonide YESYESNONONOYES400
Triesence triamcinolone acetonide YESYESNONONOYES400
Aristocort triamcinolone YESYESNONONOYES400
Pediaderm TA triamcinolone YESYESNONONOYES400
Kitabis Pak tobramycin YESYESNONONOYES400
Tobi tobramycin YESYESNONONOYES400
Tobi Podhaler tobramycin YESYESNONONOYES400
Gabitril tiagabine YESYESNONONOYES400
Granix TBO-filgrastim YESYESNONONOYES400
Nolvadex tamoxifen citrate YESYESNONONOYES400
Imlygic talimogene laherparepvec YESYESNONONOYES400
Metastron strontium chloride SR-89 YESYESNONONOYES400
Vosevi sofosbuvir/velpatasvir/voxilaprevir YESYESNONONOYES400
NebuSal sodium chloride YESYESNONONOYES400
PulmoSal sodium chloride YESYESNONONOYES400
Ammonul sodium benzoate/sodium phenylacetate YESYESNONONOYES400
Leukine sargramostim YESYESNONONOYES400
Quadramet samarium sm-153 lexidronam pentasodium YESYESNONONOYES400
Sucraid sacrosidase YESYESNONONOYES400
Nplate romiplostim YESYESNONONOYES400
Atelvia risedronate sodium YESYESNONONOYES400
Flumadine rimantadine YESYESNONONOYES400
Copegus ribavirin YESYESNONONOYES400
Virazole ribavirin YESYESNONONOYES400
H.P. Acthar Gel repository corticotropin YESYESNONONOYES400
Deltasone prednisone YESYESNONONOYES400
Rayos prednisone YESYESNONONOYES400
Millipred prednisolone sodium phosphate YESYESNONONOYES400
Econopred prednisolone acetate YESYESNONONOYES400
Orapred prednisolone YESYESNONONOYES400
Pediapred prednisolone YESYESNONONOYES400
Folotyn pralatrexate YESYESNONONOYES400
Potaba potassium p-aminobenzoate YESYESNONONOYES400
Photofrin porfimer sodium YESYESNONONOYES400
Nipent pentostatin YESYESNONONOYES400
Krystexxa pegloticase YESYESNONONOYES400
Neulasta pegfilgrastim YESYESNONONOYES400
Zemplar paricalcitol YESYESNONONOYES400
Ultresa pancrelipase YESYESNONONOYES400
Viokace pancrelipase YESYESNONONOYES400
Aredia pamidronate disodium YESYESNONONOYES400
Botox onabotulinumtoxinA YESYESNONONOYES400
Technivie ombitasvir-paritaprevir-ritonavir YESYESNONONOYES400
Sandostatin octreotide acetate YESYESNONONOYES400
Axid nizatidine YESYESNONONOYES400
Cesamet nabilone YESYESNONONOYES400
Avelox moxifloxacin YESYESNONONOYES400
Rydapt midostaurin YESYESNONONOYES400
Solu-Medrol methylprednisolone sodium succinate YESYESNONONOYES400
Depo-Medrol methylprednisolone acetate YESYESNONONOYES400
Medrol methylprednisolone YESYESNONONOYES400
Trexall methotrexate sodium YESYESNONONOYES400
Methotrexate LPF methotrexate YESYESNONONOYES400
Rasuvo methotrexate YESYESNONONOYES400
Rheumatrex methotrexate YESYESNONONOYES400
Rheumatrex Dose Pack methotrexate YESYESNONONOYES400
Xatmep methotrexate YESYESNONONOYES400
Mesnex mesna YESYESNONONOYES400
Alkeran melphalan YESYESNONONOYES400
Evomela melphalan YESYESNONONOYES400
Megace megestrol acetate YESYESNONONOYES400
Megace ES megestrol acetate YESYESNONONOYES400
Mustargen mechlorethamine YESYESNONONOYES400
Valchlor mechlorethamine YESYESNONONOYES400
Orkambi lumacaftor/vacaftor YESYESNONONOYES400
CeeNU lomustine YESYESNONONOYES400
Gleostine lomustine YESYESNONONOYES400
Xopenex HFA levalbuterol tartrate YESYESNONONOYES400
Eligard leuprolide acetate YESYESNONONOYES400
Lupron Depot leuprolide acetate YESYESNONONOYES400
Zurampic lesinurad YESYESNONONOYES400
Lenvima lenvatinib YESYESNONONOYES400
Kalydeco ivacaftor YESYESNONONOYES400
Combivent ipratropium bromide/albuterol sulfate YESYESNONONOYES400
Alferon N Injection Interferon Alfa-N3 YESYESNONONOYES400
WinRho SDF immune globulin; rh YESYESNONONOYES400
Carimune immune globulin; intravenous YESYESNONONOYES400
Privigen immune globulin; intravenous YESYESNONONOYES400
Gammaplex immune globulin; intravenous YESYESNONONOYES400
Gamunex immune globulin; intravenous YESYESNONONOYES400
Octagam immune globulin; intravenous YESYESNONONOYES400
Rhophylac immune globulin-rhoD Intravenous YESYESNONONOYES400
Ifex ifosfamide YESYESNONONOYES400
Boniva ibandronate sodium YESYESNONONOYES400
Vistaril hydroxyzine YESYESNONONOYES400
Cortef hydrocortisone YESYESNONONOYES400
Solu-Cortef hydrocortisone YESYESNONONOYES400
Panhematin hemin YESYESNONONOYES400
Mavyret glecaprevir/pibrentasvir YESYESNONONOYES400
Adrucil fluorouracil YESYESNONONOYES400
Carac fluorouracil YESYESNONONOYES400
Efudex fluorouracil YESYESNONONOYES400
Fluoroplex fluorouracil YESYESNONONOYES400
Fludara fludarabine YESYESNONONOYES400
Zarxio filgrastim-sndz YESYESNONONOYES400
Neupogen filgrastim YESYESNONONOYES400
Uloric febuxostat YESYESNONONOYES400
Toposar etoposide YESYESNONONOYES400
Femhrt ethinyl estradiol/norethindrone acetate YESYESNONONOYES400
Parsabiv etelcalcetide YESYESNONONOYES400
Prefest estradiol/norgestimate YESYESNONONOYES400
Activella estradiol/norethindrone acetate YESYESNONONOYES400
Delestrogen estradiol valerate YESYESNONONOYES400
Alora estradiol YESYESNONONOYES400
Climara estradiol YESYESNONONOYES400
Vivelle estradiol YESYESNONONOYES400
Vivelle-Dot estradiol YESYESNONONOYES400
Drisdol ergocalciferol YESYESNONONOYES400
Epogen epoetin alfa YESYESNONONOYES400
Radicava edaravone YESYESNONONOYES400
Hectorol doxercalciferol YESYESNONONOYES400
Decadron dexamethasone YESYESNONONOYES400
DexPak dexamethasone YESYESNONONOYES400
Maxidex dexamethasone YESYESNONONOYES400
Austedo deutetrabenazine YESYESNONONOYES400
Clarinex desloratadine YESYESNONONOYES400
Prolia denosumab YESYESNONONOYES400
Xgeva denosumab YESYESNONONOYES400
Vyxeos daunorubicin/cytarabine YESYESNONONOYES400
Cerubidine daunorubicin YESYESNONONOYES400
Viekira XR dasabuvir/ombitasvir/paritaprevir/ritonavir YESYESNONONOYES400
Ampyra dalfampridine YESYESNONONOYES400
Cosmegen dactinomycin YESYESNONONOYES400
Zinbryta daclizumab YESYESNONONOYES400
DepoCyt cytarabine liposome YESYESNONONOYES400
