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[null,"INSTRUCTIONS:\nSTEP 1:  Click cell below \"Category\" to choose a condition from the drop down list.\nSTEP 2:  To narrow the information, choose other parameters by clicking in the blank cells below each parameter title to display drop down lists.","Click \"CLEAR\" to clear individual selections.       Click \"CLEAR FORM\" button to clear all selections and start over."]
[]
[]
["Category","ACOEM Reference","Exempt/Non-Exempt","Therapeutic Categories","Route of Administration","Dosage Form","Special_Fill","PeriOp"]
["Traumatic Brain Injury"]
[]
[]
["Drug_Ingredient","Route_of_Administration","Dosage_Form","Strength","Exempt","Special_Fill_Amount","PeriOp_Amount","Therapeutic_Category","Reference_in_ACOEM_Guidelines",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Condition List","ACOEM","Exempt","TheraCat","Route","Dosage","SpecFill","PerOp"]
[{"$f":"_xlfn.CHOOSECOLS(_xlfn._xlws.FILTER(LOOKUP_TABLE[],(IF(A5=\"\",1,LOOKUP_TABLE[Condition]=$A$5))*(IF(B5=\"\",1,LOOKUP_TABLE[Reference_in_ACOEM_Guidelines]=$B$5))*(IF(C5=\"\",1,LOOKUP_TABLE[Exempt]=$C$5))*(IF(D5=\"\",1,LOOKUP_TABLE[Therapeutic_Category]=$D$5))*(IF(E5=\"\",1,LOOKUP_TABLE[Route_of_Administration]=$E$5))*(IF(F5=\"\",1,LOOKUP_TABLE[Dosage_Form]=$F$5))*(IF(G5=\"\",1,LOOKUP_TABLE[Special_Fill]=$G$5))*(IF(H5=\"\",1,LOOKUP_TABLE[PeriOp]=$H$5)),\"None Meet Search Criteria\"),1,3,4,5,6,8,10,11,13)","v":"almotriptan malate"},"ORAL","Tablet","12.5 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ankle and Foot Disorders",{"$f":"_xlfn._xlws.SORT(_xlfn.UNIQUE(_xlfn._xlws.FILTER(RefACOEM,RefACOEM<>\"\",\"\")))","v":"Traumatic Brain Injury (NR)"},{"$f":"_xlfn._xlws.SORT(_xlfn.UNIQUE(_xlfn._xlws.FILTER(Exempt,Exempt<>\"\",\"\")))","v":"Exempt"},{"$f":"_xlfn._xlws.SORT(_xlfn.UNIQUE(_xlfn._xlws.FILTER(TheraCat,TheraCat<>\"\",\"\")))","v":"ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants"},{"$f":"_xlfn._xlws.SORT(_xlfn.UNIQUE(_xlfn._xlws.FILTER(Route,Route<>\"\",\"\")))","v":"INJECTABLE"},{"$f":"_xlfn._xlws.SORT(_xlfn.UNIQUE(_xlfn._xlws.FILTER(Dosage,Dosage<>\"\",\"\")))","v":"ALL EXTENDED RELEASE ORAL PRODUCTS"},{"$f":"_xlfn._xlws.SORT(_xlfn.UNIQUE(_xlfn._xlws.FILTER(Special_Fill,Special_Fill<>\"\",\"\")))","v":"NO"},{"$f":"_xlfn._xlws.SORT(_xlfn.UNIQUE(_xlfn._xlws.FILTER(PeriOp,PeriOp<>\"\",\"\")))","v":"NO"}]
["almotriptan malate","ORAL","Tablet","6.25 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Antiemetics","Traumatic Brain Injury (R)","Non-Exempt","Alternative  Medicines","NASAL","ALL ORAL DOSAGE FORMS","YES","YES"]
["amantadine hcl","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Antiparkinson Agents (NMDA receptor antagonist)","Traumatic Brain Injury (R,NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Anxiety","Traumatic Brain Injury (R,NR)",null,"Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","ORAL","ALL TOPICAL DOSAGE FORMS"]
["atenolol","ORAL","Tablet","100 MG","Exempt","Not Applicable","Not Applicable","Antihypertensives","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Cervical and Thoracic Spine Disorders","Traumatic Brain Injury (X)",null,"Analgesics - Anti-Inflammatory (NSAID)","TOPICAL","Capsule"]
["atenolol","ORAL","Tablet","25 MG","Exempt","Not Applicable","Not Applicable","Antihypertensives","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Chronic Pain","Traumatic Brain Injury (X, NR)",null,"Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","TRANSDERMAL","Capsule, Delayed Release"]
["atenolol","ORAL","Tablet","50 MG","Exempt","Not Applicable","Not Applicable","Antihypertensives","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"COVID-19 Coronavirus",null,null,"Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)",null,"Capsule, Extended"]
["baclofen","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","4 days","4 days","Musculoskeletal Therapy Agents (Muscle Relaxants)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Depressive Disorders",null,null,"Analgesics - NonNarcotic (NSAID)",null,"Capsule, Extended Release"]
["boswellia serrata extract","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Chemicals","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Elbow Disorders",null,null,"Anticonvulsants",null,"Concentrate"]
["bromocriptine mesylate","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Antiparkinson and Related Therapy Agents","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Eye",null,null,"Antidepressants (SSRI)",null,"Film, Extended Release"]
["cabergoline","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Hand, Wrist, and Forearm Disorders",null,null,"Antidepressants (TCAs)",null,"For Suspension - Delayed Release"]
["celecoxib","ORAL","Capsule","100 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Hip and Groin Disorders",null,null,"Antihypertensives",null,"Powder"]
["celecoxib","ORAL","Capsule","200 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Knee Disorders",null,null,"Antiparkinson Agents (NMDA receptor antagonist)",null,"Powder for Suspension"]
["celecoxib","ORAL","Capsule","400 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Low Back Disorders",null,null,"Antiparkinson and Related Therapy Agents",null,"Solution"]
["celecoxib","ORAL","Capsule","50 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Opioid",null,null,"Antipsychotics / Antimanic Agents",null,"Solution, Subcutaneous"]
["choline magnesium trisalicylate","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","Not Applicable","Not Applicable","Analgesics - NonNarcotic (NSAID)","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Post-Traumatic Stress Disorder",null,null,"Beta Blockers",null,"Solution, Subcutaneous, cartridge"]
["cimetidine","ORAL","Tablet","200 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Shoulder",null,null,"Chemicals",null,"Spray"]
["cimetidine","ORAL","Tablet","300 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Traumatic Brain Injury",null,null,"Corticosteroids",null,"Suspension"]
["cimetidine","ORAL","Tablet","400 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Endocrine and Metabolic Agents - Misc.",null,"Syrup"]
["cimetidine","ORAL","Tablet","800 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Hemostatics",null,"Tablet"]
["citicoline","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Alternative  Medicines","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Hypnotics / Sedatives / Sleep Disorder Agents",null,"Tablet Disintegrating, Delayed Release"]
["cyclosporine","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Miscellaneous Therapeutic Classes","Traumatic Brain Injury (NR)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Migraine Products",null,"Tablet, Chewable"]
["dantrolene sodium","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","4 Days","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Miscellaneous Therapeutic Classes",null,"Tablet, Delayed Release"]
["desipramine hcl","ORAL","Tablet","10 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Musculoskeletal Therapy Agents (Muscle Relaxants)",null,"Tablet, Enteric Coated"]
["desipramine hcl","ORAL","Tablet","100 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Progestins",null,"Tablet, Enteric Coated (Delayed Release)"]
["desipramine hcl","ORAL","Tablet","150 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Psychotherapeutic and Neurological Agents - Misc.",null,"Tablet, Extended Release"]
["desipramine hcl","ORAL","Tablet","25 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Psychotherapeutic and Neurological Agents - Misc.\n(NDMA Receptor Antagonist)",null,"Tablet, Orally Disintegrating"]
["desipramine hcl","ORAL","Tablet","50 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Psychotherapeutic and Neurological Agents-Misc.",null,"Tablet, Sublingual"]
["desipramine hcl","ORAL","Tablet","75 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ulcer Drugs"]
["desmopressin acetate","NASAL","Solution","0.01 MG/ACTUATION","Exempt","Not Applicable","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ulcer Drugs (H2 receptor blocker)"]
["desmopressin acetate","ORAL","Tablet","0.1 MG","Exempt","Not Applicable","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury (R)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ulcer Drugs (Proton pump inhibitor)"]
["desmopressin acetate","ORAL","Tablet","0.2 MG","Exempt","Not Applicable","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury (R)"]
["desmopressin acetate","ORAL","Tablet, Sublingual","0.0277 MG","Exempt","Not Applicable","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury (R)"]
["desmopressin acetate","ORAL","Tablet, Sublingual","0.0553 MG","Exempt","Not Applicable","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury (R)"]
["dexamethasone","ORAL","Concentrate","1 MG/ML","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dexamethasone","ORAL","Solution","0.5 MG/5 ML","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dexamethasone","ORAL","Tablet","0.5 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dexamethasone","ORAL","Tablet","0.75 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dexamethasone","ORAL","Tablet","1 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dexamethasone","ORAL","Tablet","1.5 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dexamethasone","ORAL","Tablet","2 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dexamethasone","ORAL","Tablet","20 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dexamethasone","ORAL","Tablet","4 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dexamethasone","ORAL","Tablet","6 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["dextromethorphan hydrobromide - quinidine sulfate","ORAL","Capsule","20 MG ; 10 MG","Non-Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury (NR)"]
["diclofenac potassium","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["diclofenac sodium","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["diclofenac sodium/misoprostol","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Traumatic Brain Injury (X)"]
["diflunisal","ORAL","Tablet","500 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["dihydroergotamine mesylate","NASAL","Spray","0.5 MG/SPRAY","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["dihydroergotamine mesylate","NASAL","Spray","0.725 MG/SPRAY","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["divalproex sodium","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Anticonvulsants","Traumatic Brain Injury (X, NR)"]
["donepezil hcl","ORAL","Tablet","10 MG","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury (R)"]
["donepezil hcl","ORAL","Tablet","23 MG","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury (R)"]
["donepezil hcl","ORAL","Tablet","5 MG","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury (R)"]
["donepezil hcl","ORAL","Tablet, Orally Disintegrating","10 MG","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury (R)"]
["donepezil hcl","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury (R)"]
["eletriptan hydrobromide","ORAL","Tablet","20 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["eletriptan hydrobromide","ORAL","Tablet","40 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["esomeprazole/naproxen","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Traumatic Brain Injury (X)"]
["etodolac","ORAL","Capsule","200 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["etodolac","ORAL","Capsule","300 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["etodolac","ORAL","Tablet","400 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["etodolac","ORAL","Tablet","500 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["etodolac","ORAL","Tablet, Extended Release","400 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["etodolac","ORAL","Tablet, Extended Release","500 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["etodolac","ORAL","Tablet, Extended Release","600 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["famotidine","ORAL","Powder for Suspension","40 MG/5 ML","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury (R)"]
["famotidine","ORAL","Tablet","10 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury (R)"]
["famotidine","ORAL","Tablet","20 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury (R)"]
["famotidine","ORAL","Tablet","40 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury (R)"]
["famotidine/ibuprofen","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Traumatic Brain Injury (X)"]
