EXHIBIT_L-5_DoD_Formulary_Restrictions_and_Limitations_(Aug_29 _2013).xlsx

XLSX spreadsheet 83 KB Posted Aug 30, 2013

Attached to: TRICARE Pharmacy Program, Fourth Generation (TPharm4)
Solicitation number: HT9402-13-R-0001
Issued by: Defense Health Agency

About this file

From the source

EXHIBIT_L-5_DoD Formulary Restrictions and Limitations (Aug 29 2013)

View the file

Other files

File	Type	Posted
M270_TFL_Pharmacy_Pilot_Opt-Out_Report.pdf	PDF	Feb 14, 2014
EXHIBIT_L-10_Historical_Data_and_Other_Info_Available_to_Offerors_(Jan_13 _2013).pdf	PDF	Feb 14, 2014
M260_TFL__Pharmacy_Pilot_Override_Report.pdf	PDF	Feb 14, 2014
EXHIBIT_L-4_DoD_Benefit_Design_(Dec_17 _2013).pdf	PDF	Feb 14, 2014
Amendment_0006.pdf	PDF	Feb 14, 2014
M250_TFL_Pharmacy_Pilot_Summary_and_Savings_Report.pdf	PDF	Feb 14, 2014
Exhibit_A.pdf	PDF	Feb 14, 2014
EXHIBIT_L-8_Draft_TFL_(Over_65)_Mandatory_Mail_Drug_List_(Dec_18 _2013).pdf	PDF	Feb 14, 2014
DRAFT_Data_Pkg_23_Utilization_Data_for_Jan-Nov_2013.xlsx	XLSX spreadsheet	Jan 23, 2014
DRAFT_Data_Pkg_24_Retail_Utilization_Detail_CY2013_(Dec_16 _2013).xlsx	XLSX spreadsheet	Jan 23, 2014
Data_Pkg_6_Pre-Deployment_Out-Processing_Centers_(Dec_18_2013).docx	DOCX document	Jan 13, 2014
Data_Pkg_18_Prescription_Transfers_from_Retail_to_Mail_Order_(Dec_9_2013).xls	XLS spreadsheet	Jan 13, 2014
L-10.16_MCPF_Sample_-_MTF_Pt_2_of_3.zip	ZIP file	Jan 13, 2014
L-10.15_MCPF_Sample_-_MTF_Pt_1_of_3.zip	ZIP file	Jan 13, 2014
Data_Pkg_17_Historical_Theater_Medical_Data_Store_(TMDS)_Volume_(Dec_10 _2013).xlsx	XLSX spreadsheet	Jan 13, 2014
Data_Pkg_13_IHS_ _VA_Historical_Claims_Volume_CY12 CY13_(Dec_11 _2013).xlsx	XLSX spreadsheet	Jan 13, 2014
Data_Pkg_7_Historical_Deployed_Prescription_Volume_(Dec_6_2013).xlsx	XLSX spreadsheet	Jan 13, 2014
Data_Pkg_19_ART_Referral_Volume_FY13_(Dec_19_2013).xls	XLS spreadsheet	Jan 13, 2014
L-10.17_MCPF_Sample_-_MTF_Pt_3_of_3.zip	ZIP file	Jan 13, 2014
Data_Pkg_10_Historical_MTF_Call_Volume_(Dec_13_2013).xlsx	XLSX spreadsheet	Jan 13, 2014
Data_Pkg_4_Retail_Utilization_Detail_CY2012_(Dec_16 _2013).xlsx	XLSX spreadsheet	Jan 13, 2014
Data_Pkg_9_Historical_MTF_Claim_Volume_(Dec_10 _2013).xlsx	XLSX spreadsheet	Jan 13, 2014
Data_Pkg_5_Utilization_of_Retail_Maintenance_Meds_by_Benes_Over_65_CY11-CY13_(Dec_13 _2013).xlsx	XLSX spreadsheet	Jan 13, 2014
Data_Pkg_14_TRICARE_Beneficiaries_by_Zip_Code_(Dec_10 _2013).xlsx	XLSX spreadsheet	Jan 13, 2014
EXHIBIT_L-12_Instructions_for_Completing_Retail_Network_Reimbursement _Table_L-1_(Sep_19 _2013).pdf	PDF	Sep 19, 2013
EXHIBIT__L-1_Table_L-1_TPharm4_-_Ammendment_5_(Sep_19 _2013).xls	XLS spreadsheet	Sep 19, 2013
Q A_Clarification_to_Set__9_Answers.pdf	PDF	Sep 19, 2013
Amendment_0005.pdf	PDF	Sep 19, 2013
EXHIBIT_L-13_Background_Information_for_Retail_Network_Reimbursement_Table_L-1_(Sep_17 _2013).pdf	PDF	Sep 19, 2013
Q A_Ninth_Set_Answers.pdf	PDF	Sep 10, 2013
M240_TMDS_Claims_Volume.pdf	PDF	Aug 30, 2013
EXHIBIT__L-14_DRAFT_TPharm4_ProDUR_Parameters_(Aug_30_2013).doc	DOC document	Aug 30, 2013
Q A_Eighth_Set_Answers.pdf	PDF	Aug 30, 2013
D020_AttachA_RPC_Data_-_revised.xlsx	XLSX spreadsheet	Aug 30, 2013
W010_MTF_Data_Integrity_Report_v2.pdf	PDF	Aug 30, 2013
D030_Contractor_Payment-Check_Issue_Data.pdf	PDF	Aug 30, 2013
EXHIBIT_L-4_DoD_Benefit_Design_(Aug_29 _2013).doc	DOC document	Aug 30, 2013
D030_AttachA_Contractor_Payment-Check_Issue_Data_-_Formats.xlsx	XLSX spreadsheet	Aug 30, 2013
Amendment_0004.pdf	PDF	Aug 30, 2013
Data_Pkg_17_Historical_TMDS_Claims_Volume_(Aug_27 _2013).xlsx	XLSX spreadsheet	Aug 30, 2013
EXHIBIT_L-11_Ordering_Instructions_for_Confidential_and_Protected_Information_(Aug_14 _2013)_Amendment_3.pdf	PDF	Aug 15, 2013
Data_Pkg_21_Key_for_Additional_Claims_Level_Data_(Aug_14 _2013).xlsx	XLSX spreadsheet	Aug 15, 2013
M190_AttachA_Mail_Order_Report_Format_w_instructions.xlsx	XLSX spreadsheet	Aug 15, 2013
EXHIBIT_L-10_Historical_Data_and_Other_Info_Available_to_Offerors_Amendment_3_(Aug_13 _2013).pdf	PDF	Aug 15, 2013
Q A_Seventh_Set_Answers.pdf	PDF	Aug 15, 2013
Amendment_0003.pdf	PDF	Aug 15, 2013
EXHIBIT_L-12_Instructions_for_Completing_Retail_Network_Reimbursement _Table_L-1_(Aug_13 _2013).pdf	PDF	Aug 15, 2013
EXHIBIT_L-13_Background_Information_for_Retail_Network_Reimbursement _Table_L-1_(Aug_13 _2013).pdf	PDF	Aug 15, 2013
EXHIBIT__L-1_Table_L-1_TPharm4_-_Ammendment_3_(Aug_13 _2013).docx	DOCX document	Aug 15, 2013
Q A_Sixth_Set_Answers.pdf	PDF	Aug 8, 2013

Show 40 more

Latest 50 of 101 listed here. See the rest on GovTribe.

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

L-5. TOC

FOR OFFICIAL USE ONLY

DoD Formulary Restrictions and Limitations

Current as of Aug 28, 2013
Tab	Description
L-5.1	Quality Level Limits
L-5.2	Prior Authorization
L-5.3	Medical Necessity
L-5.4	703B (Non-Compliant with Federal Ceiling Price)
L-5.5	OTC Demo
L-5.6	Gender Edits
L-5.7	Age Edits
L-5.8	Vaccines