Cytosar-U cytarabine YESYESNONONOYES400
Gengraf cyclosporine YESYESNONONOYES400
Neosar cyclophosphamide YESYESNONONOYES400
Leustatin cladribine YESYESNONONOYES400
Platinol cisplatin YESYESNONONOYES400
Platinol-AQ cisplatin YESYESNONONOYES400
Cipro ciprofloxacin YESYESNONONOYES400
Sensipar cinacalcet YESYESNONONOYES400
Leukeran chlorambucil YESYESNONONOYES400
Bicnu carmustine YESYESNONONOYES400
Gliadel carmustine YESYESNONONOYES400
Paraplatin carboplatin YESYESNONONOYES400
Calcijex calcitriol YESYESNONONOYES400
Vectical calcitriol YESYESNONONOYES400
Fortical calcitonin salmon YESYESNONONOYES400
Cycloset bromocriptine YESYESNONONOYES400
Blenoxane bleomycin sulfate YESYESNONONOYES400
Celestone betamethasone YESYESNONONOYES400
Cystadane betaine YESYESNONONOYES400
Bendeka bendamustine YESYESNONONOYES400
Treanda bendamustine YESYESNONONOYES400
Zithromax azithromycin YESYESNONONOYES400
Azelex azelaic acid YESYESNONONOYES400
Azasan azathioprine YESYESNONONOYES400
Ethyol amifostine YESYESNONONOYES400
Duzallo allopurinol/lesinurad YESYESNONONOYES400
Lopurin allopurinol YESYESNONONOYES400
Fosamax Plus D alendronate sodium/cholecalciferol YESYESNONONOYES400
Binosto alendronate sodium YESYESNONONOYES400
Accuneb albuterol sulfate YESYESNONONOYES400
Proair HFA albuterol sulfate YESYESNONONOYES400
Vospire ER albuterol sulfate YESYESNONONOYES400
Proventil albuterol YESYESNONONOYES400
Acetadote acetylcysteine YESYESNONONOYES400
Mucomyst acetylcysteine YESYESNONONOYES400
Vincasar PFS vincristine sulfate YESYESNONONOYES400
Velban vinblastine sulfate YESYESNONONOYES400
Mycobutin rifabutin NOYESNONONOYES400
Depo-Provera medroxyprogesterone acetate NOYESNONONOYES400
Premphase conjugated estrogens/medroxyprogesterone acetate NOYESNONONOYES400
Prempro conjugated estrogens/medroxyprogesterone acetate NOYESNONONOYES400
Tygacil tigecycline NOYESNONONOYES400
Increlex injection mecasermin YESYESNONONOYES400
Somatuline Depot injection lanreotide acetate YESYESNONONOYES400
Xenazine tablet tetrabenazine YESYESNONONOYES400
Relizorb cartridge immobilized lipase YESYESNONONOYES400
Otrexup methotrexate YESYESNONONOYES400
Ixinity coagulation factor IX YESYESNONONOYES300
Gliadel wafer: polifeprosan 20 with carmustine implant carmustine YESYESNONONOYES200
Sotylize oral solution sotalol YESYESNONONOYES400
BiDil tablet isosorbide dinitrate/hydralazine YESYESNONONOYES400
Horizant gabapentin enacarbil YESYESNONONOYES400
E.E.S. granule; oral erythromycin ethylsuccinate YESYESNONONOYES400
EryPed granule; oral erythromycin ethylsuccinate YESYESNONONOYES400
ERY-TAB erythromycin YESYESNONONOYES400
PCE erythromycin YESYESNONONOYES400
Edarbi tablet azilsartan medoxomil YESYESNONONOYES400
Edarbyclor tablet azilsartan kamedoxomil/chlorthalidone YESYESNONONOYES400
Vistogard uridine triacetate YESYESNONONOYES400
Alprolix powder; lyophilized coagulation factor IX YESYESNONONOYES400
Cresemba isavuconazonium sulfate UNKNOWNNONONOYES400
Myrbetriq tablet; extended release mirabegron YESUNKNOWNNONONOYES400
Xtandi enzalutamide YESUNKNOWNNONONOYES400
Mycamine injection micafungin sodium YESUNKNOWNNONONOYES400
AmBisome injection amphotericin B liposome YESUNKNOWNNONONOYES400
Gammaplex iv immune globulin; intravenous YESYESNONONOYES400
Vosevi tablet sofosbuvir/velpatasvir/voxilaprevir YESYESNONONOYES500
Epclusa tablet sofosbuvir/velpatasvir YESYESNONONOYES500
Sovaldi tablet sofosbuvir YESYESNONONOYES500
Harvoni tablet ledipasvir/sofosbuvir YESYESNONONOYES500
Tagrisso osimertinib YESNONONONOYES400
Lynparza olaparib YESYESNONONOYES400
Iressa gefitinib YESYESNONONOYES400
Imfinzi durvalumab YESYESNONONOYES400
Calquence acalabrutinib YESYESNONONOYES400
Zevalin injectable; iv yttrium-90 YESYESNONONOYES400
Marqibo injectable; iv vincristine sulfate YESYESNONONOYES400
Folotyn solution; iv pralatrexate YESYESNONONOYES400
Beleodaq powder; injection belinostat YESYESNONONOYES400
Venclexta venetoclax YESYESNONONOYES400
Zelboraf vemurafenib YESYESNONONOYES400
Herceptin trastuzumab YESYESNONONOYES400
Actemra tocilizumab YESYESNONONOYES400
TNKase tenecteplase YESYESNONONOYES400
Rituxan Hycela rituximab/hyaluronidase YESYESNONONOYES400
Rituxan rituximab YESYESNONONOYES400
Lucentis ranibizumab YESYESNONONOYES400
Esbriet pirfenidone YESYESNONONOYES400
Perjeta pertuzumab YESYESNONONOYES400
Xolair omalizumab YESYESNONONOYES400
Ocrevus ocrelizumab YESYESNONONOYES400
Gazyva obinutuzumab YESYESNONONOYES400
Tarceva erlotinib YESYESNONONOYES400
Hemlibra emicizumab YESYESNONONOYES400
Pulmozyme dornase alfa YESYESNONONOYES400
Cotellic cobimetinib YESYESNONONOYES400
Avastin bevacizumab YESYESNONONOYES400
Activase alteplase YESYESNONONOYES400
Cathflo alteplase YESYESNONONOYES400
Alecensa alectinib YESYESNONONOYES400
Kadcyla ado-trastuzumab emtansine YESYESNONONOYES400
Erivedge vismodegib YESYESNONONOYES400
Invirase saquinavir YESYESNONONOYES400
Fuzeon enfuvirtide YESYESNONONOYES400
Brineura cerliponase alpa YESYESNONONOYES400
Enfamil formula infant YESYESNONONOYES400
CitraNatal 90 DHA tablet vitamin/mineral supplement YESYESNONONOYES400
CitraNatal B-Calm tablet vitamin/mineral supplement YESYESNONONOYES400
CitraNatal Harmony capsule; gel vitamin/mineral supplement YESYESNONONOYES400
Avar Family Products topical sulfacetamide/sulfur YESYESNONONOYES400
Ovace Plus Products topical sodium sulfacetamide YESYESNONONOYES400
Utira-C methenamine/sodium phosphate monobasic/phenyl salicylate/methylene blue/hyoscyamine sulfate YESYESNONONOYES400
Hyophen methenamine/benzoic acid/phenyl salicylate/methylene blue/hyoscyamine sulfate YESYESNONONOYES400