["fenoprofen calcium","ORAL","Capsule","200 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["fenoprofen calcium","ORAL","Capsule","400 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["fenoprofen calcium","ORAL","Tablet","600 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["flurbiprofen","ORAL","Tablet","100 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["frovatriptan succinate","ORAL","Tablet","2.5 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["ibuprofen","ORAL","Capsule","200 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ibuprofen","ORAL","Suspension","100 MG/5 ML","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ibuprofen","ORAL","Tablet","200 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ibuprofen","ORAL","Tablet","300 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ibuprofen","ORAL","Tablet","400 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ibuprofen","ORAL","Tablet","600 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ibuprofen","ORAL","Tablet","800 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["indomethacin","ORAL","Capsule","25 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["indomethacin","ORAL","Capsule","50 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["indomethacin","ORAL","Capsule, Extended Release","75 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["indomethacin","ORAL","Suspension","25 MG/5 ML","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ketoprofen","ORAL","Capsule","25 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ketoprofen","ORAL","Capsule","50 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ketoprofen","ORAL","Capsule","75 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ketoprofen","ORAL","Capsule, Extended Release","200 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["ketorolac tromethamine","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (X)"]
["ketorolac tromethamine","ORAL","Tablet","10 MG","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (X)"]
["lansoprazole","ORAL","Capsule, Delayed Release","15 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["lansoprazole","ORAL","Capsule, Delayed Release","30 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["lansoprazole","ORAL","Tablet Disintegrating, Delayed Release","15 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["lansoprazole","ORAL","Tablet Disintegrating, Delayed Release","30 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["lithium carbonate","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (NR)"]
["meclofenamate sodium","ORAL","Capsule","100 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["meclofenamate sodium","ORAL","Capsule","50 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["medroxyprogesterone acetate","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Progestins","Traumatic Brain Injury (X)"]
["mefenamic acid","ORAL","Capsule","250 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["meloxicam","ORAL","Capsule","10 MG","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["meloxicam","ORAL","Capsule","5 MG","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["meloxicam","ORAL","Tablet","15 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["meloxicam","ORAL","Tablet","7.5 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["memantine hcl","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.\n(NDMA Receptor Antagonist)","Traumatic Brain Injury (NR)"]
["methylphenidate hcl","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (R)"]
["methylphenidate hcl","ORAL","Solution","10 MG/5 ML","Non-Exempt","4 Days","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (R)"]
["methylphenidate hcl","ORAL","Solution","5 MG/5 ML","Non-Exempt","4 Days","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (R)"]
["methylphenidate hcl","ORAL","Tablet","10 MG","Non-Exempt","4 Days","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (R)"]
["methylphenidate hcl","ORAL","Tablet","20 MG","Non-Exempt","4 Days","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (R)"]
["methylphenidate hcl","ORAL","Tablet","5 MG","Non-Exempt","4 Days","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (R)"]
["methylphenidate hcl","ORAL","Tablet, Chewable","10 MG","Non-Exempt","4 Days","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (R)"]
["methylphenidate hcl","ORAL","Tablet, Chewable","2.5 MG","Non-Exempt","4 Days","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (R)"]
["methylphenidate hcl","ORAL","Tablet, Chewable","5 MG","Non-Exempt","4 Days","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (R)"]
["methylprednisolone","ORAL","Tablet","16 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["methylprednisolone","ORAL","Tablet","2 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["methylprednisolone","ORAL","Tablet","32 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["methylprednisolone","ORAL","Tablet","4 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["methylprednisolone","ORAL","Tablet","8 MG","Exempt","Not Applicable","Not Applicable","Corticosteroids","Traumatic Brain Injury (X)"]
["midazolam hcl","ORAL","Syrup","2 MG/ML","Non-Exempt","4 Days","Not Applicable","Hypnotics / Sedatives / Sleep Disorder Agents","Traumatic Brain Injury (R)"]
["misoprostol","ORAL","Tablet","100 MCG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs","Traumatic Brain Injury (R)"]
["misoprostol","ORAL","Tablet","200 MCG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs","Traumatic Brain Injury (R)"]
["modafinil","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury (NR)"]
["nabumetone","ORAL","Tablet","1 GM","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["nabumetone","ORAL","Tablet","500 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["nabumetone","ORAL","Tablet","750 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen","ORAL","Suspension","125 MG/5 ML","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen","ORAL","Tablet","250 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen","ORAL","Tablet","375 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen","ORAL","Tablet","500 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen sodium","ORAL","Capsule","220 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen sodium","ORAL","Tablet","220 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen sodium","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen sodium","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen sodium","ORAL","Tablet, Extended Release","375 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen sodium","ORAL","Tablet, Extended Release","500 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naproxen sodium","ORAL","Tablet, Extended Release","750 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["naratriptan hcl","ORAL","Tablet","1 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["naratriptan hcl","ORAL","Tablet","2.5 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet","10 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet","15 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet","2.5 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet","20 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet","5 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet","7.5 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet, Orally Disintegrating","10 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet, Orally Disintegrating","15 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["olanzapine","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","4 Days","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["omeprazole","ORAL","Capsule, Delayed Release","10 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["omeprazole","ORAL","Capsule, Delayed Release","20 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["omeprazole","ORAL","Capsule, Delayed Release","40 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["omeprazole","ORAL","Tablet, Delayed Release","20 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["omeprazole","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["oxaprozin","ORAL","Tablet","600 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["pantoprazole sodium","ORAL","For Suspension - Delayed Release","40 MG/Packet","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["pantoprazole sodium","ORAL","Tablet, Enteric Coated","20 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["pantoprazole sodium","ORAL","Tablet, Enteric Coated","40 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["phenobarbital","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Hypnotics / Sedatives / Sleep Disorder Agents","Traumatic Brain Injury (X, NR)"]
["phenytoin; \nphenytoin sodium","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Anticonvulsants","Traumatic Brain Injury (X, NR)"]
["piroxicam","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (X)"]
["progesterone","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","Not Applicable","Not Applicable","Progestins","Traumatic Brain Injury (X)"]
["propranolol hcl","ORAL","Capsule, Extended","120 MG","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Capsule, Extended","160 MG","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Capsule, Extended","60 MG","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Capsule, Extended","80 MG","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Solution","20 MG/5 ML","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Solution","4.28 MG/ML","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Solution","40 MG/5 ML","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Tablet","10 MG","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Tablet","20 MG","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Tablet","40 MG","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Tablet","60 MG","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["propranolol hcl","ORAL","Tablet","80 MG","Exempt","Not Applicable","Not Applicable","Beta Blockers","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet","100 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet","150 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet","200 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet","25 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet","300 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet","400 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet","50 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet, Extended Release","150 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet, Extended Release","200 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet, Extended Release","300 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet, Extended Release","400 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["quetiapine fumarate","ORAL","Tablet, Extended Release","50 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["rabeprazole sodium","ORAL","Tablet, Enteric Coated","20 MG","Exempt","Not Applicable","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Solution","1 MG/ML","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet","0.25 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet","0.5 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet","1 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet","2 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet","3 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet","4 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet, Orally Disintegrating","0.25 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet, Orally Disintegrating","0.5 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet, Orally Disintegrating","1 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet, Orally Disintegrating","2 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet, Orally Disintegrating","3 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["risperidone","ORAL","Tablet, Orally Disintegrating","4 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["rivastigmine","TRANSDERMAL","Film, Extended Release","13.3 MG/24 HR","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury (R)"]
["rivastigmine","TRANSDERMAL","Film, Extended Release","4.6 MG/24 HR","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury (R)"]
["rivastigmine","TRANSDERMAL","Film, Extended Release","9.5 MG/24 HR","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury (R)"]
["rivastigmine tartrate","ORAL","Capsule","1.5 MG","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury (R)"]
["rivastigmine tartrate","ORAL","Capsule","3 MG","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury (R)"]
["rivastigmine tartrate","ORAL","Capsule","4.5 MG","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury (R)"]