L-5.1. QLL

Generic Name	Dosage Form	Strength	Quality Limit Retail	Quality Limit Mail Order	Collective Limits
APREPITANT	CAPSULE	40 MG	1 CAPSULE PER DISPENSING	1 CAPSULE PER DISPENSING	no
GRANISETRON	PATCH TDWK	3.1MG/24HR	1 PATCH TDWK PER 1 FILLS	1 PATCH TDWK PER 1 FILLS	no
CERTOLIZUMAB PEGOL	SYRINGEKIT	400MG/2ML	2 PENS (1 KIT) PER 28 DAYS	1 SYRINGEKIT (6 SYRINGES) PER 28 DAYS	no
ONDANSETRON HCL	TABLET	24MG	1 TABLET PER 1 FILLS	1 TABLET PER 1 FILLS	no
ONDANSETRON HCL	TABLET	24 MG	1 TABLET PER 1 FILLS	1 TABLET PER 1 FILLS	no
MEDROXYPROGESTERONE ACETATE	VIAL	150 MG/ML	1 VIAL/SYRINGE PER 90 DAYS	1 VIAL/SYRINGE PER 90 DAYS	yes
MEDROXYPROGESTERONE ACETATE	DISP SYRIN	150 MG/ML	1 VIAL/SYRINGE PER 90 DAYS	1 VIAL/SYRINGE PER 90 DAYS	yes
MEDROXYPROGESTERONE ACET	DISP SYRIN	104MG/0.65	1 VIAL/SYRINGE PER 90 DAYS	1 VIAL/SYRINGE PER 90 DAYS	yes
MEDROXYPROGESTERONE ACETATE	DISP SYRIN	104MG/0.65	1 VIAL/SYRINGE PER 90 DAYS	1 VIAL/SYRINGE PER 90 DAYS	yes
PEGFILGRASTIM	DISP SYRIN	6MG/0.6ML	0.6 ML (1 SYRINGE) PER 21 DAYS	1.2 ML (2 PEN) PER 45 DAYS	no
BECLOMETHASONE DIPROPIONATE	SPRAY	42MCG	50 GM (2 BOTTLES) PER 30 DAYS	100 GM (4 BOTTLES) PER 90 DAYS	no
MOMETASONE FUROATE	SPRAY/PUMP	50 MCG	34 GRAM (2 BOTTLES) PER 30 DAYS	102 GRAM (6 BOTTLES) PER 90 DAYS	no
BECLOMETHASONE DIPROPIONATE	AER W/ADAP	40 MCG	34.8 GRAM (4 INHALERS) PER 30 DAYS	104.4 GRAM (12 INHALERS) PER 90 DAYS	no
ALBUTEROL SULFATE	VIAL-NEB	1.25MG/3ML	360 ML (120 NEBS) PER 30 DAYS	1080 ML (360 NEBS) PER 90 DAYS	yes
LEVALBUTEROL HCL	VIAL-NEB	0.31MG/3ML	360 ML (120 NEBS) PER 30 DAYS	1080 ML (360 NEBS) PER 90 DAYS	yes
LEVALBUTEROL HCL	VIAL-NEB	0.63MG/3ML	360 ML (120 NEBS) PER 30 DAYS	1080 ML (360 NEBS) PER 90 DAYS	yes
LEVALBUTEROL HCL	VIAL-NEB	1.25MG/3ML	360 ML (120 NEBS) PER 30 DAYS	1080 ML (360 NEBS) PER 90 DAYS	yes
IPRATROPIUM BROMIDE	SOLUTION	0.2 MG/ML	360 ML (180 NEBS) PER 30 DAYS	1080 ML (540 NEBS) PER 90 DAYS	no
IPRATROPIUM BROMIDE	SOLUTION	0.2MG/ML	360 ML (180 NEBS) PER 30 DAYS	1080 ML (540 NEBS) PER 90 DAYS	no
APREPITANT	CAP DS PK	125MG-80MG	4 CAP DOSE PK PER 28 DAYS	12 CAP DOSE PK PER 84 DAYS	no
FLUOXETINE HCL	CAPSULE DR	90 MG	4 CAPSULE DR PER 28 DAYS	12 CAPSULE DR PER 84 DAYS	no
APREPITANT	CAPSULE	125 MG	4 CAPSULE PER 28 DAYS	12 CAPSULE PER 84 DAYS	no
APREPITANT	CAPSULE	125MG	4 CAPSULE PER 28 DAYS	12 CAPSULE PER 84 DAYS	no
BUPRENORPHINE	PATCH TDWK	20 MCG/HR	4 PATCHES PER 28 DAYS	12 PATCHES PER 84 DAYS	no
BUPRENORPHINE	PATCH TDWK	5 MCG/HR	4 PATCHES PER 28 DAYS	12 PATCHES PER 84 DAYS	no
BUPRENORPHINE	PATCH TDWK	10 MCG/HR	4 PATCHES PER 28 DAYS	12 PATCHES PER 84 DAYS	no
DOLASETRON MESYLATE	TABLET	100 MG	4 TABLET PER 28 DAYS	12 TABLET PER 28 DAYS	yes
ALEFACEPT	VIAL	15 MG	4 VIAL PER 28 DAYS	12 VIAL PER 84 DAYS	no
AZELASTINE HCL	SPRAY/PUMP	137 MCG	60 GRAM (2 BOTTLES) PER 30 DAYS	120 GRAM (4 BOTTLES) PER 90 DAYS	no
AZELASTINE HCL	SPRAY/PUMP	205.5MCG	60 GRAM (2 BOTTLES) PER 30 DAYS	120 GRAM (4 BOTTLES) PER 90 DAYS	no
CABOZANTINIB S-MALATE	CAPSULE	60 MG/DAY	84 CAPSULES PER 28 DAYS FILL	126 CAPSULSE PER 42 DAYS FILL	no
IPRATROPIUM BROMIDE	SPRAY	42MCG	45 ML (3 BOTTLES) PER 30 DAYS	135 ML (9 BOTTLES) PER 90 DAYS	no
VANDETANIB	TABLET	100 MG	90 TABLET PER 30 DAYS	135 TABLET PER 45 DAYS	no
PONATINIB HCL	TABLET	15 MG	90 TABLETS PER 30 DAYS	135 TABLETS PER 45 DAYS	no
ALBUTEROL SULFATE	VIAL-NEB	2.5 MG/3ML	600 ML (200 NEBS) PER 30 DAYS	1650 ML (550 NEBS) PER 90 DAYS	yes
ALBUTEROL SULFATE	VIAL-NEB	2.5MG/3ML	600 ML (200 NEBS) PER 30 DAYS	1650 ML (550 NEBS) PER 90 DAYS	yes
CABOZANTINIB S-MALATE	CAPSULE	140 MG/DAY	112 CAPSULES PER 28 DAY FILL	168 CAPSULES PER 42 DAY FILL	no
SUMATRIPTAN	SPRAY	5 MG	6 DEVICES PER 30 DAYS	18 DEVICES PER 90 DAYS	yes
SUMATRIPTAN	SPRAY	20 MG	6 DEVICES PER 30 DAYS	18 DEVICES PER 90 DAYS	yes
TADALAFIL	TABLET	10 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
SILDENAFIL CITRATE	TABLET	50 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
VARDENAFIL HCL	TABLET	10 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
SILDENAFIL CITRATE	TABLET	100 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
TADALAFIL	TABLET	5 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
TADALAFIL	TABLET	2.5 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
VARDENAFIL HCL	TABLET	20 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
VARDENAFIL HCL	TABLET	20MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
VARDENAFIL HCL	TAB RAPDIS	10 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
SILDENAFIL CITRATE	TABLET	25 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
TADALAFIL	TABLET	20 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
VARDENAFIL HCL	TABLET	5 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
VARDENAFIL HCL	TABLET	2.5 MG	6 TABLET PER 30 DAYS FOR ED	18 TABLET PER 90 DAYS FOR ED	yes
ALPROSTADIL	SUPP.URETH	250 MCG	6 URETHRAL SUPPOSITORIES PER 30 DAYS	18 URETHRAL SUPPOSITORIES PER 90 DAYS	yes
ALPROSTADIL	SUPP.URETH	1000 MCG	6 URETHRAL SUPPOSITORIES PER 30 DAYS	18 URETHRAL SUPPOSITORIES PER 90 DAYS	yes
ALPROSTADIL	SUPP.URETH	500 MCG	6 URETHRAL SUPPOSITORIES PER 30 DAYS	18 URETHRAL SUPPOSITORIES PER 90 DAYS	yes
ALPROSTADIL	SUPP.URETH	125 MCG	6 URETHRAL SUPPOSITORIES PER 30 DAYS	18 URETHRAL SUPPOSITORIES PER 90 DAYS	yes
ALPROSTADIL	VIAL	20 MCG	6 VIAL PER 30 DAYS	18 VIAL PER 90 DAYS	yes
ALPROSTADIL	VIAL	40 MCG	6 VIAL PER 30 DAYS	18 VIAL PER 90 DAYS	yes
ALPROSTADIL	KIT	10 MCG	6 VIAL PER 30 DAYS	18 VIAL PER 90 DAYS	yes
ALPROSTADIL	KIT	20 MCG	6 VIAL PER 30 DAYS	18 VIAL PER 90 DAYS	yes
ALPROSTADIL	KIT	40 MCG	6 VIAL PER 30 DAYS	18 VIAL PER 90 DAYS	yes
FLUTICASONE PROPIONATE	DISK W/DEV	250 MCG	60 BLISTERS (1 DISKUS) PER 30 DAYS	180 BLISTERS (3 DISKUS) PER 90 DAYS	no
FLUTICASONE/SALMETEROL	DISK W/DEV	250-50MCG	60 BLISTERS (1 DISKUS) PER 30 DAYS	180 BLISTERS (3 DISKUS) PER 90 DAYS	yes