Texacort solution; topical hydrocortizone YESYESNONONOYES400
Eletone emolent YESYESNONONOYES400
CitraNatal Assure tablet dual-iron/DHA YESYESNONONOYES400
Ferralet 90 tablet dual-iron YESYESNONONOYES400
Aquoral spray artificial saliva YESYESNONONOYES400
Eloctate injection antihemophilic factor YESYESNONONOYES400
Rubraca rucaparib YESNONONOYES400
Xtampza ER oxycodone YESYESNONONOYES400
ConvaTec Ostomy Products ostomy products pouches-skin barriers YESNONONOYES400
Korlym tablet mifepristone YESYESNONONOYES400
Orencia abatacept NONONONONOYES400
BCAD 2 Medical Food powder medical food NOYESNONONOYES400
HCY 2 Medical Food powder medical food NOYESNONONOYES400
OA 2 Medical Food powder medical food NOYESNONONOYES400
PFD 2 Medical Food powder medical food NOYESNONONOYES400
PFD Toddler Medical Food powder medical food NOYESNONONOYES400
Tyros 1 Medical Food powder medical food NOYESNONONOYES400
Tyros 2 Medical Food powder medical food NOYESNONONOYES400
3232 A Infant Formula powder formula infant NOYESNONONOYES400
BCAD 1 Infant Formula powder formula infant NOYESNONONOYES400
Enfagrow Toddler Transitions Gentlease powder formula infant NOYESNONONOYES400
Enfagrow Toddler Transitions Soy powder formula infant NOYESNONONOYES400
Enfamil 24 liquid formula infant NOYESNONONOYES400
Enfamil A.R. powder formula infant NOYESNONONOYES400
Enfamil EnfaCare powder formula infant NOYESNONONOYES400
Enfamil Gentlease liquid formula infant NOYESNONONOYES400
Enfamil Human Milk Fortifier powder formula infant NOYESNONONOYES400
Enfamil Premature 30 liquid formula infant NOYESNONONOYES400
Enfamil Premature High Protein 24 liquid formula infant NOYESNONONOYES400
Enfamil Premature Low Iron 20 liquid formula infant NOYESNONONOYES400
Enfamil Premature Low Iron 24 liquid formula infant NOYESNONONOYES400
Enfamil Premature with Iron 20 liquid formula infant NOYESNONONOYES400
Enfamil Premature with Iron 24 liquid formula infant NOYESNONONOYES400
Enfamil ProSobee liquid formula infant NOYESNONONOYES400
Enfamil Reguline powder formula infant NOYESNONONOYES400
Enfaport liquid formula infant NOYESNONONOYES400
GA Infant Formula powder formula infant NOYESNONONOYES400
HCY 1 Infant Formula powder formula infant NOYESNONONOYES400
LMD Infant Formula powder formula infant NOYESNONONOYES400
Nutramigen with Enflora LGG powder formula infant NOYESNONONOYES400
Nutramigen with Enflora LGG Toddler powder formula infant NOYESNONONOYES400
OA 1 Infant Formula powder formula infant NOYESNONONOYES400
Pregestimil powder formula infant NOYESNONONOYES400
PurAmino powder formula infant NOYESNONONOYES400
WND 1 Infant Formula powder formula infant NOYESNONONOYES400
Stiolto Respimat tiotropium bromide/olodaterol YESNONONONOYES400
Zilretta triamcinolone acetonide YESUNKNOWNDetermined case by caseNoNot disclosedDoctor's office or specific site400
Myobloc injection rimabotulinumtoxinB YESYESNONONOYES400
Otezla tablet apremilast YESYESNONONOYES400
Sylvant disposal container container for Sylvant YESYESNONONOYES400
Stelara ustekinumab NONONONONOYES400
Tremfya guselkumab NONONONONOYES400
Simponi golimumab NONONONONOYES400
Cosentyx secukinumab NONONONONOYES400
Evzio injectable; subcutaneous naloxone YESYESNONONOYES150
Auryxia tablet ferric citrate NOYESNONONOYES400
Makena solution hydroxyprogesterone caproate YESYESNONONOYES400
Mytesi tablet; delayed-release crofelemer YESYESNONONOYES200
Rasuvo injection methotrexate YESYESNONONOYES200
Cayston aztreonam YESYESNONONOYES400
AlphaNine SD coagulation factor IX YESYESNONONOYES400
Alphanate antihemophilic factor human YESYESNONONOYES400
Urocit-K potassium citrate YESYESNONONOYES150
Uribel capsule methenamine/sodium phosphate/monobasic/monohydrate/phenyl salicylate YESYESNONONOYES150
Lithostat tablet acetohydroxamic acid YESYESNONONOYES150
Defitelio defibrotide NONONONONOYES400
Erwinaze injection asparaginase erwinia chrysanthemi NONONONONOYES400
Prialt injectable; intrathecal ziconotide NONONONONOYES400
Xyrem oral solution sodium oxybate NONONONONOYES400
Entereg capsule alvimopan YESYESNONONOYES400
Gleostine capsule lomustine NOYESNONONOYES200
Isentress raltegravir YESNONONONOYES400
Dulera formoterol fumarate/mometasone furoate YESNONONONOYES400
Fareston tablet toremifene citrate YESYESNONONOYES400
Roxicodone tablet oxycodone NOYESNONONOYES200
Tofranil tablet imipramine NOYESNONONOYES200
Exalgo tablet hydromorphone NOYESNONONOYES200
Anafranil capsule clomipramine NOYESNONONOYES200
Zubsolv tablet; sublingual buprenorphine/naloxone NONONONONOYES300
Sucraid oral solution sacrosidase NOYESNONONOPatient's home, unless otherwise noted400
Northera capsule droxidopa NOYESNONONOYES400
Onfi tablet clobazam YESYESNONONOYES400
Orbactiv oritavancin diphosphate NOYESNONONOYES400
Baxdela delafloxacin YESYESNONONOYES400
Otiprio ciprofloxacin NONONONONOYES400
Photofrin injection porfimer sodium YESNONONOYES200
Prothelial paste polymerized sucralfate malate YESYESNONONOYES400
EMSAM transdermal selegiline NOYESNONONOYES400
EpiPen 2-Pak injection epinephrine NOYESNONONOYES400
EpiPen Jr 2-Pak injection epinephrine NOYESNONONOYES400
Samsca tablet tolvaptan NONONONONOYES400
Vivotif capsule typhoid vaccine live oral Ty21a YESUNKNOWNNONONOYES400
Chemet capsule succimer YESNONONOYES400
Desoxyn tablet methamphetamine YESNONONOYES400
NeoProfen injection ibuprofen lysine YESNONONOYES400
Panhematin powder; injection hematin hemin/sodium carbonate/sorbitol))YESNONONOYES400
Peganone tablet ethotoin YESNONONOYES400
Cosmegen injection dactinomycin YESNONONOYES400
Tranxene clorazepate dipotassium YESNONONOYES400
Odomzo capsule sonidegib YESUNKNOWNDetermined case by caseContact program for details.Not disclosedPatient's home400