["rivastigmine tartrate","ORAL","Capsule","6 MG","Exempt","Not Applicable","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury (R)"]
["rizatriptan benzoate","ORAL","Tablet","10 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["rizatriptan benzoate","ORAL","Tablet","5 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["rizatriptan benzoate","ORAL","Tablet, Orally Disintegrating","10 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["rizatriptan benzoate","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["salsalate","ORAL","Tablet","500 MG","Exempt","Not Applicable","Not Applicable","Analgesics - NonNarcotic (NSAID)","Traumatic Brain Injury (NR)"]
["salsalate","ORAL","Tablet","750 MG","Exempt","Not Applicable","Not Applicable","Analgesics - NonNarcotic (NSAID)","Traumatic Brain Injury (NR)"]
["sertraline hcl","ORAL","Capsule","150 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury (R)"]
["sertraline hcl","ORAL","Capsule","200 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury (R)"]
["sertraline hcl","ORAL","Concentrate","20 MG/ML","Exempt","Not Applicable","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury (R)"]
["sertraline hcl","ORAL","Tablet","100 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury (R)"]
["sertraline hcl","ORAL","Tablet","25 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury (R)"]
["sertraline hcl","ORAL","Tablet","50 MG","Exempt","Not Applicable","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury (R)"]
["sucralfate","ORAL","Suspension","1 GM/10 ML","Exempt","Not Applicable","Not Applicable","Ulcer Drugs","Traumatic Brain Injury (R)"]
["sucralfate","ORAL","Tablet","1 GM","Exempt","Not Applicable","Not Applicable","Ulcer Drugs","Traumatic Brain Injury (R)"]
["sulindac","ORAL","Tablet","150 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["sulindac","ORAL","Tablet","200 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["sumatriptan succinate","NASAL","Powder","11 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["sumatriptan succinate","INJECTABLE","Solution, Subcutaneous","3 MG/05 ML","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["sumatriptan succinate","INJECTABLE","Solution, Subcutaneous, cartridge","4 MG/0.5 ML","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["sumatriptan succinate","INJECTABLE","Solution, Subcutaneous, cartridge","6 MG/0.5 ML","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["sumatriptan succinate","NASAL","Spray","10 MG/SPRAY","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["sumatriptan succinate","NASAL","Spray","20 MG/SPRAY","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["sumatriptan succinate","NASAL","Spray","5 MG/SPRAY","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["sumatriptan succinate","ORAL","Tablet","100 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["sumatriptan succinate","ORAL","Tablet","25 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["sumatriptan succinate","ORAL","Tablet","50 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["tizanidine hcl","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","4 days","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Traumatic Brain Injury (R)"]
["tolmetin sodium","ORAL","Capsule","400 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["tolmetin sodium","ORAL","Tablet","600 MG","Exempt","Not Applicable","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury (NR)"]
["tranexamic acid","ORAL","Tablet","650 MG","Exempt","Not Applicable","Not Applicable","Hemostatics","Traumatic Brain Injury (R)"]
["valproic acid","ORAL","Capsule","250 MG","Non-Exempt","Not Applicable","Not Applicable","Anticonvulsants","Traumatic Brain Injury (X, NR)"]
["valproic acid","ORAL","Solution","250 MG/5 ML","Non-Exempt","Not Applicable","Not Applicable","Anticonvulsants","Traumatic Brain Injury (X, NR)"]
["ziprasidone hcl","ORAL","Capsule","20 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["ziprasidone hcl","ORAL","Capsule","40 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["ziprasidone hcl","ORAL","Capsule","60 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["ziprasidone hcl","ORAL","Capsule","80 MG","Exempt","Not Applicable","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury (R)"]
["zolmitriptan","NASAL","Spray","2.5 MG/SPRAY","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["zolmitriptan","NASAL","Spray","5 MG/SPRAY","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["zolmitriptan","ORAL","Tablet","2.5 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["zolmitriptan","ORAL","Tablet","5 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["zolmitriptan","ORAL","Tablet, Orally Disintegrating","2.5 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]
["zolmitriptan","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","Not Applicable","Not Applicable","Migraine Products","Traumatic Brain Injury (R)"]

{"sheet":"Lookup_Table","index":1,"n_rows":3981,"n_cols":14,"rows_kept":3981,"cut":false,"hidden":true,"merged":[]}
["Drug_Ingredient","Reference_ Brand_Name","Route_of_Administration","Dosage_Form","Strength","Exempt","Special_Fill","Special_Fill_Amount","PeriOp","PeriOp_Amount","Therapeutic_Category","Condition","Reference_in_ACOEM_Guidelines","RxCUI"]
["acetaminophen","TYLENOL","ORAL","Capsule","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","198436"]
["acetaminophen","TYLENOL","ORAL","Capsule","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198436"]
["acetaminophen","TYLENOL","ORAL","Capsule","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (R)","198436"]
["acetaminophen","TYLENOL","ORAL","Capsule","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R,X)","198436"]
["acetaminophen","TYLENOL","ORAL","Capsule","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","198436"]
["acetaminophen","TYLENOL","ORAL","Capsule","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","198436"]
["acetaminophen","TYLENOL","ORAL","Capsule","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","198436"]
["acetaminophen","TYLENOL","ORAL","Capsule","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","198436"]
["acetaminophen","TYLENOL","ORAL","Capsule","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","198436"]
["acetaminophen","TYLENOL","ORAL","Capsule","500 mg","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","198439"]
["acetaminophen","TYLENOL","ORAL","Capsule","500 mg","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198439"]
["acetaminophen","TYLENOL","ORAL","Capsule","500 mg","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (R)","198439"]
["acetaminophen","TYLENOL","ORAL","Capsule","500 mg","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R,X)","198439"]
["acetaminophen","TYLENOL","ORAL","Capsule","500 mg","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","198439"]
["acetaminophen","TYLENOL","ORAL","Capsule","500 mg","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","198439"]
["acetaminophen","TYLENOL","ORAL","Capsule","500 mg","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","198439"]
["acetaminophen","TYLENOL","ORAL","Capsule","500 mg","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","198439"]
["acetaminophen","TYLENOL","ORAL","Capsule","500 mg","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","198439"]
["acetaminophen","TYLENOL","ORAL","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","238159"]
["acetaminophen","TYLENOL","ORAL","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","238159"]
["acetaminophen","TYLENOL","ORAL","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (R)","238159"]
["acetaminophen","TYLENOL","ORAL","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R,X)","238159"]
["acetaminophen","TYLENOL","ORAL","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","238159"]
["acetaminophen","TYLENOL","ORAL","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","238159"]
["acetaminophen","TYLENOL","ORAL","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","238159"]
["acetaminophen","TYLENOL","ORAL","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","238159"]
["acetaminophen","TYLENOL","ORAL","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","238159"]
["acetaminophen","TYLENOL","ORAL","Suspension","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","243675"]
["acetaminophen","TYLENOL","ORAL","Suspension","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","243675"]
["acetaminophen","TYLENOL","ORAL","Suspension","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (R)","243675"]
["acetaminophen","TYLENOL","ORAL","Suspension","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R,X)","243675"]
["acetaminophen","TYLENOL","ORAL","Suspension","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","243675"]
["acetaminophen","TYLENOL","ORAL","Suspension","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","243675"]
["acetaminophen","TYLENOL","ORAL","Suspension","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","243675"]
["acetaminophen","TYLENOL","ORAL","Suspension","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","243675"]
["acetaminophen","TYLENOL","ORAL","Suspension","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","243675"]
["acetaminophen","TYLENOL","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","313782"]
["acetaminophen","TYLENOL","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","313782"]
["acetaminophen","TYLENOL","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (R)","313782"]
["acetaminophen","TYLENOL","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R,X)","313782"]
["acetaminophen","TYLENOL","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","313782"]
["acetaminophen","TYLENOL","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","313782"]
["acetaminophen","TYLENOL","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","313782"]
["acetaminophen","TYLENOL","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","313782"]
["acetaminophen","TYLENOL","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","313782"]
["acetaminophen","TYLENOL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","198440"]
["acetaminophen","TYLENOL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198440"]
["acetaminophen","TYLENOL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (R)","198440"]
["acetaminophen","TYLENOL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R,X)","198440"]
["acetaminophen","TYLENOL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","198440"]
["acetaminophen","TYLENOL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","198440"]
["acetaminophen","TYLENOL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","198440"]
["acetaminophen","TYLENOL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","198440"]
["acetaminophen","TYLENOL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","198440"]
["acetaminophen","TYLENOL","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","198444"]
["acetaminophen","TYLENOL","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198444"]
["acetaminophen","TYLENOL","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (R)","198444"]
["acetaminophen","TYLENOL","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R,X)","198444"]
["acetaminophen","TYLENOL","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","198444"]
["acetaminophen","TYLENOL","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","198444"]
["acetaminophen","TYLENOL","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","198444"]
["acetaminophen","TYLENOL","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","198444"]
["acetaminophen","TYLENOL","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","198444"]
["acetaminophen","TYLENOL","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","432477"]
["acetaminophen","TYLENOL","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","432477"]
["acetaminophen","TYLENOL","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (R)","432477"]
["acetaminophen","TYLENOL","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R,X)","432477"]
["acetaminophen","TYLENOL","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","432477"]
["acetaminophen","TYLENOL","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","432477"]
["acetaminophen","TYLENOL","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","432477"]
["acetaminophen","TYLENOL","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","432477"]
["acetaminophen","TYLENOL","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","432477"]