FLUTICASONE/SALMETEROL	DISK W/DEV	100-50MCG	60 BLISTERS (1 DISKUS) PER 30 DAYS	180 BLISTERS (3 DISKUS) PER 90 DAYS	yes
FLUTICASONE PROPIONATE	DISK W/DEV	50 MCG	60 BLISTERS (1 DISKUS) PER 30 DAYS	180 BLISTERS (3 DISKUS) PER 90 DAYS	no
FLUTICASONE/SALMETEROL	DISK W/DEV	500-50 MCG	60 BLISTERS (1 DISKUS) PER 30 DAYS	180 BLISTERS (3 DISKUS) PER 90 DAYS	yes
FLUTICASONE/SALMETEROL	DISK W/DEV	100-50 MCG	60 BLISTERS (1 DISKUS) PER 30 DAYS	180 BLISTERS (3 DISKUS) PER 90 DAYS	yes
FLUTICASONE/SALMETEROL	DISK W/DEV	250-50 MCG	60 BLISTERS (1 DISKUS) PER 30 DAYS	180 BLISTERS (3 DISKUS) PER 90 DAYS	yes
FLUTICASONE PROPIONATE	DISK W/DEV	100 MCG	60 BLISTERS (1 DISKUS) PER 30 DAYS	180 BLISTERS (3 DISKUS) PER 90 DAYS	no
FLUTICASONE/SALMETEROL	DISK W/DEV	500-50MCG	60 BLISTERS (1 DISKUS) PER 30 DAYS	180 BLISTERS (3 DISKUS) PER 90 DAYS	yes
SALMETEROL XINAFOATE	DISK W/DEV	50 MCG	60 BLISTERS PER 30 DAYS	180 BLISTERS PER 90 DAYS	no
VORINOSTAT	CAPSULE	100 MG	120 CAPSULE PER 30 DAYS	180 CAPSULE PER 45 DAYS	no
ENZALUTAMIDE	CAPSULE	40 MG	120 CAPSULE PER 30 DAYS	180 CAPSULE PER 45 DAYS	no
FORMOTEROL FUMARATE	CAP W/DEV	12 MCG	60 CAPSULE PER 30 DAYS	180 CAPSULE PER 90 DAYS	no
TAZAROTENE	CREAM (G)	0.05 %	60 GRAM PER 30 DAYS	180 GRAM PER 90 DAYS	yes
ALITRETINOIN	GEL (GRAM)	0.1 %	60 GRAM PER 30 DAYS	180 GRAM PER 90 DAYS	no
ALITRETINOIN	GEL (GM)	0.1%	60 GRAM PER 30 DAYS	180 GRAM PER 90 DAYS	no
TAZAROTENE	CREAM (G)	0.1 %	60 GRAM PER 30 DAYS	180 GRAM PER 90 DAYS	yes
LEVALBUTEROL HCL	VIAL-NEB	1.25MG/0.5	60 ML (120 NEBS) PER 30 DAYS	180 ML (360 NEBS) PER 90 DAYS	yes
SORAFENIB TOSYLATE	TABLET	200 MG	120 TABLET PER 30 DAYS	180 TABLET PER 45 DAYS	no
PAZOPANIB HCL	TABLET	200 MG	120 TABLET PER 30 DAYS	180 TABLET PER 45 DAYS	no
ABIRATERONE ACETATE	TABLET	250 MG	120 TABLET PER 30 DAYS	180 TABLET PER 45 DAYS	no
ONDANSETRON	TAB RAPDIS	8 MG	60 TABLET PER 30 DAYS	180 TABLET PER 90 DAYS	yes
ONDANSETRON HCL	TABLET	4 MG	60 TABLET PER 30 DAYS	180 TABLET PER 90 DAYS	yes
ONDANSETRON HCL	TABLET	8 MG	60 TABLET PER 30 DAYS	180 TABLET PER 90 DAYS	yes
ONDANSETRON	FILM	4 MG	60 TABLET PER 30 DAYS	180 TABLET PER 90 DAYS	yes
ONDANSETRON	TAB RAPDIS	4 MG	60 TABLET PER 30 DAYS	180 TABLET PER 90 DAYS	yes
ONDANSETRON	FILM	8 MG	60 TABLET PER 30 DAYS	180 TABLET PER 90 DAYS	yes
ALBUTEROL SULFATE	VIAL-NEB	2.5 MG/0.5	60 VIAL-NEB (60 ML) PER 30 DAYS	180 VIAL-NEB (180 ML) PER 90 DAYS	yes
ENFUVIRTIDE	KIT	90 MG	1 KIT PER 30 DAYS	2 KIT PER 60 DAYS	no
KETOROLAC TROMETHAMINE	TABLET	10 MG	20 TABLET PER 30 DAYS	20 TABLET PER 30 DAYS	no
KETOROLAC TROMETHAMINE	TABLET	10MG	20 TABLET PER 30 DAYS	20 TABLET PER 30 DAYS	no
FLUNISOLIDE	SPRAY	25 MCG	75 ML (3 BOTTLES) PER 30 DAYS	200 ML (8 BOTTLES) PER 90 DAYS	no
NILOTINIB HCL	CAPSULE	200 MG	112 CAPSULES PER 28 DAYS	224 CAPSULES PER 56 DAYS	no
NILOTINIB HCL	CAPSULE	150 MG	112 CAPSULES PER 28 DAYS	224 CAPSULES PER 56 DAYS	no
ALBUTEROL SULFATE	VIAL-NEB	0.63MG/3ML	750 ML (250 NEBS) PER 30 DAYS	2250 ML (750 NEBS) PER 90 DAYS	yes
BUTORPHANOL TARTRATE	SPRAY	10 MG/ML	8 BOTTLES PER 30 DAYS	24 BOTTLES PER 90 DAYS	no
APREPITANT	CAPSULE	80 MG	8 CAPSULE PER 28 DAYS	24 CAPSULE PER 84 DAYS	no
APREPITANT	CAPSULE	80MG	8 CAPSULE PER 28 DAYS	24 CAPSULE PER 84 DAYS	no
SUMATRIPTAN SUCCINATE	CARTRIDGE	6 MG/0.5ML	8 ML (16 DEVICES) PER 30 DAYS	24 ML (48 DEVICES) PER 90 DAYS	yes
SUMATRIPTAN SUCCINATE	KIT-REFILL	6MG/0.5ML	8 ML (16 DEVICES) PER 30 DAYS	24 ML (48 DEVICES) PER 90 DAYS	yes
SUMATRIPTAN SUCCINATE	PEN INJCTR	6 MG/0.5ML	8 ML (16 DEVICES) PER 30 DAYS	24 ML (48 DEVICES) PER 90 DAYS	yes
SUMATRIPTAN SUCCINATE	PEN INJCTR	4 MG/0.5ML	8 ML (16 DEVICES) PER 30 DAYS	24 ML (48 DEVICES) PER 90 DAYS	yes
SUMATRIPTAN SUCCINATE	PEN IJ KIT	6MG/0.5ML	8 ML (16 DEVICES) PER 30 DAYS	24 ML (48 DEVICES) PER 90 DAYS	yes
SUMATRIPTAN SUCCINATE	CARTRIDGE	4 MG/0.5ML	8 ML (16 DEVICES) PER 30 DAYS	24 ML (48 DEVICES) PER 90 DAYS	yes
SUMATRIPTAN SUCCINATE	VIAL	6 MG/0.5ML	8ML (16 VIALS) PER 30 DAYS	24 ML (48 VIALS) PER 90 DAYS	no
DIHYDROERGOTAMINE MESYLATE	SPRAY/PUMP	0.5MG/SPRY	8 SPRAY/PUMP PER 30 DAYS	24 SPRAY/PUMP PER 90 DAYS	no
GRANISETRON HCL	TABLET	1 MG	8 TABLET PER 28 DAYS	24 TABLET PER 84 DAYS	no
DOLASETRON MESYLATE	TABLET	50 MG	8 TABLET PER 28 DAYS	24 TABLET PER 84 DAYS	yes
SUMATRIPTAN SUCCINATE	TABLET	100MG	9 TABLET PER 30 DAYS	27 TABLET PER 90 DAYS	no
NARATRIPTAN HCL	TABLET	2.5 MG	9 TABLET PER 30 DAYS	27 TABLET PER 90 DAYS	yes
NARATRIPTAN HCL	TABLET	1 MG	9 TABLET PER 30 DAYS	27 TABLET PER 90 DAYS	yes
SUMATRIPTAN SUCCINATE	TABLET	100 MG	9 TABLET PER 30 DAYS	27 TABLET PER 90 DAYS	no
FROVATRIPTAN SUCCINATE	TABLET	2.5 MG	9 TABLET PER 30 DAYS	27 TABLET PER 90 DAYS	no
SUMATRIPTAN SUCC/NAPROXEN S	TABLET	85MG-500MG	9 TABLET PER 30 DAYS	27 TABLET PER 90 DAYS	no
BECLOMETHASONE DIPROPIONATE	HFA AER AD	80 MCG	1 CANISTER PER 30 DAYS	3 CANISTERS PER 90 DAYS	no
FOLLITROPIN BETA,RECOMB	VIAL	150/0.5ML	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING, NO REFILLS	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING	no
MENOTROPINS	VIAL	75 UNIT	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING	no
UROFOLLITROPIN	VIAL	75 UNIT	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING, NO REFILLS	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING	no
FOLLITROPIN BETA,RECOMB	VIAL	75/0.5ML	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING, NO REFILLS	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING	no
FOLLITROPIN BETA,RECOMB	CARTRIDGE	300/0.36ML	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING, NO REFILLS	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING	no
FOLLITROPIN BETA,RECOMB	CARTRIDGE	900/1.08ML	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING, NO REFILLS	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING	no
FOLLITROPIN BETA,RECOMB	CARTRIDGE	600/0.72ML	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING, NO REFILLS	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING	no