Rexulti tablet brexpiprazole NONONONONOYES400
Abilify Maintena injection; extended release aripiprazole NONONONONOYES400
Cimzia certolizumab pegol NONONONOYES400
Rasuvo Container disposal container container for Rasuvo sharps YESNONONOYES400
Saizen somatropin YESNONONONOYES400
Hizentra vial; single-use 20% immune globulin; subcutaneous YESYESNONONOYES400
Privigen vial; single-use immune globulin; intravenous YESYESNONONOYES400
LMX cream; anesthetic lidocaine YESUNKNOWNMay have insuranceYesAt or below 100% of FPLDoctor's office or patient's home150
Detachol unit dose adhesive remover YESUNKNOWNMay have insuranceYesAt or below 100% of FPLDoctor's office or patient's home150
Mastisol liquid adhesive YESUNKNOWNMay have insuranceYesAt or below 100% of FPLDoctor's office or patient's home150
Serostim injection somatropin YESUNKNOWNDetermined case by caseNoNot disclosedDoctor's office or patient's home400
Saizen injection somatropin YESUNKNOWNContact program for details.NoNot disclosedPatient's home400
Zomacton somatropin YESUNKNOWNMust be uninsured or have a temporary lapse in insurance coverage.NoVariesPatient's home, unless otherwise noted400
Hyalgan vial sodium hyaluronate NOUNKNOWNMust have no prescription coverage for needed medicationContact program for details.At or below 250% of FPLDoctor's office250
Procysbi cysteamine bitartrate YESNONONONOYES400
Vimovo naproxen/esomeprazole YESYESNONONOYES400
Duexis ibuprofen/famotidine YESYESNONONOYES400
Pennsaid diclofenac sodium YESYESNONONOYES400
Letairis ambrisentan YESYESNONONOYES500
Ranexa tablet; extended release ranolazine YESYESNONONOYES500
Suboxone film; sublingual buprenorphine/naloxone YESYESNONONOYES250
Nascobal spray; nasal cyanocobalamin NOUNKNOWNMust have no prescription coverageNoAt or below 200% of FPLDoctor's office200
Velphoro tablet; chewable sucroferric oxyhydroxide YESUNKNOWNMay have insuranceYes, but contact program for detailsNot disclosedPatient's home400
Ocaliva obeticholic acid NOYESNONONOYES400
Diclegis tablet doxylamine succinate/pyridoxine NOYESNONONOYES250
Hymovis high molecular weight viscoelastic hyaluronan NOUNKNOWNMust have no prescription coverage for needed medicationYes, if medication is not coveredAt or below 250% of FPLDoctor's office250
Prolastin C alpha1-proteinase inhibitor YESYESNONONOYES400
Emverm mebendazole YESYESNONONOYES300
Rytary carbidopa/levodopa YESYESNONONOYES300
Albenza albendazole YESYESNONONOYES300
Zomig zolmitriptan YESYESNONONOYES300
Xeomin injection incobotulinumtoxinA YESYESNONONOYES400
Dermagraft dermal substitute dermagraft bilayered skin substitute NONONONONOYES400
Apligraf dermal substitute bilayered skin substitute NONONONONOYES400
Advair Diskus fluticasone propionate/salmeterol xinafoate YESNONONONOYES400
Advair HFA fluticasone propionate/salmeterol xinafoate YESNONONONOYES400
Flovent Diskus fluticasone propionate YESNONONONOYES400
Flovent HFA fluticasone propionate YESNONONONOYES400
Breo Ellipta fluticasone furoate/vilanterol trifenatate YESNONONONOYES400
Arnuity Ellipta fluticasone furoate YESNONONONOYES400
Coreg CR carvedilol YESNONONONOYES400
Soriatane acitretin YESNONONONOYES400
Bavencio avelumab NOUNKNOWNMust have no prescription coverage for needed medicationContact program for details.Not disclosedDoctor's office or specific site400
Wilate liquid von willebrand factor/coagulation factor Vlll complex NONONONONOYES400
Nuwiq antihemophilic factor NONONONONOYES400
Sancuso transdermal patch granisetron YESYESNONONOYES300
Lenvima capsule lenvatinib YESUNKNOWNMay have insuranceYesNot disclosedPatient's home, unless otherwise noted400
Belviq tablet lorcaserin YESUNKNOWNMay have insuranceYesAt or below 150% of FPLPatient's home150
Fycompa perampanel YESUNKNOWNMust be uninsured, denied coverage or are awaiting public assistance determinationNoAt or below 300% of FPLPatient is sent savings card to be used at pharmacy300
MatriStem MicroMatrix tissue matrix; extracellular matrix; lyophilized extracellular YESNONONOYES400
Carbaglu carglumic acid YESYESNONONOYES400
Lupaneta PackYESYESNONONOYES300Varies1286
LUPRON DEPOT GYNnorethindrone acetateYESYESNONONOYES300Varies1546
ProliaDenosumabYESYESNONONOYES500Varies3000
NeulastapegfilgrastimYESYESNONONOYES500Varies5000
Neulasta Onpro KitpegfilgrastimYESYESNONONOYES500Varies5000
NeupogenfilgrastimYESYESNONONOYES500Varies5000
Onglyza TabletsaxagliptinNOYESNO3NOYES300Varies384.59
DaklinzadaclatasvirNOYESNO3NOYES400Varies22959
Eliquis TabletapixabanNOYESNO3NOYES400Varies383.13
Nulojix InjectionbelataceptNOYESNO3NOYES400Varies1022.91
OrenciaabataceptNOYESNO3NOYES400Varies4403.86
PlavixNOYESNO3NOYES400Varies159
SustivaEfavirenzYESYESNO3NOYES400Varies1176.74
SpryceldasatinibNOYESNO3NOYES400Varies13217.4
YervoyipilimumabNOYESNO3NOYES400Varies30000
ELIgard InjectionleuprolideNO'YESYES5NOYES250Varies230
Coartem Tabletartmether and lumefantrineYESNONONONOYES250Varies1224.43
Focalin XRdexmethyiphenidate HCIYESNONONONOYES250Varies396.5
Focalin XRCapsule ERdexmethyiphenidate HCIYESNONONONOYES250Varies396.5
JadenudeferasiroxYESNONONONOYES250Varies20000
Jadenu SprinkledeferasiroxYESNONONONOYES250Varies20000
Lamisil Oral GranulesterbinafineYESNONONONOYES250Varies859
Myfortic Tablet; Delayed Releasemycophenolic acidYESNONONONOYES250Varies1176.55
Neoral Capsulecyclosporine USPYESNONONONOYES250Varies134.96
Neoral Oral SolutioncyclosporineYESNONONONOYES250Varies486.43
Reclast Injectable; IVzoledronic acidYESNONONONOYES250Varies1247.6
Sandimmune Capsule, GelcyclosporineYESNONONONOYES250Varies917.87