["acetaminophen","TYLENOL","ORAL","Tablet, Extended Release","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1148399"]
["acetaminophen","TYLENOL","ORAL","Tablet, Extended Release","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1148399"]
["acetaminophen","TYLENOL","ORAL","Tablet, Extended Release","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (R)","1148399"]
["acetaminophen","TYLENOL","ORAL","Tablet, Extended Release","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R,X)","1148399"]
["acetaminophen","TYLENOL","ORAL","Tablet, Extended Release","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1148399"]
["acetaminophen","TYLENOL","ORAL","Tablet, Extended Release","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","1148399"]
["acetaminophen","TYLENOL","ORAL","Tablet, Extended Release","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","1148399"]
["acetaminophen","TYLENOL","ORAL","Tablet, Extended Release","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","1148399"]
["acetaminophen","TYLENOL","ORAL","Tablet, Extended Release","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","1148399"]
["acetyl l-carnitine","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc","Chronic Pain","Chronic Pain (X)","Not Applicable"]
["acyclovir","ZOVIRAX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antivirals","Chronic Pain","Chronic Pain (NR)","1153461"]
["adalimumab","HUMIRA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1163691"]
["adalimumab","HUMIRA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","1163691"]
["adalimumab","HUMIRA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","1163691"]
["adalimumab","HUMIRA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","1163691"]
["adalimumab-aacf","IDACIO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","2659920"]
["adalimumab-aacf","IDACIO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","2659921"]
["adalimumab-aacf","IDACIO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","2659922"]
["adalimumab-aacf","IDACIO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","2659923"]
["adalimumab-aaty","YUFLYMA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","2661777"]
["adalimumab-aaty","YUFLYMA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","2661777"]
["adalimumab-aaty","YUFLYMA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","2661777"]
["adalimumab-aaty","YUFLYMA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","2661777"]
["adalimumab-adaz","HYRIMOZ","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","2662733"]
["adalimumab-adaz","HYRIMOZ","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","2662733"]
["adalimumab-adaz","HYRIMOZ","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","2662733"]
["adalimumab-adaz","HYRIMOZ","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","2662733"]
["adalimumab-adbm","CYLEZO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","2663270"]
["adalimumab-adbm","CYLEZO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","2663270"]
["adalimumab-adbm","CYLEZO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","2663270"]
["adalimumab-adbm","CYLEZO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","2663270"]
["adalimumab-afzb","ABRILADA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","2668062"]
["adalimumab-afzb","ABRILADA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","2668062"]
["adalimumab-afzb","ABRILADA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","2668062"]
["adalimumab-afzb","ABRILADA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","2668062"]
["adalimumab-aqvh","YUSIMRY","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","2662134"]
["adalimumab-aqvh","YUSIMRY","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","2662134"]
["adalimumab-aqvh","YUSIMRY","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","2662134"]
["adalimumab-aqvh","YUSIMRY","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","2662134"]
["adalimumab-atto","AMJEVITA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","2662284"]
["adalimumab-atto","AMJEVITA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","2662284"]
["adalimumab-atto","AMJEVITA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","2662284"]
["adalimumab-atto","AMJEVITA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","2662284"]
["adalimumab-bwwd","HADLIMA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","2659135"]
["adalimumab-bwwd","HADLIMA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","2659135"]
["adalimumab-bwwd","HADLIMA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","2659135"]
["adalimumab-bwwd","HADLIMA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","2659135"]
["adalimumab-fkjp","HULIO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","2661140"]
["adalimumab-fkjp","HULIO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","2661140"]
["adalimumab-fkjp","HULIO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","2661140"]
["adalimumab-fkjp","HULIO","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","2661140"]
["albuterol sulfate","PROAIR HFA","INHALATION","MDI - HFA, 200 Actuations","0.09 MG/Actuation","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","2123072"]
["albuterol sulfate","VENTOLIN HFA","INHALATION","MDI - HFA, 200 Actuations","0.09 MG/Actuation","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","2123076"]
["albuterol sulfate","PROVENTIL HFA","INHALATION","MDI - HFA, 200 Actuations","0.09 MG/Actuation","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","2123111"]
["albuterol sulfate","VENTOLIN HFA","INHALATION","MDI - HFA, 60 Actuations","0.09 MG/Actuation","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","801092"]
["albuterol sulfate","PROAIR RESPICLICK","INHALATION","MDI - Powder","0.09 MG/Actuation","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1649560"]
["albuterol sulfate","PROAIR DIGIHALER","INHALATION","MDI - Powder","0.09 MG/Actuation","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","2166796"]
["albuterol sulfate","PROVENTIL, VENTOLIN","INHALATION","Solution","0.083% Base","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","630208"]
["albuterol sulfate","ACCUNEB","INHALATION","Solution","0.21%","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","351137"]
["albuterol sulfate","ACCUNEB","INHALATION","Solution","0.42%","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","351136"]
["albuterol sulfate","PROVENTIL, VENTOLIN","INHALATION","Solution","0.5% Base","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","199924"]
["albuterol sulfate","PROVENTIL, VENTOLIN","ORAL","Syrup","2 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","755497"]
["albuterol sulfate","PROVENTIL, VENTOLIN","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","197316"]
["albuterol sulfate","PROVENTIL, VENTOLIN","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","197318"]
["albuterol sulfate","VOSPIRE ER","ORAL","Tablet, Extended Release","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","359144"]
["albuterol sulfate","VOSPIRE ER","ORAL","Tablet, Extended Release","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","359145"]
["alcaftadine","LASTACAFT","OPHTHALMIC","Solution","0.25%","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","1000085"]
["alclometasone dipropionate","ACLOVATE","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1154609"]
["alendronate sodium","FOSAMAX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Chronic Pain","Chronic Pain (R)","1367010"]
["alendronate sodium","FOSAMAX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1367010"]
["alendronate sodium","FOSAMAX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Knee Disorders","Knee Disorders (NR)","1367010"]
["alendronate sodium","FOSAMAX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Shoulder","Shoulder (R,NR)","1367010"]
["almotriptan malate","AXERT","ORAL","Tablet","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","284205"]
["almotriptan malate","AXERT","ORAL","Tablet","6.25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","284204"]
["alprazolam","XANAX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antianxiety Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1155284"]
["amantadine hcl","GOCOVRI, SYMMETREL, OSMOLEX ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiparkinson Agents (NMDA receptor antagonist)","Chronic Pain","Chronic Pain (X)","1151229"]
["amantadine hcl","GOCOVRI, SYMMETREL, OSMOLEX ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiparkinson Agents (NMDA receptor antagonist)","Low Back Disorders","Low Back Disorders (X)","1151229"]
["amantadine hcl","GOCOVRI, SYMMETREL, OSMOLEX ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiparkinson Agents (NMDA receptor antagonist)","Traumatic Brain Injury","Traumatic Brain Injury (R,NR)","1151229"]
["amcinonide","CYCLOCORT","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1157140"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856783"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R,X)","856783"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","856783"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","856783"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","856783"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","856783"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856783"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","856783"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856762"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R,X)","856762"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","856762"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","856762"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","856762"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","856762"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856762"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","856762"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856773"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R,X)","856773"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","856773"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","856773"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","856773"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","856773"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856773"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","856773"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856834"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R,X)","856834"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","856834"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","856834"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","856834"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","856834"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856834"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","856834"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856845"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R,X)","856845"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","856845"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","856845"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","856845"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","856845"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856845"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","856845"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856853"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R,X)","856853"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","856853"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","856853"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","856853"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","856853"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856853"]
["amitriptyline hcl","ELAVIL","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","856853"]
["amlodipine besylate","NORVASC, KATERZIA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Calcium Channel Blockers","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1152291"]
["amoxapine","ASENDIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","197363"]
["amoxapine","ASENDIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","197364"]
["amoxapine","ASENDIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","197365"]
["amoxapine","ASENDIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","197366"]
["amoxicillin/clavulanate potassium","AUGMENTIN '125'","ORAL","Powder for Suspension","125 MG/5 ML-31.25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","617302"]