FOLLITROPIN ALFA, RECOMB	AMPUL	150 UNIT	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING, NO REFILLS	30 DAYS SUPPLY (MAX 3600 UNITS) PER DISPENSING	no
FLUTICASONE FUROATE	SPRAY SUSP	27.5 MCG	10 GRAM (1 BOTTLE) PER 30 DAYS	30 GRAM (3 BOTTLES) PER 90 DAYS	no
BUDESONIDE/FORMOTEROL FUMAR	HFA AER AD	160-4.5MCG	10.2 GRAM (1 INHALER) PER 30 DAYS	30.6 GRAMS (3 INHALERS) PER 90 DAYS	yes
BUDESONIDE/FORMOTEROL FUMAR	HFA AER AD	80-4.5 MCG	10.2 GRAM (1 INHALER) PER 30 DAYS	30.6 GRAMS (3 INHALERS) PER 90 DAYS	yes
TAZAROTENE	GEL (GRAM)	0.1 %	100 GRAM PER 30 DAYS	300 GRAM PER 90 DAYS	yes
TAZAROTENE	GEL (GRAM)	0.05 %	100 GRAM PER 30 DAYS	300 GRAM PER 90 DAYS	yes
ZOLMITRIPTAN	SPRAY	5MG	12 DEVICES PER 30 DAYS	36 DEVICES PER 90 DAYS	yes
ZOLMITRIPTAN	SPRAY	5 MG	12 DEVICES PER 30 DAYS	36 DEVICES PER 90 DAYS	yes
IMIQUIMOD	CREAM PACK	5 %	12 PACKETS PER 30 DAYS	36 PACKETS PER 90 DAYS	no
IMIQUIMOD	CREAM PACK	3.75 %	12 PACKETS PER 30 DAYS	36 PACKETS PER 90 DAYS	no
ELETRIPTAN HBR	TABLET	40 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	no
RIZATRIPTAN BENZOATE	TAB RAPDIS	5 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ZOLMITRIPTAN	TAB RAPDIS	2.5MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ZOLMITRIPTAN	TABLET	5MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ELETRIPTAN HBR	TABLET	20 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	no
ALMOTRIPTAN MALATE	TABLET	12.5 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
RIZATRIPTAN BENZOATE	TAB RAPDIS	10 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
RIZATRIPTAN BENZOATE	TABLET	5 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ZOLMITRIPTAN	TABLET	5 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ALMOTRIPTAN MALATE	TABLET	12.5MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
RIZATRIPTAN BENZOATE	TABLET	10 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ZOLMITRIPTAN	TABLET	2.5 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ZOLMITRIPTAN	TAB RAPDIS	5MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ZOLMITRIPTAN	TAB RAPDIS	2.5 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ELETRIPTAN HYDROBROMIDE	TABLET	40 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	no
ZOLMITRIPTAN	TABLET	2.5MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ZOLMITRIPTAN	TAB RAPDIS	5 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
ALMOTRIPTAN MALATE	TABLET	6.25 MG	12 TABLET PER 30 DAYS	36 TABLET PER 90 DAYS	yes
CICLESONIDE	HFA AER AD	160 MCG	12.2 GRAM (2 INHALERS) PER 30 DAYS	36.6 GRAM (6 INHALERS) PER 90 DAYS	no
CICLESONIDE	HFA AER AD	80 MCG	12.2 GRAM (2 INHALERS) PER 30 DAYS	36.6 GRAM (6 INHALERS) PER 90 DAYS	no
MOMETASONE FUROATE	AER POW BA	220MCG(30)	120 INHALATIONS (4 INHALERS) PER 30 DAYS	360 INHALATIONS (12 INHALERS) PER 90 DAYS	no
MOMETASONE FUROATE	AER POW BA	110MCG(30)	120 INHALATIONS (4 INHALERS) PER 30 DAYS	360 INHALATIONS (12 INHALERS) PER 90 DAYS	no
MOMETASONE FUROATE	AER POW BA	220MCG 120	120 INHALATIONS (1 INHALER) PER 30 DAYS	360 INHALATIONS (3 INHALERs) PER 90 DAYS	no
MOMETASONE FUROATE	AER POW BA	220MCG(60)	120 INHALATIONS (2 INHALERS) PER 30 DAYS	360 INHALATIONS (6 INHALERS) PER 90 DAYS	no
FENTANYL CITRATE	LOZENGE HD	1600 MCG	120 LOZENGE HD PER 30 DAYS	360 LOZENGES HD PER 90 DAYS	yes
FENTANYL CITRATE	LOZENGE HD	800 MCG	120 LOZENGE HD PER 30 DAYS	360 LOZENGES HD PER 90 DAYS	yes
FENTANYL CITRATE	LOZENGE HD	1600MCG	120 LOZENGE HD PER 30 DAYS	360 LOZENGES HD PER 90 DAYS	yes
FENTANYL CITRATE	LOZENGE HD	400 MCG	120 LOZENGE HD PER 30 DAYS	360 LOZENGES HD PER 90 DAYS	yes
FENTANYL CITRATE	LOZENGE HD	1200 MCG	120 LOZENGE HD PER 30 DAYS	360 LOZENGES HD PER 90 DAYS	yes
FENTANYL CITRATE	LOZENGE HD	1200MCG	120 LOZENGE HD PER 30 DAYS	360 LOZENGES HD PER 90 DAYS	yes
FENTANYL CITRATE	LOZENGE HD	200 MCG	120 LOZENGE HD PER 30 DAYS	360 LOZENGES HD PER 90 DAYS	yes
FENTANYL CITRATE	LOZENGE HD	600 MCG	120 LOZENGE HD PER 30 DAYS	360 LOZENGES HD PER 90 DAYS	yes
FORMOTEROL FUMARATE	VIAL-NEB	20 MCG/2ML	120 ML (60 NEBS) PER 30 DAYS	360 ML (180 NEBS) PER 90 DAYS	no
BUDESONIDE	AMPUL-NEB	0.5 MG/2ML	120 ML (60 NEBS) PER 30 DAYS	360 ML (180 NEBS) PER 90 DAYS	no
ARFORMOTEROL TARTRATE	VIAL-NEB	15MCG/2ML	120 ML (60 NEBS) PER 30 DAYS	360 ML (180 NEBS) PER 90 DAYS	no
CICLESONIDE	SPRAY/PUMP	50 MCG	12.5 GRAM (1 BOTTLE) PER 30 DAYS	37.5 GRAM (3 BOTTLES) PER 90 DAYS	no
ANAKINRA	DISP SYRIN	100MG/0.67	18.76 ML (28 SYRINGES) PER 28 DAYS	37.52 ML (56 SYRINGES) PER 56 DAYS	no
MOMETASONE/FORMOTEROL	HFA AER AD	200-5 MCG	13 GRAMS (1 INHALER) PER 30 DAYS	39 GRAMS (3 INHALERS) PER 90 DAYS	no
MOMETASONE/FORMOTEROL	HFA AER AD	100-5 MCG	13 GRAMS (1 INHALER) PER 30 DAYS	39 GRAMS (3 INHALERS) PER 90 DAYS	no
LENALIDOMIDE	CAPSULE	25 MG	21 CAPSULE PER 28 DAYS	42 CAPSULE PER 56 DAYS	no
LENALIDOMIDE	CAPSULE	15 MG	21 CAPSULE PER 28 DAYS	42 CAPSULE PER 56 DAYS	no
QUININE SULFATE	CAPSULE	324 MG	42 CAPSULE PER DISPENSING	42 CAPSULE PER DISPENSING	no
CAPECITABINE	TABLET	150 MG	21 DAYS SUPPLY PER DISPENSING	42 DAYS SUPPLY PER DISPENSING	no
CAPECITABINE	TABLET	500 MG	21 DAYS SUPPLY PER DISPENSING	42 DAYS SUPPLY PER DISPENSING	no
METHYLNALTREXONE BROMIDE	VIAL	12MG/0.6ML	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER MAIL DISPENSING	no
PONATINIB HCL	TABLET	45 MG	30 TABLETS PER 30 DAYS	45 TABLETS PER 45 DAYS	no
BOSUTINIB	TABLET	500 MG	30 DAYS PER DISPENSING	45 DAYS PER DISPENSING	no
BOSUTINIB	TABLET	100 MG	30 DAYS PER DISPENSING	45 DAYS PER DISPENSING	no
GEFITINIB	TABLET	250 MG	30 DAYS SUPPLY (MAX 60 TABS) PER DISPENSING	45 DAYS SUPPLY (MAX 90 TABS) PER DISPENSING	no
THALIDOMIDE	CAPSULE	200 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
SUNITINIB MALATE	CAPSULE	50MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