Sandimmune Oral SolutioncyclosporineYESNONONONOYES250Varies644.4
Tegretol XR TabletcarbamazepineYESNONONONOYES250Varies162.88
TOBI Inhalation SolutiontobramycinYESNONONONOYES250Varies8439.59
TOBI Podhaler PowdertobramycinYESNONONONOYES250Varies9300.99
Travatan ZtravoprostYESNONONONOYES250Varies156.71
Trileptal TabletoxcarbazepineYESNONONONOYES250Varies293.62
Zortress TableteverolimusYESNONONONOYES250Varies1432.97
Novoeightantihemophilic factor recombinantNONONONONONO400Varies10
ErbituxcetuximabNONONONONOYES500Varies80532
Nicotrolnicotine inhalation systemYESYESNONONOYES400Varies443
NitrostatnitroglycerinYESYESNONONOYES400Varies70
NorpaceDisopyramideYESYESNONONOYES400Varies471
Norpace CRDisopyramide CRYESYESNONONOYES400Varies471
SkelaxinNO PROGRAM AVAILABLENOYESNONONOVARIES400VARIES150
SomavertpegvisomantNOYESNONONOVARIES400VARIES3174
JevtanacabazitaxelNOYESYES5NOYES250Varies3170.53
Adacel Injectiontetanus toxoid/reduced diptheria toxoid/acellular pertussisYESYESNO5NOYES250Varies129.61
Apidra SoloStar Peninsulin glulisine [rDNA origin]YESYESNO5NOYES250Varies567.75
ApidraVialsinsulin glulisine [rDNA origin]YESYESNO5NOYES250Varies294.38
ClolarVialclofarabineYESYESNO5NOYES250Varies3170.53
Elitek VialrasburicaseYESYESNO5NOYES250Varies2491.76
Enoxaparin SodiumInjectableenoxaparin sodiumYESYESNO5NOYES250Varies683.21
Imogam Injectionrabies immune globulinYESYESNO5NOYES250Varies809.05
Imovax Injectionrabies vaccineYESYESNO5NOYES250Varies964.03
Jevtana InjectioncabazitaxelYESYESNO5NOYES250Varies10519.98
LantusBasaglarYESYESNO5NOYES250Varies400
Lantus SoloSTAR Peninsulin glargineYESYESNO5NOYES250Varies372.27
Lantus U-100BasaglarYESYESNO5NOYES250Varies400
Lantus U-100Vialinsulin glargineYESYESNO5NOYES250Varies248.51
Leukine VialsargramostimYESYESNO5NOYES250Varies1337.54
Lovenox Injectionenoxaparin sodiumYESYESNO5NOYES250Varies381.37
Menactra Injectiondiphtheria toxid conjugate vaccineYESYESNO5NOYES250Varies113.36
Menomune Injectionmeningococcal polysacchaaide vaccineYESYESNO5NOYES250Varies123.55
Mozobil InjectionplerixaforYESYESNO5NOYES250Varies7846.82
MultaqdronedaroneYESYESNO5NOYES250Varies566.43
PriftinrifapentineYESYESNO5NOYES250Varies122.06
Tenivac Injectiontetanus and diphtheria toxoids adsorbedYESYESNO5NOYES250Varies319.96
Thymoglobulin Vialanti-thymocyte globulin rabbitYESYESNO5NOYES250Varies815.9
Toujeoinsulin glargineYESYESNO5NOYES250Varies397
Toujeo Solostarinsulin glargineYESYESNO5NOYES250Varies335.14
Zaltrap IVziv-afliberceptYESYESNO5NOYES250Varies1792
Arcapta NeohalerPowderindaceterolYes if not listed in the formularyYESNONONOYES250Varies247.02
LatudalurasidoneYESNONONOYES250Varies247.02
SeebriGlycopyrrolateYESNONONOYES250Varies49
Utibronglycopyrrolate and indacaterolYESNONONOYES250Varies$46 
Arcaptaindacaterol (inhalation)Yes if not listed in the formularyYESNONONOYES250Varies277
Pro-Phree medical food YESYESNONONOYES400
Nuplazid tablet pimavanserin YESYESNONONOYES400
Qutenza patch capsaicin YESYESNONONOYES400
Feraheme ferumoxytol NOYESNONONOYES400
MuGard oral solution mucadhesive NOYESNONONOYES400
Venofer iron sucrose NONONONONOYES400
Injectafer injection ferric carboxymaltose NONONONONOYES400
Lexiscan solution; iv regadenoson NOUNKNOWNNONONOYES400
Onzetra Xsail sumatriptan NOUNKNOWNNONONONO400
Xofigo radium ra-223 dichloride NOYESNONONOYES400
Stivarga regorafenib NOYESNONONOYES400
Biltricide praziquantel NOYESNONONOYES400
Mirena levonorgestrel-releasing intrauterine system NOYESNONONOYES400
Kyleena levonorgestrel NOYESNONONOYES400
Skyla levonorgestrel NOYESNONONOYES400
Betaseron interferon beta-1b NOYESNONONOYES400
Climara Pro estradiol/levonorgestrel NOYESNONONOYES400
Natazia estradiol valerate and estradiol valerate/dienogest NOYESNONONOYES400
Safyral drospirenone/ethinyl estradiol/levomefolate calcium NOYESNONONOYES400
Angeliq drospirenone/estradiol NOYESNONONOYES400
Spinraza nusinersen NOYESNONONOYES400
Kuvan sapropterin dihydrochloride NOYESNONONOYES400
Gelsyn-3 sodium hyaluronate NOYESNONONOYES400
Supartz injection sodium hyaluronate NOYESNONONOYES400
Vectra DA Blood Test NOYESNONONOYES400
Ferriprox tablet; oral deferiprone NOYESNONONOYES400
Banzel oral suspension rufinamide NOUNKNOWNMay have insuranceYesVaries400
Rebif syringe; subcutaneous interferon beta-1a NOUNKNOWNVariesNot disclosedPatient's home400
Supprelin LA implant; subcutaneous histrelin acetate NOUNKNOWNDetermined case by caseNo1 dose400
Valcyte valganciclovir NOYESNONONOYES400
Vemlidy tenofovir alafenamide NOYESNONONOYES400
Hepsera adefovir dipivoxil NOYESNONONOYES400
Iclusig ponatinib NONONONONOYES400
Entocort EC budesonide NONONONONOYES400
Caprelsa vandetanib NONONONONOYES400
Jetrea ocriplasmin NONONONONOYES400
Faslodex fulvestrant NONONONONOYES400
Zaltrap ziv-aflibercept NONONONONOYES400
Marqibo Kit vincristine NONONONONOYES400
Tyvaso treprostinil NONONONONOYES400
Tyzeka telbivudine NONONONONOYES400
Incivek telaprevir NONONONONOYES400
Norditropin somatropin NONONONONOYES400
Nutropin somatropin NONONONONOYES400
Omnitrope somatropin NONONONONOYES400
Tev-Tropin somatropin NONONONONOYES400
Valtropin somatropin NONONONONOYES400
Provenge sipuleucel-T NONONONONOYES400
Jakafi ruxolitinib NONONONONOYES400
PegIntron-Rebetol combo pack ribavirin/peginterferon alfa-2b NONONONONOYES400
Signifor pasireotide diaspartate NONONONONOYES400
Tasigna nilotinib monohydrate NONONONONOYES400
Opsumit macitentan NONONONONOYES400
Tykerb lapatinib ditosylate NONONONONOYES400
Epivir lamivudine NONONONONOYES400
Onmel itraconzazole NONONONONOYES400
Sporanox itraconazole NONONONONOYES400
Extavia interferon beta-1b NONONONONOYES400
Remicade infliximab NONONONONOYES400