["amoxicillin/clavulanate potassium","AUGMENTIN '125'","ORAL","Powder for Suspension","125 MG/5 ML-31.25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","617302"]
["amoxicillin/clavulanate potassium","AUGMENTIN '125'","ORAL","Powder for Suspension","125 MG/5 ML-31.25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","617302"]
["amoxicillin/clavulanate potassium","AUGMENTIN '200'","ORAL","Powder for Suspension","200 MG/5 ML-28.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","617423"]
["amoxicillin/clavulanate potassium","AUGMENTIN '200'","ORAL","Powder for Suspension","200 MG/5 ML-28.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","617423"]
["amoxicillin/clavulanate potassium","AUGMENTIN '200'","ORAL","Powder for Suspension","200 MG/5 ML-28.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","617423"]
["amoxicillin/clavulanate potassium","AUGMENTIN '250'","ORAL","Powder for Suspension","250 MG/5 ML-62.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","617322"]
["amoxicillin/clavulanate potassium","AUGMENTIN '250'","ORAL","Powder for Suspension","250 MG/5 ML-62.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","617322"]
["amoxicillin/clavulanate potassium","AUGMENTIN '250'","ORAL","Powder for Suspension","250 MG/5 ML-62.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","617322"]
["amoxicillin/clavulanate potassium","AUGMENTIN '400'","ORAL","Powder for Suspension","400 MG/5 ML-57 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","617430"]
["amoxicillin/clavulanate potassium","AUGMENTIN '400'","ORAL","Powder for Suspension","400 MG/5 ML-57 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","617430"]
["amoxicillin/clavulanate potassium","AUGMENTIN '400'","ORAL","Powder for Suspension","400 MG/5 ML-57 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","617430"]
["amoxicillin/clavulanate potassium","AUGMENTIN ES-600","ORAL","Powder for Suspension","600 MG/5 ML-42.9 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","617993"]
["amoxicillin/clavulanate potassium","AUGMENTIN ES-600","ORAL","Powder for Suspension","600 MG/5 ML-42.9 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","617993"]
["amoxicillin/clavulanate potassium","AUGMENTIN ES-600","ORAL","Powder for Suspension","600 MG/5 ML-42.9 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","617993"]
["amoxicillin/clavulanate potassium","AUGMENTIN '250'","ORAL","Tablet","250 MG-125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","562251"]
["amoxicillin/clavulanate potassium","AUGMENTIN '250'","ORAL","Tablet","250 MG-125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","562251"]
["amoxicillin/clavulanate potassium","AUGMENTIN '250'","ORAL","Tablet","250 MG-125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","562251"]
["amoxicillin/clavulanate potassium","AUGMENTIN '500'","ORAL","Tablet","500 MG-125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","617296"]
["amoxicillin/clavulanate potassium","AUGMENTIN '500'","ORAL","Tablet","500 MG-125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","617296"]
["amoxicillin/clavulanate potassium","AUGMENTIN '500'","ORAL","Tablet","500 MG-125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","617296"]
["amoxicillin/clavulanate potassium","AUGMENTIN '875'","ORAL","Tablet","875 MG-125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","562508"]
["amoxicillin/clavulanate potassium","AUGMENTIN '875'","ORAL","Tablet","875 MG-125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","562508"]
["amoxicillin/clavulanate potassium","AUGMENTIN '875'","ORAL","Tablet","875 MG-125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","562508"]
["amoxicillin/clavulanate potassium","AUGMENTIN '200'","ORAL","Tablet, Chewable","200 MG - 28.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","617309"]
["amoxicillin/clavulanate potassium","AUGMENTIN '200'","ORAL","Tablet, Chewable","200 MG - 28.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","617309"]
["amoxicillin/clavulanate potassium","AUGMENTIN '200'","ORAL","Tablet, Chewable","200 MG - 28.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","617309"]
["amoxicillin/clavulanate potassium","AUGMENTIN '400'","ORAL","Tablet, Chewable","400 MG - 57 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","617316"]
["amoxicillin/clavulanate potassium","AUGMENTIN '400'","ORAL","Tablet, Chewable","400 MG - 57 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","617316"]
["amoxicillin/clavulanate potassium","AUGMENTIN '400'","ORAL","Tablet, Chewable","400 MG - 57 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","617316"]
["amoxicillin/clavulanate potassium","AUGMENTIN XR","ORAL","Tablet, Extended Release","1000 MG-62.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","617995"]
["amoxicillin/clavulanate potassium","AUGMENTIN XR","ORAL","Tablet, Extended Release","1000 MG-62.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","617995"]
["amoxicillin/clavulanate potassium","AUGMENTIN XR","ORAL","Tablet, Extended Release","1000 MG-62.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Low Back Disorders","Low Back Disorders (R)","617995"]
["anakinra","KINERET","INJECTABLE","Prefilled syringe, 0.67 ML","100 MG/0.67 ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-inflammatory","Knee Disorders","Knee Disorders (X)","727711"]
["apixaban","ELIQUIS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","14 Days","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","1364432"]
["apixaban","ELIQUIS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","14 Days","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1364432"]
["apixaban","ELIQUIS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","14 Days","Anticoagulants","Knee Disorders","Knee Disorders (R)","1364432"]
["aprepitant","EMEND","ORAL","Capsule","125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","403811"]
["aprepitant","EMEND","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","644088"]
["aprepitant","EMEND","ORAL","Capsule","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","403810"]
["aprepitant","EMEND","ORAL","Suspension","125 MG/KIT","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","1729308"]
["aripiprazole","ABILIFY","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","1158261"]
["aripiprazole","ABILIFY","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1158261"]
["artificial tears ointments","REFRESH PM","OPHTHALMIC","Ointment","42.5% / 57.3%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Artificial Tears)","Eye","Eye (R)","702008"]
["ascorbic acid","VITAMIN C","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Ankle and Foot Disorders","Ankle and Foot Disorders (X, NR)","1152950"]
["ascorbic acid","VITAMIN C","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1152950"]
["ascorbic acid","VITAMIN C","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Chronic Pain","Chronic Pain (NR)","1152950"]
["ascorbic acid","VITAMIN C","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Low Back Disorders","Low Back Disorders (X)","1152950"]
["aspirin","BAYER","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","212033"]
["aspirin","BAYER","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","212033"]
["aspirin","BAYER","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (X)","212033"]
["aspirin","BAYER","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R)","212033"]
["aspirin","BAYER","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","212033"]
["aspirin","BAYER","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","212033"]
["aspirin","BAYER","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","212033"]
["aspirin","BAYER","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","212033"]
["aspirin","BAYER","ORAL","Tablet","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","212033"]
["aspirin","BAYER","ORAL","Tablet","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","243670"]
["aspirin","BAYER","ORAL","Tablet","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","243670"]
["aspirin","BAYER","ORAL","Tablet","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (X)","243670"]
["aspirin","BAYER","ORAL","Tablet","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R)","243670"]
["aspirin","BAYER","ORAL","Tablet","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","243670"]
["aspirin","BAYER","ORAL","Tablet","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","243670"]
["aspirin","BAYER","ORAL","Tablet","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","243670"]
["aspirin","BAYER","ORAL","Tablet","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","243670"]
["aspirin","BAYER","ORAL","Tablet","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","243670"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","198467"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198467"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (X)","198467"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R)","198467"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198467"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","198467"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","198467"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","198467"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","325 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","198467"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","308416"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","308416"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Chronic Pain","Chronic Pain (X)","308416"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Elbow Disorders","Elbow Disorders (R)","308416"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","308416"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hip and Groin Disorders","Hip and Groin Disorders (R)","308416"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Knee Disorders","Knee Disorders (R)","308416"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Low Back Disorders","Low Back Disorders (R)","308416"]
["aspirin","BAYER","ORAL","Tablet, Enteric Coated","81 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Shoulder","Shoulder (R)","308416"]
["aspirin/caffeine/dihydrocodeine bitartrate","SYNALGOS-DC","ORAL","Capsule","356.4 MG/30 MG/16 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesic Combination","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1234872"]
["aspirin/caffeine/dihydrocodeine bitartrate","SYNALGOS-DC","ORAL","Capsule","356.4 MG/30 MG/16 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesic Combination","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1234872"]
["aspirin/caffeine/dihydrocodeine bitartrate","SYNALGOS-DC","ORAL","Capsule","356.4 MG/30 MG/16 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesic Combination","Chronic Pain","Chronic Pain (X)","1234872"]
["aspirin/caffeine/dihydrocodeine bitartrate","SYNALGOS-DC","ORAL","Capsule","356.4 MG/30 MG/16 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesic Combination","Elbow Disorders","Elbow Disorders (X)","1234872"]
["aspirin/caffeine/dihydrocodeine bitartrate","SYNALGOS-DC","ORAL","Capsule","356.4 MG/30 MG/16 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesic Combination","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1234872"]
["aspirin/caffeine/dihydrocodeine bitartrate","SYNALGOS-DC","ORAL","Capsule","356.4 MG/30 MG/16 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesic Combination","Hip and Groin Disorders","Hip and Groin Disorders (X)","1234872"]
["aspirin/caffeine/dihydrocodeine bitartrate","SYNALGOS-DC","ORAL","Capsule","356.4 MG/30 MG/16 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesic Combination","Knee Disorders","Knee Disorders (X)","1234872"]
["aspirin/caffeine/dihydrocodeine bitartrate","SYNALGOS-DC","ORAL","Capsule","356.4 MG/30 MG/16 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesic Combination","Low Back Disorders","Low Back Disorders (X)","1234872"]
["aspirin/caffeine/dihydrocodeine bitartrate","SYNALGOS-DC","ORAL","Capsule","356.4 MG/30 MG/16 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesic Combination","Shoulder","Shoulder (X)","1234872"]
["atenolol","TENORMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Traumatic Brain Injury","Traumatic Brain Injury (R)","197379"]
["atenolol","TENORMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Traumatic Brain Injury","Traumatic Brain Injury (R)","197380"]
["atenolol","TENORMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Traumatic Brain Injury","Traumatic Brain Injury (R)","197381"]