IMATINIB MESYLATE	TABLET	100 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
SUNITINIB MALATE	CAPSULE	50 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
SUNITINIB MALATE	CAPSULE	25MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
TRETINOIN	CAPSULE	10 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
THALIDOMIDE	CAPSULE	100 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
IMATINIB MESYLATE	TABLET	400 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
THALIDOMIDE	CAPSULE	50 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
MITOTANE	TABLET	500 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
SUNITINIB MALATE	CAPSULE	25 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
SUNITINIB MALATE	CAPSULE	12.5 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
THIOGUANINE	TABLET	40 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
PROCARBAZINE HCL	CAPSULE	50 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
SUNITINIB MALATE	CAPSULE	12.5MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
LAPATINIB DITOSYLATE	TABLET	250 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
THALIDOMIDE	CAPSULE	150 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER DISPENSING	no
VEMURAFENIB	TABLET	240 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER MAIL DISPENSING	no
ERLOTINIB HCL	TABLET	25 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER MAIL DISPENSING	no
ERLOTINIB HCL	TABLET	150 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER MAIL DISPENSING	no
ERLOTINIB HCL	TABLET	100 MG	30 DAYS SUPPLY PER DISPENSING	45 DAYS SUPPLY PER MAIL DISPENSING	no
BECAPLERMIN	GEL (GRAM)	0.01 %	15 GRAM PER 30 DAYS	45 GRAM PER 90 DAYS	no
DASATINIB	TABLET	140 MG	30 TABLET PER 30 DAYS	45 TABLET PER 45 DAYS	no
VANDETANIB	TABLET	300 MG	30 TABLET PER 30 DAYS	45 TABLET PER 45 DAYS	no
DASATINIB	TABLET	100 MG	30 TABLET PER 30 DAYS	45 TABLET PER 45 DAYS	no
DASATINIB	TABLET	80 MG	30 TABLET PER 30 DAYS	45 TABLET PER 45 DAYS	no
EVEROLIMUS	TABLET	10 MG	30 TABLET PER 30 DAYS	45 TABLET PER 45 DAYS	no
FLUTICASONE PROPIONATE	SPRAY SUSP	50 MCG	16 GRAM (1 BOTTLE) PER 30 DAYS	48 GRAM (3 BOTTLES) PER 90 DAYS	no
TRIAMCINOLONE ACETONIDE	SPRAY	55MCG	16.5 GRAM (1 BOTTLE) PER 30 DAYS	49.5 GRAM (3 BOTTLES) PER 90 DAYS	no
KETOROLAC TROMETHAMINE	SPRAY	15.75 MG	5 BOTTLES PER 30 DAYS	5 BOTTLES PER 30 DAYS	no
IPRATROPIUM/ALBUTEROL SULFA	AER W/ADAP	20-100 MCG	2 AER W/ADAP (8 GM) PER 30 DAYS	5 AER W/ADAP (20 GM) PER 90 DAYS	no
BUDESONIDE	SPRAY/PUMP	32MCG	17.2 GRAM (1 BOTTLE) PER 30 DAYS	51.6 GRAM (3 BOTTLES) PER 90 DAYS	no
BECLOMETHASONE DIPROPIONATE	AER W/ADAP	80 MCG	17.4 GRAM (2 INHALERS) PER 30 DAYS	52.2 GRAM (6 INHALERS) PER 90 DAYS	no
SUMATRIPTAN SUCCINATE	TABLET	50MG	18 TABLET PER 30 DAYS	54 TABLET PER 90 DAYS	yes
SUMATRIPTAN SUCCINATE	TABLET	50 MG	18 TABLET PER 30 DAYS	54 TABLET PER 90 DAYS	yes
SUMATRIPTAN SUCCINATE	TABLET	25 MG	18 TABLET PER 30 DAYS	54 TABLET PER 90 DAYS	yes
IPRATROPIUM/ALBUTEROL SULFA	AMPUL-NEB	0.5-3MG/3	180 AMPUL-NEB (540 ML) PER 30 DAYS	540 AMPUL-NEB (1620 ML) PER 90 DAYS	no
ETANERCEPT	PEN INJCTR	50 MG/ML	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
TEMOZOLOMIDE	CAPSULE	20 MG	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
TEMOZOLOMIDE	CAPSULE	100 MG	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
TEMOZOLOMIDE	CAPSULE	140 MG	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
TEMOZOLOMIDE	CAPSULE	5 MG	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
TEMOZOLOMIDE	CAPSULE	180 MG	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
ETANERCEPT	VIAL	25 MG	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
ETANERCEPT	DISP SYRIN	25MG/0.5ML	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
TEMOZOLOMIDE	CAPSULE	250 MG	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
ETANERCEPT	DISP SYRIN	50 MG/ML	28 DAYS SUPPLY PER DISPENSING	56 DAYS SUPPLY PER DISPENSING	no
IPRATROPIUM/ALBUTEROL SULFA	AER W/ADAP	18-103MCG	2 AER W/ADAP (29.4 GM) PER 30 DAYS	6 AER W/ADAP (88.2 GM) PER 90 DAYS	no
ACLIDINIUM BROMIDE	AER POW BA	400 MCG	2 INHALERS PER 30 DAYS	6 INHALERS PER 90 DAYS	no
ALBUTEROL SULFATE	HFA AER AD	90 MCG	2 INHALERS PER 30 DAYS	6 INHALERS PER 90 DAYS	no
ALBUTEROL SULFATE	HFA AER AD	90MCG	2 INHALERS PER 30 DAYS	6 INHALERS PER 90 DAYS	no
CERTOLIZUMAB PEGOL	KIT	400 MG	2 VIALS (1 KIT) PER 28 DAYS	6 VIALS (3 KITS) PER 84 DAYS	no
NICOTINE POLACRILEX	GUM	2MG		600 PIECES PER 60 DAYS	no
NICOTINE POLACRILEX	GUM	4 MG		600 PIECES PER 60 DAYS	no
NICOTINE POLACRILEX	GUM	2 MG		600 PIECES PER 60 DAYS	no
NICOTINE POLACRILEX	LOZENGE	2 MG		600 PIECES PER 60 DAYS	no
NICOTINE POLACRILEX	GUM	4MG		600 PIECES PER 60 DAYS	no
NICOTINE POLACRILEX	LOZENGE	4 MG		600 PIECES PER 60 DAYS	no
LANCETS	EACH		204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	30 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	23 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	28 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
RING	EACH		204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	33 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	26 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	21 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	25 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	17 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
BED PAN	EACH		204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	32 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	18 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS & BLOOD GLUCOSE STR	COMBO. PKG		204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
RING	EACH	2 1/2"	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
RING	EACH	2"	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
LANCETS	EACH	31 GAUGE	204 LANCETS PER 30 DAYS	612 LANCETS PER 90 DAYS	no