Gleevec imatinib NONONONONOYES400
Ventavis iloprost NONONONONOYES400
Cytovene ganciclovir NONONONONOYES400
Foscavir foscarnet sodium NONONONONOYES400
Zortress everolimus NONONONONOYES400
Veletri epoprostenol sodium NONONONONOYES400
Baraclude tablet entecavir NONONONONOYES400
Exjade deferasirox NONONONONOYES400
Jadenu deferasirox NONONONONOYES400
Sprycel dasatinib NONONONONOYES400
Cystagon cysteamine bitartrate NONONONONOYES400
Cystaran cysteamine NONONONONOYES400
Vistide cidofovir NONONONONOYES400
Tracleer bosentan NONONONONOYES400
Eylea aflibercept NONONONONOYES400
Humira adalimumab NONONONONOYES400
Zytiga abiraterone acetate NONONONONOYES400
Bactrim sulfamethoxazole/trimethoprim NONONONONOYES400
Increlex mecasermin NONONONONOYES400
Genotropin somatropin recombinant NONONONONOYES400
Humatrope somatropin NONONONONOYES400
Miacalcin calcitonin salmon NOYESNONONOYES400
Rocaltrol calcitriol NOYESNONONOYES400
Bethkis tobramycin NOYESNONONOYES400
Xenazine tetrabenazine NOYESNONONOYES400
Temodar temozolomide NOYESNONONOYES400
Priftin rifapentine NOYESNONONOYES400
Vigamox moxifloxacin NOYESNONONOYES400
Haldol Decanoate haloperidol decanoate NOYESNONONOYES400
Zometa zoledronic acid NOYESNONONOYES400
Nebcin tobramycin NOYESNONONOYES400
Pred Forte prednisolone acetate NOYESNONONOYES400
Farydak panobinostat lactate NOYESNONONOYES400
Zenpep pancrelipase NOYESNONONOYES400
Zevalin ibritumomab tiuxetan NOYESNONONOYES400
Tymlos abaloparatide NOYESNONONOYES400
Actigall ursodiol NOYESNONONOYES400
Zantac ranitidine NOYESNONONOYES400
Provigil modafinil NOYESNONONOYES400
Lithobid lithium carbonate NOYESNONONOYES400
Xyzal levocetirizine NOYESNONONOYES400
Allegra fexofenadine NOYESNONONOYES400
Zyrtec cetirizine NOYESNONONOYES400
Nuvigil armodafinil NOYESNONONOYES400
Zyloprim allopurinol NOYESNONONOYES400
Myfortic mycophenolic acid NOYESNONONOYES400
Viagra sildenafil citrate NOYESNONONOYES400
Dysport injection abobotulinumtoxinA NOYESNONONOYES400
Tremfya disposal container container for Tremfya NOYESNONONOYES400
Stelara disposal container container for Stelara NOYESNONONOYES400
Simponi Container disposal container container for simponi sharps NOYESNONONOYES400
Doxil disposal container container for Doxil NOYESNONONOYES400
Darzalex disposal container container for Darzalex NOYESNONONOYES400
Auvi-Q epinephrine NOYESNONONOYES400
Xermelo telotristat ethyl NOYESNONONOYES400
Pamelor capsule nortriptyline NOYESNONONOYES400
WND 2 Medical Food powder medical food NOYESNONONOYES400
EpiLocker epinephrine carton NOYESNONONOYES400
Neocate Infant DHA and ARA powder formula infant NONONONONOYES400
Omidria solution phenylephrine/ketorolac tromethamine NONONONONOYES400
Abilify tablet aripiprazole NONONONONOYES400
Retrovir zidovudine NONONONONOYES400
Zolinza vorinostat NONONONONOYES400
Synagis palivizumab NONONONONOYES400
Viracept nelfinavir NONONONONOYES400
Selzentry maraviroc NONONONONOYES400
Combivir lamivudine/zidovudine NONONONONOYES400
Epivir-HBV tablet lamivudine NONONONONOYES400
Flebogamma DIF iv; 5% immune globulin; iv NONONONONOYES400
Lexiva fosamprenavir calcium NONONONONOYES400
Juluca dolutegravir/rilpivirine NONONONONOYES400
Tivicay dolutegravir sodium NONONONONOYES400
Praluent disposal container container for Praluent sharps NONONONONOYES400
Symbicort budesonide/formoterol fumarate dihydrate NONONONONOYES400
Fasenra benralizumab NONONONONOYES400
Trizivir abacavir sulfate/lamivudine/zidovudine NONONONONOYES400
Epzicom abacavir sulfate/lamivudine NONONONONOYES400
Triumeq abacavir sulfate/dolutegravir sodium/lamivudine NONONONONOYES400
Ziagen abacavir sulfate NONONONONOYES400
Sabril tablet vigabatrin NONONONONOYES400
VPRIV velaglucerase alfa NONONONONOYES400
Aptivus tipranavir NONONONONOYES400
Entresto sacubitril/valsartan NONONONONOYES400
Norvir ritonavir NONONONONOYES400
Edurant rilpivirine NONONONONOYES400
Kisqali Femara tablet; co-pack ribociclib-letrozole NONONONONOYES400
Kisqali ribociclib NONONONONOYES400
Veltassa patiromer NONONONONOYES400
Kaletra lopinavir/ritonavir NONONONONOYES400
Fosrenol lanthanum carbonate NONONONONOYES400
Combivent Respimat ipratropium bromide/albuterol NONONONONOYES400
Atrovent HFA ipratropium bromide NONONONONOYES400
Avonex pen interferon beta-1a NONONONONOYES400
Crixivan indinavir sulfate NONONONONOYES400
Iluvien fluocinolone acetonide NONONONONOYES400
Vytorin ezetimibe/simvastatin NONONONONOYES400
Intelence etravirine NONONONONOYES400
Sustiva efavirenz NONONONONOYES400
Multaq dronedarone NONONONONOYES400
Durezol difluprednate NONONONONOYES400
Prezcobix darunavir ethanolate/cobicistat NONONONONOYES400
Prezista darunavir ethanolate NONONONONOYES400
NovoSeven RT coagulation factor viia NONONONONOYES400
Jevtana cabazitaxel NONONONONOYES400
Ridaura auranofin NONONONONOYES400
Emend aprepitant NONONONONOYES400
Novoeight antihemophilic factor NONONONONOYES400
Neupro rotigotine NONONONONOYES400
Triglide fenofibrate NONONONONOYES400
Repatha Sureclick auto-injector; pre-filled evolocumab NONONONONOYES400
EstroGel estradiol NONONONONOYES400
Olux clobetasol NONONONONOYES400
Reyataz atazanavir sulfate NONONONONOYES400
Kineret anakinra NONONONONOYES400
Calan verapamil NONONONONOYES400
Calan SR verapamil NONONONONOYES400
Aldactone spironolactone NONONONONOYES400
Altace ramipril NONONONONOYES400
Accupril quinapril NONONONONOYES400
Procardia XL nifedipine NONONONONOYES400
Levoxyl levothyroxine NONONONONOYES400
Accuretic hydrochlorothiazide/quinapril NONONONONOYES400
Lopid gemfibrozil NONONONONOYES400
Colestid colestipol NONONONONOYES400
Lipitor atorvastatin calcium NONONONONOYES400