["atorvastin calcium","LIPITOR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlidemics","Shoulder","Shoulder (NR)","1158284"]
["azelastine ophth","OPTIVAR","OPHTHALMIC","Solution","0.05%","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","860805"]
["azithromycin","ZITHROMAX, ZMAX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Macrolides)","COVID-19 Coronavirus","COVID-19 Coronavirus (X, NR)","1155011"]
["azithromycin","ZITHROMAX, ZMAX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Macrolides)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1155011"]
["azithromycin ophth","AZASITE","OPHTHALMIC","Solution","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Macrolides)","Eye","Eye (R,X,NR)","706868"]
["bacitracin","Not Applicable","TOPICAL","Cream","0.5 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1098408"]
["bacitracin","Not Applicable","TOPICAL","Cream","0.5 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (NR)","1098408"]
["bacitracin","Not Applicable","TOPICAL","Ointment","500 U/GM","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","164810"]
["bacitracin","Not Applicable","TOPICAL","Ointment","500 U/GM","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (NR)","164810"]
["baclofen","LIORESAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","YES","4 days","Musculoskeletal Therapy Agents (Muscle Relaxants)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1155670"]
["baclofen","LIORESAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","YES","4 days","Musculoskeletal Therapy Agents (Muscle Relaxants)","Chronic Pain","Chronic Pain (R,X,NR)","1155670"]
["baclofen","LIORESAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","YES","4 days","Musculoskeletal Therapy Agents (Muscle Relaxants)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1155670"]
["baclofen","LIORESAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","YES","4 days","Musculoskeletal Therapy Agents (Muscle Relaxants)","Knee Disorders","Knee Disorders (X, NR)","1155670"]
["baclofen","LIORESAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","YES","4 days","Musculoskeletal Therapy Agents (Muscle Relaxants)","Low Back Disorders","Low Back Disorders (R,X)","1155670"]
["baclofen","LIORESAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","YES","4 days","Musculoskeletal Therapy Agents (Muscle Relaxants)","Shoulder","Shoulder (R,X)","1155670"]
["baclofen","LIORESAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","YES","4 days","Musculoskeletal Therapy Agents (Muscle Relaxants)","Traumatic Brain Injury","Traumatic Brain Injury (R)","1155670"]
["baricitinib","OLUMIANT","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","2205472"]
["baricitinib","OLUMIANT","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","2047241"]
["becaplermin","REGRANEX","TOPICAL","Gel","0.01%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","308579"]
["beclomethasone dipropionate","QVAR","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1155693"]
["bepotastine besilate ophth","BEPREVE","OPHTHALMIC","Solution","1.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","863038"]
["besifloxacin ophth","BESIVANCE","OPHTHALMIC","Suspension","0.6%","Exempt","NO","Not Applicable","NO","Not Applicable","Topical antibiotic","Eye","Eye (R,X,NR)","850305"]
["betamethasone dipropionate","DIPROLENE, DIPROSONE, SERNIVO","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1153804"]
["betamethasone valerate","VALISONE, BETAVAL, BETATREX, LUXIQ","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1153804"]
["boswellia serrata extract","Not Applicable","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Chemicals","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1486391"]
["brexpiprazole","REXULTI","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","1658316"]
["bromfenac sodium ophth","PROLENSA","OPHTHALMIC","Solution","0.07%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (NSAID)","Eye","Eye (R,X)","1375917"]
["bromfenac sodium ophth","BROMSITE","OPHTHALMIC","Solution","0.075%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (NSAID)","Eye","Eye (R,X)","1790141"]
["bromfenac sodium ophth","BROMDAY, XIBROM","OPHTHALMIC","Solution","0.09%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (NSAID)","Eye","Eye (R,X)","578018"]
["bromocriptine mesylate","PARLODEL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiparkinson and Related Therapy Agents","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1155381"]
["budesonide","PULMICORT","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1156070"]
["budesonide/formoterol","SYMBICORT","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1156069"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1295269"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1295269"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1295269"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1295269"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1295269"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1295269"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1295269"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1295269"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Opioid","Opioid (R)","1295269"]
["buprenorphine","BUTRANS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1295269"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1716055"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1716055"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1716055"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1716055"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1716055"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1716055"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1716055"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1716055"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Opioid","Opioid (R)","1716055"]
["buprenorphine (hcl)","BELBUCA","ORAL","ALL BUCCAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1716055"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1295116"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1295116"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1295116"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1295116"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1295116"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1295116"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1295116"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1295116"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Opioid","Opioid (R)","1295116"]
["buprenorphine (hcl)","SUBUTEX","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1295116"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1294831"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1294831"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1294831"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1294831"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1294831"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1294831"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1294831"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1294831"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Opioid","Opioid (R)","1294831"]
["buprenorphine hcl/naloxone","SUBOXONE, ZUBSOLV","ORAL","ALL SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1294831"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","993687"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","993687"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","993687"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","993687"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","993687"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","993687"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","993687"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","993687"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","993691"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","993691"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","993691"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","993691"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","993691"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","993691"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","993691"]
["bupropion hcl","WELLBUTRIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","993691"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","993503"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","993503"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","993503"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","993503"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","993503"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","993503"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","993503"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","993503"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","993518"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","993518"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","993518"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","993518"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","993518"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","993518"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","993518"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","993518"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","993536"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","993536"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","993536"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","993536"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","993536"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","993536"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","993536"]
["bupropion hcl","WELLBUTRIN SR","ORAL","Tablet, Extended Release, 12 HR","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","993536"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","993541"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","993541"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","993541"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","993541"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","993541"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","993541"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","993541"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","993541"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","993557"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","993557"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","993557"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","993557"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","993557"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","993557"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","993557"]
["bupropion hcl","WELLBUTRIN XL","ORAL","Tablet, Extended Release, 24 HR","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","993557"]
["bupropion hcl","FORFIVO XL","ORAL","Tablet, Extended Release, 24 HR","450 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1232585"]
["bupropion hcl","FORFIVO XL","ORAL","Tablet, Extended Release, 24 HR","450 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","1232585"]
["bupropion hcl","FORFIVO XL","ORAL","Tablet, Extended Release, 24 HR","450 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1232585"]
["bupropion hcl","FORFIVO XL","ORAL","Tablet, Extended Release, 24 HR","450 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1232585"]
["bupropion hcl","FORFIVO XL","ORAL","Tablet, Extended Release, 24 HR","450 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","1232585"]
["bupropion hcl","FORFIVO XL","ORAL","Tablet, Extended Release, 24 HR","450 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1232585"]
["bupropion hcl","FORFIVO XL","ORAL","Tablet, Extended Release, 24 HR","450 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1232585"]
["bupropion hcl","FORFIVO XL","ORAL","Tablet, Extended Release, 24 HR","450 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","1232585"]
["butalbital/apap/caffeine","FIORICET","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1152255"]
["butalbital/asa/caffeine","FIORINAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1154060"]
["butenafine hcl","LOTRIMIN ULTRA, MENTAX","TOPICAL","CREAM","1%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1298448"]
["butorphanol tartrate","STADOL","NASAL","Spray","1 MG/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","886634"]