BLOOD SUGAR DIAGNOSTIC	STRIP		204 STRIP PER 30 DAYS	612 STRIP PER 90 DAYS	no
BLOOD SUGAR DIAGNOSTIC	KIT		204 STRIP PER 30 DAYS	612 STRIP PER 90 DAYS	no
BLOOD SUGAR DIAGNOSTIC, DRU	STRIP		204 STRIP PER 30 DAYS	612 STRIP PER 90 DAYS	no
BLOOD SUGAR DIAGNOSTIC, DIS	STRIP		204 STRIP PER 30 DAYS	612 STRIP PER 90 DAYS	no
FLUTICASONE PROPIONATE	AER W/ADAP	44MCG	21.2 GRAM (2 INHALERS) PER 30 DAYS	63.6 GRAM (6 INHALERS) PER 90 DAYS	yes
AZELASTINE/FLUTICASONE	SPRAY/PUMP	137-50 MCG	23 GRAMS (1 BOTTLE) PER 30 DAYS	69 GRAMS (3 BOTTLES) PER 90 DAYS	no
GEMIFLOXACIN MESYLATE	TABLET	320 MG	7 TABLET PER 30 DAYS	7 TABLET PER 30 DAYS	no
FLUTICASONE PROPIONATE	AER W/ADAP	220MCG	24 GRAM (2 INHALERS) PER 30 DAYS	72 GRAM (6 INHALERS) PER 90 DAYS	yes
FLUTICASONE/SALMETEROL	HFA AER AD	230-21MCG	24 GRAM (2 INHALERS) PER 30 DAYS	72 GRAM (6 INHALERS) PER 90 DAYS	no
FLUTICASONE/SALMETEROL	HFA AER AD	115-21MCG	24 GRAM (2 INHALERS) PER 30 DAYS	72 GRAM (6 INHALERS) PER 90 DAYS	no
FLUTICASONE PROPIONATE	AER W/ADAP	220 MCG	24 GRAM (2 INHALERS) PER 30 DAYS	72 GRAM (6 INHALERS) PER 90 DAYS	no
FLUTICASONE/SALMETEROL	HFA AER AD	45-21MCG	24 GRAM (2 INHALERS) PER 30 DAYS	72 GRAM (6 INHALERS) PER 90 DAYS	no
FLUTICASONE PROPIONATE	AER W/ADAP	110MCG	24 GRAM (2 INHALERS) PER 30 DAYS	72 GRAM (6 INHALERS) PER 90 DAYS	yes
BUDESONIDE	AMPUL-NEB	0.25MG/2ML	240 ML (120 NEBS) PER 30 DAYS	720 ML (360 NEBS) PER 90 DAYS	no
CROMOLYN SODIUM	AMPUL-NEB	20 MG/2 ML	240 ML (120 NEBS) PER 30 DAYS	720 ML (360 NEBS) PER 90 DAYS	yes
CROMOLYN SODIUM	AMPUL-NEB	20MG/2ML	240 ML (120 NEBS) PER 30 DAYS	720 ML (360 NEBS) PER 90 DAYS	yes
TRAMADOL HCL/ACETAMINOPHEN	TABLET	37.5-325MG	240 TABLET PER 30 DAYS	720 TABLET PER 90 DAYS	yes
TRAMADOL HCL	TABLET	50 MG	240 TABLET PER 30 DAYS	720 TABLET PER 90 DAYS	yes
TRAMADOL HCL	TABLET	50MG	240 TABLET PER 30 DAYS	720 TABLET PER 90 DAYS	yes
PIRBUTEROL ACETATE	AER BR.ACT	200 MCG	25.6 GRAM (1 INHALER) PER 30 DAYS	76.8 GRAM (3 INHALERS) PER 90 DAYS	no
IPRATROPIUM BROMIDE	HFA AER AD	17MCG	25.8 GRAM (2 INHALERS) PER 30 DAYS	77.4 GRAM (6 INHALERS) PER 90 DAYS	no
ADALIMUMAB	KIT	40MG/0.8ML	4 PENS (2 KIT) PER 28 DAYS	8 PENS (4 KITS) PER 56 DAYS	yes
ADALIMUMAB	KIT	20MG/0.4ML	4 PENS (2 KIT) PER 28 DAYS	8 PENS (4 KITS) PER 56 DAYS	yes
ADALIMUMAB	PEN IJ KIT	40MG/0.8ML	4 PENS (2 KIT) PER 28 DAYS	8 PENS (4 KITS) PER 56 DAYS	yes
ABATACEPT	DISP SYRIN	125 MG/ML	4 SYRINGES PER 28 DAYS	8 SYRINGES PER 56 DAYS	no
CABOZANTINIB S-MALATE	CAPSULE	100 MG/DAY	56 CAPSULES PER 28 DAYS	84 CAPSULE PER 42 DAYS FILL	no
LENALIDOMIDE	CAPSULE	10 MG	42 CAPSULE PER 28 DAYS	84 CAPSULE PER 56 DAYS	no
LENALIDOMIDE	CAPSULE	5 MG	42 CAPSULE PER 28 DAYS	84 CAPSULE PER 56 DAYS	no
SUMATRIPTAN SUCCINATE	NDL FR INJ	6 MG/0.5ML	3 ML (6 INJECTIONS) PER 30 DAYS	9 ML (18 INJECTIONS) PER 90 DAYS	yes
DIHYDROERGOTAMINE MESYLATE	AMPUL	1 MG/ML	30 AMPUL PER 30 DAYS	90 AMPUL PER 90 DAYS	yes
TIOTROPIUM BROMIDE	CAP W/DEV	18MCG	30 BLISTER CAPS PER 30 DAYS	90 BLISTER CAPS PER 90 DAYS	no
TIOTROPIUM BROMIDE	CAP W/DEV	18 MCG	30 BLISTER CAPS PER 30 DAYS	90 BLISTER CAPS PER 90 DAYS	no
IPRATROPIUM BROMIDE	SPRAY	21 MCG	30 ML (1 BOTTLE) PER 30 DAYS	90 ML (3 BOTTLES) PER 90 DAYS	no
TRAMADOL HCL	TAB ER 24H	100 MG	30 TAB ER 24H PER 30 DAYS	90 TAB ER 24H PER 90 DAYS	yes
TRAMADOL HCL	TAB ER 24H	200 MG	30 TAB ER 24H PER 30 DAYS	90 TAB ER 24H PER 90 DAYS	yes
TRAMADOL HCL	TAB ER 24H	300 MG	30 TAB ER 24H PER 30 DAYS	90 TAB ER 24H PER 90 DAYS	yes
DASATINIB	TABLET	50 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
RUXOLITINIB PHOSPHATE	TABLET	10 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
EVEROLIMUS	TABLET	2.5 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
DASATINIB	TABLET	70 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
RUXOLITINIB PHOSPHATE	TABLET	15 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
DASATINIB	TABLET	20 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
RUXOLITINIB PHOSPHATE	TABLET	20 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
RUXOLITINIB PHOSPHATE	TABLET	25 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
EVEROLIMUS	TABLET	5 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
RUXOLITINIB PHOSPHATE	TABLET	5 MG	60 TABLET PER 30 DAYS	90 TABLET PER 45 DAYS	no
CALCIPOTRIENE	CREAM(GM)	0.005%	300 GRAM PER 30 DAYS	900 GRAM PER 90 DAYS	yes
CALCIPOTRIENE	OINT.(GM)	0.005%	300 GRAM PER 30 DAYS	900 GRAM PER 90 DAYS	yes
CALCIPOTRIENE	CREAM (G)	0.005 %	300 GRAM PER 30 DAYS	900 GRAM PER 90 DAYS	yes
CALCIPOTRIENE	OINT. (G)	0.005 %	300 GRAM PER 30 DAYS	900 GRAM PER 90 DAYS	yes
CALCIPOTRIENE	SOLUTION	0.005 %	300 ML PER 30 DAYS	900 ML PER 90 DAYS	no
CALCIPOTRIENE	SOLUTION	0.005%	300 ML PER 30 DAYS	900 ML PER 90 DAYS	no
NICOTINE	PATCH TD24	21 MG/24HR		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	SPRAY	10MG/ML		MAXIMUM 60 DAYS PER FILL	no
VARENICLINE TARTRATE	TAB DS PK	0.5(11)-1		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	PATCH TD24	7MG/24HR		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	PATCH TD24	21MG/24HR		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	PATCH TD24	14MG/24HR		MAXIMUM 60 DAYS PER FILL	no
VARENICLINE TARTRATE	TABLET	0.5 MG		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	PATCH DYSQ	21-14-7MG		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	CARTRIDGE	10 MG		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	PATCH TD24	22MG/24HR		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	SPRAY	10 MG/ML		MAXIMUM 60 DAYS PER FILL	no
BUPROPION HCL	TABLET ER	150 MG		MAXIMUM 60 DAYS PER FILL	no
VARENICLINE TARTRATE	TABLET	1 MG		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	PATCH TD24	22 MG/24HR		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	CARTRIDGE	10MG		MAXIMUM 60 DAYS PER FILL	no
NICOTINE	PATCH TD24	11MG/24HR		MAXIMUM 60 DAYS PER FILL	no