Norvasc amlodipine besylate NONONONONOYES400
Xanax alprazolam NONONONONOYES400
Accolate zafirlukast NONONONONOYES400
Jantoven warfarin sodium NONONONONOYES400
Coumadin warfarin NONONONONOYES400
Diovan HCT valsartan/hydrochlorothiazide NONONONONOYES400
Diovan valsartan NONONONONOYES400
Dyrenium triamterene NONONONONOYES400
Mavik trandolapril NONONONONOYES400
Zanaflex tizanidine NONONONONOYES400
Micardis telmisartan NONONONONOYES400
Betapace sotalol NONONONONOYES400
Sorine sotalol NONONONONOYES400
Kionex sodium polystyrene sulfonate NONONONONOYES400
Zocor simvastatin NONONONONOYES400
Kevzara sarilumab NONONONONOYES400
Crestor rosuvastatin calcium NONONONONOYES400
Requip ropinirole NONONONONOYES400
Exelon rivastigmine NONONONONOYES400
Azilect rasagiline NONONONONOYES400
Rythmol propafenone NONONONONOYES400
Pravachol pravastatin sodium NONONONONOYES400
Mirapex ER pramipexole dihydrochloride NONONONONOYES400
Lovaza omega-3-acid ethyl esters NONONONONOYES400
Benicar olmesartan medoxomil NONONONONOYES400
Nilandron nilutamide NONONONONOYES400
Niaspan niacin NONONONONOYES400
Anaprox DS naproxen sodium NONONONONOYES400
Naprosyn naproxen NONONONONOYES400
Lopressor metoprolol tartrate NONONONONOYES400
Toprol XL metoprolol sussinate NONONONONOYES400
Dutoprol metoprolol succinate/hydrochlorothiazide NONONONONOYES400
Zaroxolyn metolazone NONONONONOYES400
Reglan metoclopramide NONONONONOYES400
Mobic meloxicam NONONONONOYES400
Cozaar losartan NONONONONOYES400
Ativan lorazepam NONONONONOYES400
Prinivil lisinopril NONONONONOYES400
Zestril lisinopril NONONONONOYES400
Synthroid levothyroxine NONONONONOYES400
Arava leflunomide NONONONONOYES400
Onivyde irinotecan liposome NONONONONOYES400
Avalide irbesartan/hydrochlorothiazide NONONONONOYES400
Avapro irbesartan NONONONONOYES400
Indocin indomethacin NONONONONOYES400
Plaquenil hydroxychloroquine NONONONONOYES400
Dyazide hydrochlorothiazide/triamterene NONONONONOYES400
Maxzide hydrochlorothiazide/triamterene NONONONONOYES400
Benicar HCT hydrochlorothiazide/olmesartan medoxomil NONONONONOYES400
Hyzaar hydrochlorothiazide/losartan NONONONONOYES400
Zestoretic hydrochlorothiazide/lisinopril NONONONONOYES400
Microzide hydrochlorothiazide NONONONONOYES400
Ultravate halobetasol propionate NONONONONOYES400
Lasix furosemide NONONONONOYES400
AirDuo RespiClick fluticasone propionate/salmeterol NONONONONOYES400
Flonase fluticasone propionate NONONONONOYES400
Fibricor fenofibric acid NONONONONOYES400
Tricor fenofibrate NONONONONOYES400
Estrace estradiol NONONONONOYES400
Vaseretic enalapril maleate/hydrochlorothiazide NONONONONOYES400
Vasotec enalapril maleate NONONONONOYES400
Aricept donepezil NONONONONOYES400
Dilacor XR diltiazem NONONONONOYES400
Lanoxin digoxin NONONONONOYES400
Voltaren XR diclofenac sodium NONONONONOYES400
Welchol colesevelam NONONONONOYES400
Trilipix choline fenofibrate NONONONONOYES400
Prevalite cholestyramine NONONONONOYES400
Celebrex celecoxib NONONONONOYES400
Stalevo carbidopa/levodopa/entacapone NONONONONOYES400
Atacand HCT candesartan cilexetil/hydrochlorothiazide NONONONONOYES400
Atacand candesartan cilexetil NONONONONOYES400
Phoslo calcium acetate NONONONONOYES400
Ziac bisoprolol fumarate/hydrochlorothiazide NONONONONOYES400
Casodex bicalutamide NONONONONOYES400
Targretin bexarotene NONONONONOYES400
Diprolene AF betamethasone dipropionate NONONONONOYES400
Lotensin HCT benazepril/hydrochlorothiazide NONONONONOYES400
Lotensin benazepril NONONONONOYES400
Colazal balsalazide disodium NONONONONOYES400
Tenoretic atenolol/chlorthalidone NONONONONOYES400
Tenormin atenolol NONONONONOYES400
Pacerone amiodarone NONONONONOYES400
Proair Respiclick albuterol NONONONONOYES400
memantine Namenda NONONONONOYES400
Singulair montelukast sodium NONONONONOYES400
Elocon mometasone furoate NONONONONOYES400
Zetia ezetimibe NONONONONOYES400
Prograf tacrolimus NONONONONOYES400
Rescriptor delavirdine NONONONONOYES400
Sinemet carbidopa/levodopa NONONONONOYES400
Ruconest C1 esterase inhibitor recombinant NOYESNONONO400
Emflaza oral suspension deflazacort NOYESNONONOVaries400
Eylea injection aflibercept NOYESNONONONot applicable400
Omnitrope cartridge somatropin NOYESNONONONot specified400
Lotronex alosetron NOYESNONONOYES400
Kineret injection anakinra NOYESNONONOYES400
Trokendi XR capsule; extended release topiramate NOYESNONONOYES400
Oxtellar XR tablet; extended release oxcarbazepine NOYESNONONOYES400
Egrifta injection tesamorelin NOYESNONONOYES400
Mepsevii vestronidase alfa-vjbk NOYESNONONOYES400
Tyvaso solution; inhalation treprostinil NOYESNONONOYES400
Sabril vigabatrin NOYESNONONOYES400
AndroGel pump testosterone topical NOYESNONONOYES400
Firazyr Container disposal container container for firazyr sharps NOYESNONONOYES400
rufinamide Banzel NOYESNONONOYES400
Emend suspension aprepitant NOYESNONONOYES400
Praluent alirocumab NOYESNONONOYES400
Lamictal lamotrigine NOYESNONONOYES400
Lamictal starter kit lamotrigine NOYESNONONOYES400
Lamictal XR lamotrigine NOYESNONONOYES400
Humalog injection; cartridge insulin lispro protamine NOYESNONONOYES400
Hetlioz capsule tasimelteon NOYESNONONOYES400
Orkambi tablet lumacaftor/vacaftor NOYESNONONOYES400
Kalydeco tablet ivacaftor NOYESNONONOYES400
Daraprim tablet pyrimethamine NOYESNONONOYES400
 100%133%138%150%200%250%300%400%
11,0121,3461,3961,5182,0232,5293,0354,047
21,3721,8241,8932,0582,7433,4294,1155,487
31,7322,3032,3902,5983,4634,3295,1956,927
42,0922,7822,8873,1384,1835,2296,2758,367
52,4523,2613,3833,6784,9036,1297,3559,807
62,8123,7403,8804,2185,6237,0298,43511,247
73,1724,2184,3774,7586,3437,9299,51512,687
83,5324,6974,8745,2987,0638,82910,59514,127