["butorphanol tartrate","STADOL","NASAL","Spray","1 MG/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","886634"]
["butorphanol tartrate","STADOL","NASAL","Spray","1 MG/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","886634"]
["butorphanol tartrate","STADOL","NASAL","Spray","1 MG/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","886634"]
["butorphanol tartrate","STADOL","NASAL","Spray","1 MG/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","886634"]
["butorphanol tartrate","STADOL","NASAL","Spray","1 MG/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","886634"]
["butorphanol tartrate","STADOL","NASAL","Spray","1 MG/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","886634"]
["butorphanol tartrate","STADOL","NASAL","Spray","1 MG/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","886634"]
["butorphanol tartrate","STADOL","NASAL","Spray","1 MG/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","886634"]
["cabergoline","DOSTINEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1164946"]
["calcitonin-salmon","FORTICAL; MIACALCIN","NASAL","Spray","200 UNIT/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","313919"]
["calcitonin-salmon","FORTICAL; MIACALCIN","NASAL","Spray","200 UNIT/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Chronic Pain","Chronic Pain (R,X)","313919"]
["calcitonin-salmon","FORTICAL; MIACALCIN","NASAL","Spray","200 UNIT/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","313919"]
["calcitonin-salmon","FORTICAL; MIACALCIN","NASAL","Spray","200 UNIT/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Knee Disorders","Knee Disorders (NR)","313919"]
["calcitonin-salmon","FORTICAL; MIACALCIN","NASAL","Spray","200 UNIT/ACTUATION","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Low Back Disorders","Low Back Disorders (X)","313919"]
["calcium phosphate tribasic","Not Applicable","ORAL","Tablet","600 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Minerals & Electrolytes","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","204647"]
["camphor","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (NR)","1155400"]
["camphor","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Chronic Pain","Chronic Pain (NR)","1155400"]
["camphor","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1155400"]
["camphor","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hip and Groin Disorders","Hip and Groin Disorders (X)","1155400"]
["camphor","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Low Back Disorders","Low Back Disorders (NR)","1155400"]
["camphor","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Shoulder","Shoulder (NR)","1155400"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198555"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Chronic Pain","Chronic Pain (R,NR)","198555"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","198555"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hip and Groin Disorders","Hip and Groin Disorders (R)","198555"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Low Back Disorders","Low Back Disorders (R)","198555"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Shoulder","Shoulder (R,X,NR)","198555"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.033%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1803727"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.033%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Chronic Pain","Chronic Pain (R,NR)","1803727"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.033%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1803727"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.033%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1803727"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.033%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Low Back Disorders","Low Back Disorders (R)","1803727"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.033%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Shoulder","Shoulder (R,X,NR)","1803727"]
["capsaicin","Not Applicable","TOPICAL","Cream","0.075%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","141868"]
["capsaicin","Not Applicable","TOPICAL","Cream","0.075%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Chronic Pain","Chronic Pain (R,NR)","141868"]
["capsaicin","Not Applicable","TOPICAL","Cream","0.075%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","141868"]
["capsaicin","Not Applicable","TOPICAL","Cream","0.075%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hip and Groin Disorders","Hip and Groin Disorders (R)","141868"]
["capsaicin","Not Applicable","TOPICAL","Cream","0.075%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Low Back Disorders","Low Back Disorders (R)","141868"]
["capsaicin","Not Applicable","TOPICAL","Cream","0.075%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Shoulder","Shoulder (R,X,NR)","141868"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","646333"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Chronic Pain","Chronic Pain (R,NR)","646333"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","646333"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hip and Groin Disorders","Hip and Groin Disorders (R)","646333"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Low Back Disorders","Low Back Disorders (R)","646333"]
["capsaicin","ZOSTRIX","TOPICAL","Cream","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Shoulder","Shoulder (R,X,NR)","646333"]
["capsaicin","Not Applicable","TOPICAL","Patch","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1043399"]
["capsaicin","Not Applicable","TOPICAL","Patch","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Chronic Pain","Chronic Pain (R,NR)","1043399"]
["capsaicin","Not Applicable","TOPICAL","Patch","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1043399"]
["capsaicin","Not Applicable","TOPICAL","Patch","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1043399"]
["capsaicin","Not Applicable","TOPICAL","Patch","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Low Back Disorders","Low Back Disorders (R)","1043399"]
["capsaicin","Not Applicable","TOPICAL","Patch","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals (Topical creams and ointments)","Shoulder","Shoulder (R,X,NR)","1043399"]
["carbamazepine","CARBATROL, TEGRETOL, TEGRETOL XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1155760"]
["carbamazepine","CARBATROL, TEGRETOL, TEGRETOL XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (R)","1155760"]
["carbamazepine","CARBATROL, TEGRETOL, TEGRETOL XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1155760"]
["carbamazepine","CARBATROL, TEGRETOL, TEGRETOL XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1155760"]
["carbamazepine","CARBATROL, TEGRETOL, TEGRETOL XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (R,X)","1155760"]
["carboxymethylcellulose sodium ophthalmic","REFRESH PLUS","OPHTHALMIC","Solution","0.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Artificial Tears)","Eye","Eye (R)","1188426"]
["carisoprodol","SOMA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1151411"]
["carisoprodol","SOMA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Chronic Pain","Chronic Pain (X)","1151411"]
["carisoprodol","SOMA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1151411"]
["carisoprodol","SOMA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Knee Disorders","Knee Disorders (X)","1151411"]
["carisoprodol","SOMA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Low Back Disorders","Low Back Disorders (X)","1151411"]
["carisoprodol","SOMA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Shoulder","Shoulder (X)","1151411"]
["cefadroxil","DURACEF","ORAL","Capsule","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309049"]
["cefadroxil","DURACEF","ORAL","Powder for Suspension","250 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","105170"]
["cefadroxil","DURACEF","ORAL","Powder for Suspension","500 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309048"]
["cefadroxil","DURACEF","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309047"]
["cefuroxime axetil","CEFTIN","ORAL","Tablet","125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","309095"]
["cefuroxime axetil","CEFTIN","ORAL","Tablet","125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309095"]
["cefuroxime axetil","CEFTIN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","309097"]
["cefuroxime axetil","CEFTIN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309097"]
["cefuroxime axetil","CEFTIN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","309098"]
["cefuroxime axetil","CEFTIN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309098"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Depressive Disorders","Depressive Disorders (X)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","205322"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Depressive Disorders","Depressive Disorders (X)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","205323"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Depressive Disorders","Depressive Disorders (X)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","349514"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Depressive Disorders","Depressive Disorders (X)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","686379"]
["celecoxib","CELEBREX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","686379"]
["cephalexin","KEFLEX","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","309112"]
["cephalexin","KEFLEX","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","309112"]
["cephalexin","KEFLEX","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309112"]
["cephalexin","KEFLEX","ORAL","Capsule","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","309114"]
["cephalexin","KEFLEX","ORAL","Capsule","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","309114"]
["cephalexin","KEFLEX","ORAL","Capsule","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309114"]
["cephalexin","KEFLEX","ORAL","Capsule","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","637173"]
["cephalexin","KEFLEX","ORAL","Capsule","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","637173"]
["cephalexin","KEFLEX","ORAL","Capsule","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","637173"]
["cephalexin","KEFLEX","ORAL","Powder for Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","309110"]
["cephalexin","KEFLEX","ORAL","Powder for Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","309110"]
["cephalexin","KEFLEX","ORAL","Powder for Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309110"]
["cephalexin","KEFLEX","ORAL","Powder for Suspension","250 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","309113"]
["cephalexin","KEFLEX","ORAL","Powder for Suspension","250 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","309113"]
["cephalexin","KEFLEX","ORAL","Powder for Suspension","250 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309113"]
["cephalexin","KEFTAB","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","309115"]
["cephalexin","KEFTAB","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","309115"]
["cephalexin","KEFTAB","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","309115"]
["cephalexin","KEFTAB","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","197454"]
["cephalexin","KEFTAB","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","197454"]
["cephalexin","KEFTAB","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Cephalosporins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","197454"]
["certolizumab pegol","CIMZIA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Gastrointestinal Agents (TNF Blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1131226"]
["certolizumab pegol","CIMZIA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Gastrointestinal Agents (TNF Blocker)","Knee Disorders","Knee Disorders (X)","1131226"]
["certolizumab pegol","CIMZIA","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Gastrointestinal Agents (TNF Blocker)","Low Back Disorders","Low Back Disorders (X)","1131226"]
["chloroquine phosphate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antimalarials","COVID-19 Coronavirus","COVID-19 Coronavirus (X, NR)","1153861"]
["chlorzoxazone","LORZONE, PARAFLEX, PARAFON FORTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1155809"]
["chlorzoxazone","LORZONE, PARAFLEX, PARAFON FORTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Chronic Pain","Chronic Pain (X)","1155809"]
["chlorzoxazone","LORZONE, PARAFLEX, PARAFON FORTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1155809"]