L-5.2. PA

Generic Name	Dosage Form	Strength	Prior Authorization Form	Step Therapy
FENTANYL CITRATE	LOZENGE HD	1600 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
OXYCODONE HCL	TAB ER 12H	80 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	TABLET ER	200 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CPMP 24HR	90 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CPMP 24HR	60 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	TABLET ER	100 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CPMP 24HR	45 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	TABLET SA	100 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TABLET EFF	300 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TABLET EFF	400 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TABLET EFF	800 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CAP ER PEL	130 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	FILM	600 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	FILM	400 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	FILM	1200 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	LOZENGE HD	800 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CPMP 24HR	120 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE/NALTREXONE	CAP ER PEL	100MG-4MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	LOZENGE HD	1600MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CAP SR PEL	100 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TABLET EFF	100 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
OXYCODONE HCL	TAB.SR 12H	80 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TAB SUBL	600 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL	SPRAY	1200 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CAP ER PEL	150 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	LOZENGE HD	400 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	LOZENGE HD	1200 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CAP ER PEL	200 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	LOZENGE HD	1200MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	TABLET SA	200 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL	SPRAY	100 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL	SPRAY	400 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL	SPRAY	600 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	FILM	800 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
OXYCODONE HCL	TAB ER 12H	60 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CAP ER PEL	100 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TAB SUBL	300 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL	SPRAY	200 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL	SPRAY	800 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
HYDROMORPHONE HCL	TAB ER 24H	12 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	CPMP 24HR	75 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	SPRAY/PUMP	100 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	SPRAY/PUMP	400 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TAB SUBL	100 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	TABLET SA	100MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	FILM	200 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TABLET EFF	600 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	LOZENGE HD	200 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TAB SUBL	200 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TAB SUBL	800 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
OXYCODONE HCL	TAB.SR 12H	80MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	LOZENGE HD	600 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TABLET EFF	200 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL CITRATE	TAB SUBL	400 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
MORPHINE SULFATE	TABLET SA	200MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
OXYCODONE HCL	TAB.SR 12H	160 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
FENTANYL	SPRAY	1600 MCG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
HYDROMORPHONE HCL	TAB ER 24H	32 MG	PAC_HIGHDOSEOPIOID_20110413.pdf	yes
TESTOSTERONE	GEL MD PMP	10 MG (2%)	PAF_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	GEL PACKET	1.25G-1.62	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	PATCH TD24	5 MG/24 HR	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	GEL PACKET	2.5G-1.62%	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	GEL MD PMP	1.25G (1%)	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	GEL (GRAM)	50 MG (1%)	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	GEL PACKET	25MG(1%)	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	MUC ER 12H	30 MG	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	PATCH TD24	4 MG/24 HR	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	PATCH TD24	2 MG/24 HR	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	PATCH TD24	2.5MG/24HR	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	SOL MD PMP	30MG/1.5ML	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	GEL PACKET	50 MG (1%)	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
TESTOSTERONE	GEL MD PMP	20.25/1.25	PAF_TESTOSTERONE_REPL_OTHER_THAN_FORTESTA_20130206_FF.pdf	yes
ADALIMUMAB	KIT	40MG/0.8ML	PAFC_ADALIMUMAB_20121018_FF.pdf	no
ADALIMUMAB	KIT	20MG/0.4ML	PAFC_ADALIMUMAB_20121018_FF.pdf	no
ADALIMUMAB	PEN IJ KIT	40MG/0.8ML	PAFC_ADALIMUMAB_20121018_FF.pdf	no
SILDENAFIL CITRATE	TABLET	20 MG	PAFC_ADCIRCA_REVATIO20091230.pdf	no
TADALAFIL	TABLET	20 MG	PAFC_ADCIRCA_REVATIO20091230.pdf	no
ALEFACEPT	VIAL	15 MG	PAFC_ALEFACEPT20080201.pdf	no
ANAKINRA	DISP SYRIN	100MG/0.67	PAFC_ANAKINRA20080201.pdf	no
ARMODAFINIL	TABLET	50 MG	PAFC_ARMODAFINIL_20120711_FF.pdf	yes
ARMODAFINIL	TABLET	150 MG	PAFC_ARMODAFINIL_20120711_FF.pdf	yes
ARMODAFINIL	TABLET	250 MG	PAFC_ARMODAFINIL_20120711_FF.pdf	yes
DUTASTERIDE/TAMSULOSIN HCL	CPMP 24HR	0.5-0.4 MG	PAFC_BPH_JALYN_20111005_FF.pdf	yes
SILODOSIN	CAPSULE	4 MG	PAFC_BPH_RAPAFLO_20111005_FF.pdf	yes
SILODOSIN	CAPSULE	8 MG	PAFC_BPH_RAPAFLO_20111005_FF.pdf	yes
BUPRENORPHINE	PATCH TDWK	20 MCG/HR	PAFC_BUTRANS_20120104_FF.pdf	no
BUPRENORPHINE	PATCH TDWK	5 MCG/HR	PAFC_BUTRANS_20120104_FF.pdf	no
BUPRENORPHINE	PATCH TDWK	10 MCG/HR	PAFC_BUTRANS_20120104_FF.pdf	no
CERTOLIZUMAB PEGOL	KIT	400 MG	PAFC_CERTOLIZUMAB20091230.pdf	no
CERTOLIZUMAB PEGOL	SYRINGEKIT	400MG/2ML	PAFC_CERTOLIZUMAB20091230.pdf	no
TADALAFIL	TABLET	10 MG	PAFC_CIALIS_20120418.pdf	yes
TADALAFIL	TABLET	5 MG	PAFC_CIALIS_20120418.pdf	yes
TADALAFIL	TABLET	2.5 MG	PAFC_CIALIS_20120418.pdf	yes
ROSUVASTATIN CALCIUM	TABLET	10 MG	PAFC_CRESTOR_20101006.pdf	yes
ROSUVASTATIN CALCIUM	TABLET	40 MG	PAFC_CRESTOR_20101006.pdf	yes
ROSUVASTATIN CALCIUM	TABLET	20 MG	PAFC_CRESTOR_20101006.pdf	yes
ROSUVASTATIN CALCIUM	TABLET	5 MG	PAFC_CRESTOR_20101006.pdf	yes
BROMOCRIPTINE MESYLATE	TABLET	0.8 MG	PAFC_CYCLOSET_ST_20120104_FF.pdf	yes
DULOXETINE HCL	CAPSULE DR	30 MG	PAFC_CYMBALTA__ST_20120418.pdf	yes
DULOXETINE HCL	CAPSULE DR	60 MG	PAFC_CYMBALTA__ST_20120418.pdf	yes
DULOXETINE HCL	CAPSULE DR	30MG	PAFC_CYMBALTA__ST_20120418.pdf	yes
DULOXETINE HCL	CAPSULE DR	20 MG	PAFC_CYMBALTA__ST_20120418.pdf	yes
DULOXETINE HCL	CAPSULE DR	60MG	PAFC_CYMBALTA__ST_20120418.pdf	yes
SITAGLIPTIN PHOS/METFORMIN	TABLET	50MG-500MG	PAFC_DPP-4_INHIBITORS_JANUMET_20120711_FF.pdf	yes
SITAGLIPTIN PHOS/METFORMIN	TABLET	50-1000 MG	PAFC_DPP-4_INHIBITORS_JANUMET_20120711_FF.pdf	yes
SITAGLIPTIN PHOS/METFORMIN	TBMP 24HR	50-1000 MG	PAFC_DPP-4_INHIBITORS_JANUMET_JANUMET_XR_20130109_FF.pdf	yes
SITAGLIPTIN PHOS/METFORMIN	TBMP 24HR	100-1000MG	PAFC_DPP-4_INHIBITORS_JANUMET_JANUMET_XR_20130109_FF.pdf	yes
SITAGLIPTIN PHOS/METFORMIN	TBMP 24HR	50MG-500MG	PAFC_DPP-4_INHIBITORS_JANUMET_JANUMET_XR_20130109_FF.pdf	yes
SITAGLIPTIN PHOSPHATE	TABLET	25 MG	PAFC_DPP-4_INHIBITORS_JANUVIA_ST_20120711_FF.pdf	yes
SITAGLIPTIN PHOSPHATE	TABLET	100 MG	PAFC_DPP-4_INHIBITORS_JANUVIA_ST_20120711_FF.pdf	yes
SITAGLIPTIN PHOSPHATE	TABLET	50 MG	PAFC_DPP-4_INHIBITORS_JANUVIA_ST_20120711_FF.pdf	yes
SITAGLIPTIN/SIMVASTATIN	TABLET	100MG-20MG	PAFC_DPP-4_INHIBITORS_JUVISYNC_20120711_FF.pdf	yes
SITAGLIPTIN/SIMVASTATIN	TABLET	100MG-40MG	PAFC_DPP-4_INHIBITORS_JUVISYNC_20120711_FF.pdf	yes
SITAGLIPTIN/SIMVASTATIN	TABLET	100MG-10MG	PAFC_DPP-4_INHIBITORS_JUVISYNC_20120711_FF.pdf	yes
SAXAGLIPTIN HCL/METFORMIN H	TBMP 24HR	5 MG-500MG	PAFC_DPP-4_INHIBITORS_ST__NON_PREF_MET_COMBO_AGENTS_20130109_FF.pdf	yes
SAXAGLIPTIN HCL/METFORMIN H	TBMP 24HR	5MG-1000MG	PAFC_DPP-4_INHIBITORS_ST__NON_PREF_MET_COMBO_AGENTS_20130109_FF.pdf	yes
SAXAGLIPTIN HCL/METFORMIN H	TBMP 24HR	2.5-1000MG	PAFC_DPP-4_INHIBITORS_ST__NON_PREF_MET_COMBO_AGENTS_20130109_FF.pdf	yes
LINAGLIPTIN/METFORMIN HCL	TABLET	2.5-500 MG	PAFC_DPP-4_INHIBITORS_ST__NON_PREF_MET_COMBO_AGENTS_20130109_FF.pdf	yes
LINAGLIPTIN/METFORMIN HCL	TABLET	2.5-850 MG	PAFC_DPP-4_INHIBITORS_ST__NON_PREF_MET_COMBO_AGENTS_20130109_FF.pdf	yes
LINAGLIPTIN/METFORMIN HCL	TABLET	2.5-1000MG	PAFC_DPP-4_INHIBITORS_ST__NON_PREF_MET_COMBO_AGENTS_20130109_FF.pdf	yes
SAXAGLIPTIN HCL	TABLET	2.5 MG	PAFC_DPP-4_INHIBITORS_ST__NON_PREF_SINGLE_AGENTS_20130109_FF.pdf	yes
LINAGLIPTIN	TABLET	5 MG	PAFC_DPP-4_INHIBITORS_ST__NON_PREF_SINGLE_AGENTS_20130109_FF.pdf	yes
SAXAGLIPTIN HCL	TABLET	5 MG	PAFC_DPP-4_INHIBITORS_ST__NON_PREF_SINGLE_AGENTS_20130109_FF.pdf	yes
ETANERCEPT	PEN INJCTR	50 MG/ML	PAFC_ETANERCEPT20080801.pdf	no
ETANERCEPT	VIAL	25 MG	PAFC_ETANERCEPT20080801.pdf	no
ETANERCEPT	DISP SYRIN	25MG/0.5ML	PAFC_ETANERCEPT20080801.pdf	no
ETANERCEPT	DISP SYRIN	50 MG/ML	PAFC_ETANERCEPT20080801.pdf	no
FINGOLIMOD HCL	CAPSULE	0.5 MG	PAFC_GILENYA_PA_20110413.pdf	no
LIRAGLUTIDE	PEN INJCTR	0.6MG/0.1	PAFC_GLP1RAs_BYDUREON_BYETTA_VICTOZA_20130320_FF.pdf	yes
EXENATIDE MICROSPHERES	VIAL	2 MG	PAFC_GLP1RAs_BYDUREON_BYETTA_VICTOZA_20130320_FF.pdf	yes
EXENATIDE	PEN INJCTR	10MCG/0.04	PAFC_GLP1RAs_BYDUREON_BYETTA_VICTOZA_20130320_FF.pdf	yes
EXENATIDE	PEN INJCTR	5MCG/0.02	PAFC_GLP1RAs_BYDUREON_BYETTA_VICTOZA_20130320_FF.pdf	yes
GOLIMUMAB	PEN INJCTR	50MG/0.5ML	PAFC_GOLIMUMAB20091202.pdf	no
GOLIMUMAB	DISP SYRIN	50MG/0.5ML	PAFC_GOLIMUMAB20091202.pdf	no
GABAPENTIN ENACARBIL	TAB ER 24H	600 MG	PAFC_GRALISE_HORIZANT_20120919.pdf	yes
GABAPENTIN	TAB ER 24H	600 MG	PAFC_GRALISE_HORIZANT_20120919.pdf	yes
GABAPENTIN	TAB ER 24H	300-600 MG	PAFC_GRALISE_HORIZANT_20120919.pdf	yes
GABAPENTIN	TAB ER 24H	300 MG	PAFC_GRALISE_HORIZANT_20120919.pdf	yes