We work with prescription drug advocates to find a financial alternative to pay for medications.  This is mostly for people struggling to pay for their high-cost brand medications.  One of the reasons our clients work with us is, we can help you enroll into a Part D drug plan, but also because we can help determine if you qualify for a Prescription Assistance Program that pays the cost of your Brand-name medications.

Did you know (Our Agency) is partnered with a patient assistance company called Find Prescription Relief for assistance with medications?  We are the only agency that has this type of relationship with a company that specializes in getting costly drugs for qualified patients who cannot afford them, directly from the manufacturer of your medication.  There are a few questions I need to ask you to see if you qualify….


1.What Brand name medications are you taking? If you already know this information CONFIRM, ask if this is the only brand medication.

2.How much are you paying out of pocket for the cost of these medicines? If you know this info CONFIRM and move on to the next question.

3.Is that for 30,60,90,120 day supply? If you know this info CONFIRM and move on to the next question.

4.What type of prescription coverage do you have through insurance? How much do they pay?

5.Some programs will qualify you based on income. What is the monthly gross (before taxes) of your household income?

6.How much, in total for just this (these) medication(s), would you say that you've spent this year?

7.How many people currently reside in your home?


Great News, I have qualified you based on the information you provided to me which means that you would pay a $0 copay for your medications for the next 12 months at the very least. Once approved for the program, you'll receive your medications by mail direct from the manufacturing company every 90 or 120 days. These are annual enrollment programs, and through our partnership with Find Prescription Relief, and the great part about working with them is you will be re-enrolled each year until you either stop taking the medication or if you require other medications as an alternative.


To get you started and enrolled today, it will be a one-time enrollment amount of (ENROLLMENT FEE PRICE) and the monthly amount of (MONTHLY PRICE). That covers filing all the necessary paperwork needed to get you approved for the program. That also pays for Find Prescription Relief to file your refills every 90 days in a timely manner so you have medications on time and without issue.  How does that sound?


After submitting the the application through the online webportal, using the inbound verification line below, please conduct a warm transfer with the patient on hold into our to administration for a recorded verification to confirm enrollment.

We request you to keep the patient (client) on a hold while communications between you are discussing with our rep what is going on. Before transferring your applicant, we ask your rep to give the follow over the phone before leaving the conference call.


1. Name of client

2. Plan we will be enrolling them with along with the monthly payment and enrollment fee

3. Medication names

4. Household Income amount

5. Are you ready for me to send over? HERE IS MY NAME/NUMBER/ EXTENSION (incase of issue)

6. We ask for the initial start of our enrollments that you stay on the verification silently for the first 3 to 5 minutes.  (UNTIL WE VERIFY PAYMENT INFORMATION….)


This is only to prevent errors and ensure submission completions. Once ready, please have your rep bring the applicant on the line and make a warm introduction as to who we are and what the enrollment process is. Ask them to hold any questions until the end and make sure that your rep gives their phone number and extension and the patient as well.