SOMATROPIN	CARTRIDGE	5 MG/1.5ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	1MG/0.25ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	1.4MG/0.25	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	PEN INJCTR	15MG/1.5ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	VIAL	10 MG/2 ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	VIAL	8.8 MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	VIAL	5.8MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	VIAL	5 MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	12 MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	0.6MG/0.25	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	2MG/0.25ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	6MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	24 MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	VIAL	10 MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	PEN INJCTR	10MG/1.5ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	12MG/ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	10 MG/2 ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	10MG/1.5ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	VIAL	6 MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	PEN INJCTR	30 MG/3 ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	1.8MG/0.25	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	0.2MG/0.25	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	0.4MG/0.25	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	24MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	6 MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	5 MG/ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	1.2MG/0.25	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	1.6MG/0.25	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	DISP SYRIN	0.8MG/0.25	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	5 MG/2 ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	20 MG/2 ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	VIAL	5.8 MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	12MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	12 MG/ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	PEN INJCTR	5 MG/1.5ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	15MG/1.5ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	5MG/1.5ML	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	8.8 MG/1.5	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	VIAL	4 MG	PAFC_GROWTHHORMONE20070801.pdf	no
SOMATROPIN	CARTRIDGE	8.8MG/1.5	PAFC_GROWTHHORMONE20070801.pdf	no
FOLLITROPIN ALFA, RECOMB	VIAL	75 UNIT	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN ALFA, RECOMB	PEN INJCTR	900/1.5 ML	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN ALFA, RECOMB	VIAL	450 UNIT	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN BETA,RECOMB	VIAL	150/0.5ML	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
MENOTROPINS	VIAL	75 UNIT	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN ALFA, RECOMB	PEN INJCTR	450/0.75ML	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN ALFA, RECOMB	PEN INJCTR	300/0.5ML	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN BETA,RECOMB	VIAL	75/0.5ML	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN ALFA, RECOMB	AMPUL	37.5 UNIT	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN BETA,RECOMB	CARTRIDGE	300/0.36ML	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN BETA,RECOMB	CARTRIDGE	900/1.08ML	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN ALFA, RECOMB	VIAL	1050 UNIT	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN BETA,RECOMB	CARTRIDGE	600/0.72ML	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
FOLLITROPIN ALFA, RECOMB	AMPUL	150 UNIT	PAFC_INJECTABLEGONADOTROPINS20120918.pdf	no
VARDENAFIL HCL	TABLET	10 MG	PAFC_LEVITRA_20120418.pdf	yes
VARDENAFIL HCL	TABLET	20 MG	PAFC_LEVITRA_20120418.pdf	yes
VARDENAFIL HCL	TABLET	20MG	PAFC_LEVITRA_20120418.pdf	yes
VARDENAFIL HCL	TAB RAPDIS	10 MG	PAFC_LEVITRA_20120418.pdf	yes
VARDENAFIL HCL	TABLET	5 MG	PAFC_LEVITRA_20120418.pdf	yes
VARDENAFIL HCL	TABLET	2.5 MG	PAFC_LEVITRA_20120418.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	5MG-80MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	2.5MG-10MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	2.5MG-20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
NIACIN/LOVASTATIN	TBMP 24HR	750MG-20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
LOVASTATIN	TAB ER 24H	40 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
PITAVASTATIN CALCIUM	TABLET	2 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	10MG-20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	10MG-80MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
NIACIN/LOVASTATIN	TBMP 24HR	1000-40 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
NIACIN/SIMVASTATIN	TBMP 24HR	1000-20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
LOVASTATIN	TAB.SR 24H	40MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	5MG-20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
FLUVASTATIN SODIUM	CAPSULE	20 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	5MG-40MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	10MG-40MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
NIACIN/SIMVASTATIN	TBMP 24HR	500MG-20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
NIACIN/SIMVASTATIN	TBMP 24HR	1000-40 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	2.5MG-40MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	5 MG-10 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
NIACIN/LOVASTATIN	TBMP 24HR	1000-20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
LOVASTATIN	TAB.SR 24H	20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
AMLODIPINE/ATORVASTATIN	TABLET	10MG-10MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
FLUVASTATIN SODIUM	TAB ER 24H	80 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
NIACIN/SIMVASTATIN	TBMP 24HR	500MG-40MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
NIACIN/SIMVASTATIN	TBMP 24HR	750MG-20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
FLUVASTATIN SODIUM	CAPSULE	40 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
FLUVASTATIN SODIUM	TAB SR 24H	80 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
LOVASTATIN	TAB.SR 24H	60MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
LOVASTATIN	TAB ER 24H	60 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
LOVASTATIN	TAB ER 24H	20 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
NIACIN/LOVASTATIN	TBMP 24HR	500MG-20MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
PITAVASTATIN CALCIUM	TABLET	1 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
PITAVASTATIN CALCIUM	TABLET	4 MG	PAFC_LIP-1_LOWMODINTENSITY20101006.pdf	yes
FENOFIBRATE	TABLET	160 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRIC ACID	TABLET	35 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE,MICRONIZED	CAPSULE	134MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE NANOCRYSTALLIZE	TABLET	50 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRIC ACID (CHOLINE)	CAPSULE DR	45 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE,MICRONIZED	CAPSULE	67 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE,MICRONIZED	CAPSULE	200 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE NANOCRYSTALLIZE	TABLET	160 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE	CAPSULE	50 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRIC ACID	TABLET	105 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE,MICRONIZED	CAPSULE	43MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE,MICRONIZED	CAPSULE	130MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE	TABLET	50 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRIC ACID (CHOLINE)	CAPSULE DR	135 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE,MICRONIZED	CAPSULE	43 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE,MICRONIZED	CAPSULE	130 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
FENOFIBRATE	CAPSULE	150 MG	PAFC_LIP-2s_FIBRIC_ACID_DERIVATIVES_PA_ST_20110713_FF.pdf	yes
OMEGA-3 ACID ETHYL ESTERS	CAPSULE	1 G	PAFC_LOVAZA_20110811_FF.pdf	no
PREGABALIN	CAPSULE	75 MG	PAFC_LYRICA_20120418.pdf	yes
PREGABALIN	CAPSULE	25 MG	PAFC_LYRICA_20120418.pdf	yes
PREGABALIN	CAPSULE	50 MG	PAFC_LYRICA_20120418.pdf	yes
PREGABALIN	CAPSULE	100 MG	PAFC_LYRICA_20120418.pdf	yes
PREGABALIN	CAPSULE	150 MG	PAFC_LYRICA_20120418.pdf	yes
PREGABALIN	CAPSULE	225 MG	PAFC_LYRICA_20120418.pdf	yes
PREGABALIN	CAPSULE	200 MG	PAFC_LYRICA_20120418.pdf	yes
PREGABALIN	CAPSULE	300 MG	PAFC_LYRICA_20120418.pdf	yes
MECASERMIN	VIAL	10 MG/ML	PAFC_MECASERMIN20070801.pdf	no
MODAFINIL	TABLET	200 MG	PAFC_MODAFINIL20091230.pdf	no
MODAFINIL	TABLET	200MG	PAFC_MODAFINIL20091230.pdf	no
MODAFINIL	TABLET	100 MG	PAFC_MODAFINIL20091230.pdf	no
ZOLPIDEM TARTRATE	TAB MPHASE	12.5 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ZOLPIDEM TARTRATE	TAB MPHASE	6.25 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ESZOPICLONE	TABLET	1 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
DOXEPIN HCL	TABLET	6 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ZOLPIDEM TARTRATE	TAB MPHASE	6.25MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ZOLPIDEM TARTRATE	TAB SUBL	5 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ZOLPIDEM TARTRATE	TAB SUBL	3.5 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
RAMELTEON	TABLET	8 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ZOLPIDEM TARTRATE	SPRAY/PUMP	5 MG/SPRAY	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ESZOPICLONE	TABLET	3 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ZOLPIDEM TARTRATE	TAB MPHASE	12.5MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ESZOPICLONE	TABLET	2 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ZOLPIDEM TARTRATE	TAB SUBL	10 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ZOLPIDEM TARTRATE	TAB SUBL	1.75 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
DOXEPIN HCL	TABLET	3 MG	PAFC_NEWER_SEDATIVE_HYPNOTICS_20130204_FF.pdf	yes
ABATACEPT	DISP SYRIN	125 MG/ML	PAFC_ORENCIA_SQ_201204118.pdf	no
PANTOPRAZOLE SODIUM	TABLET DR	40 MG	PAFC_PPI_20110928_FF.pdf	no
PANTOPRAZOLE SODIUM	TABLET DR	20 MG	PAFC_PPI_20110928_FF.pdf	no
LANSOPRAZOLE	CAPSULE DR	30 MG	PAFC_PPI_20110928_FF.pdf	yes
OMEPRAZOLE/SODIUM BICARBONA	CAPSULE	40MG-1.1G	PAFC_PPI_20110928_FF.pdf	yes
DEXLANSOPRAZOLE	CAP DR MP	60 MG	PAFC_PPI_20110928_FF.pdf	yes
OMEPRAZOLE/SODIUM BICARBONA	PACKET	40-1680MG	PAFC_PPI_20110928_FF.pdf	yes
LANSOPRAZOLE	CAPSULE DR	15 MG	PAFC_PPI_20110928_FF.pdf	yes
LANSOPRAZOLE	TAB RAP DR	30 MG	PAFC_PPI_20110928_FF.pdf	yes

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Oct 27, 2026.