["chlorzoxazone","LORZONE, PARAFLEX, PARAFON FORTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Knee Disorders","Knee Disorders (X)","1155809"]
["chlorzoxazone","LORZONE, PARAFLEX, PARAFON FORTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Low Back Disorders","Low Back Disorders (X)","1155809"]
["chlorzoxazone","LORZONE, PARAFLEX, PARAFON FORTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Shoulder","Shoulder (X)","1155809"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1151434"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1151434"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Chronic Pain","Chronic Pain (R)","1151434"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","1151434"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","1151434"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1151434"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Knee Disorders","Knee Disorders (R,NR)","1151434"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Low Back Disorders","Low Back Disorders (R)","1151434"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Shoulder","Shoulder (R)","1151434"]
["choline magnesium trisalicylate","TRILISATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1151434"]
["chondroitin sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative Medicines (OTC nutraceutical)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (NR)","1151450"]
["chondroitin sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative Medicines (OTC nutraceutical)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1151450"]
["chondroitin sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative Medicines (OTC nutraceutical)","Knee Disorders","Knee Disorders (NR)","1151450"]
["chondroitin sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative Medicines (OTC nutraceutical)","Shoulder","Shoulder (NR)","1151450"]
["ciclesonide","ALVESCO","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1163128"]
["ciclopirox olamine","LOPROX, PENLAC","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1163131"]
["cimetidine","TAGAMET","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197505"]
["cimetidine","TAGAMET","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","197505"]
["cimetidine","TAGAMET","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","197505"]
["cimetidine","TAGAMET","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","197505"]
["cimetidine","TAGAMET","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","197505"]
["cimetidine","TAGAMET","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","197505"]
["cimetidine","TAGAMET","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","197505"]
["cimetidine","TAGAMET","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury","Traumatic Brain Injury (R)","197505"]
["cimetidine","TAGAMET","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197506"]
["cimetidine","TAGAMET","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","197506"]
["cimetidine","TAGAMET","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","197506"]
["cimetidine","TAGAMET","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","197506"]
["cimetidine","TAGAMET","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","197506"]
["cimetidine","TAGAMET","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","197506"]
["cimetidine","TAGAMET","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","197506"]
["cimetidine","TAGAMET","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury","Traumatic Brain Injury (R)","197506"]
["cimetidine","TAGAMET","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197507"]
["cimetidine","TAGAMET","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","197507"]
["cimetidine","TAGAMET","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","197507"]
["cimetidine","TAGAMET","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","197507"]
["cimetidine","TAGAMET","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","197507"]
["cimetidine","TAGAMET","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","197507"]
["cimetidine","TAGAMET","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","197507"]
["cimetidine","TAGAMET","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury","Traumatic Brain Injury (R)","197507"]
["cimetidine","TAGAMET","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197508"]
["cimetidine","TAGAMET","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","197508"]
["cimetidine","TAGAMET","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","197508"]
["cimetidine","TAGAMET","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","197508"]
["cimetidine","TAGAMET","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","197508"]
["cimetidine","TAGAMET","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","197508"]
["cimetidine","TAGAMET","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","197508"]
["cimetidine","TAGAMET","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury","Traumatic Brain Injury (R)","197508"]
["ciprofloxacin","CIPRO","ORAL","Powder for Suspension","250 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","309308"]
["ciprofloxacin","CIPRO","ORAL","Powder for Suspension","250 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","309308"]
["ciprofloxacin","CIPRO","ORAL","Powder for Suspension","500 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","309310"]
["ciprofloxacin","CIPRO","ORAL","Powder for Suspension","500 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","309310"]
["ciprofloxacin hcl","CIPRO","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","199370"]
["ciprofloxacin hcl","CIPRO","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","199370"]
["ciprofloxacin hcl","CIPRO","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197511"]
["ciprofloxacin hcl","CIPRO","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","197511"]
["ciprofloxacin hcl","CIPRO","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","309309"]
["ciprofloxacin hcl","CIPRO","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","309309"]
["ciprofloxacin hcl","CIPRO","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197512"]
["ciprofloxacin hcl","CIPRO","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","197512"]
["ciprofloxacin hcl ophthalmic","CILOXAN","OPHTHALMIC","Ointment","0.3%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Antibiotics)","Eye","Eye (R,X,NR)","309306"]
["ciprofloxacin hcl ophthalmic","CILOXAN","OPHTHALMIC","Solution","0.3%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Antibiotics)","Eye","Eye (R,X,NR)","309307"]
["ciprofloxacin; ciprofloxacin hcl","CIPRO XR","ORAL","Tablet, Extended Release","1000 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","403921"]
["ciprofloxacin; ciprofloxacin hcl","CIPRO XR","ORAL","Tablet, Extended Release","1000 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","403921"]
["ciprofloxacin; ciprofloxacin hcl","CIPRO XR","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","359383"]
["ciprofloxacin; ciprofloxacin hcl","CIPRO XR","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","359383"]
["citalopram hydrobromide","CELEXA","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","309313"]
["citalopram hydrobromide","CELEXA","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","309313"]
["citalopram hydrobromide","CELEXA","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","309313"]
["citalopram hydrobromide","CELEXA","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","309313"]
["citalopram hydrobromide","CELEXA","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","309313"]
["citalopram hydrobromide","CELEXA","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","309313"]
["citalopram hydrobromide","CELEXA","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","309313"]
["citalopram hydrobromide","CELEXA","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","309313"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","283672"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","283672"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","283672"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","283672"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","283672"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","283672"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","283672"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","283672"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","200371"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","200371"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","200371"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","200371"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","200371"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","200371"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","200371"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","200371"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","309314"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","309314"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","309314"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","309314"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","309314"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","309314"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","309314"]
["citalopram hydrobromide","CELEXA","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","309314"]
["citicoline","CERAXON","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative  Medicines","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1152139"]
["clarithromycin","BIAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Macrolides)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1152762"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","197518"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197518"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hip and Groin Disorders","Hip and Groin Disorders (R)","197518"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Knee Disorders","Knee Disorders (R)","197518"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","300MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","284215"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","300MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","284215"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","300MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hip and Groin Disorders","Hip and Groin Disorders (R)","284215"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","300MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Knee Disorders","Knee Disorders (R)","284215"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","75MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","309329"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","75MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","309329"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","75MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hip and Groin Disorders","Hip and Groin Disorders (R)","309329"]
["clindamycin hcl","CLEOCIN","ORAL","Capsule","75MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Knee Disorders","Knee Disorders (R)","309329"]
["clindamycin palmitate hcl","CLEOCIN","ORAL","Powder for Suspension","75 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","562266"]
["clindamycin palmitate hcl","CLEOCIN","ORAL","Powder for Suspension","75 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","562266"]
["clindamycin palmitate hcl","CLEOCIN","ORAL","Powder for Suspension","75 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hip and Groin Disorders","Hip and Groin Disorders (R)","562266"]
["clindamycin palmitate hcl","CLEOCIN","ORAL","Powder for Suspension","75 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Knee Disorders","Knee Disorders (R)","562266"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","857297"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","857297"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","857297"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","857297"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","857297"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (X)","857297"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","857297"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","857301"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","857301"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","857301"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","857301"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","857301"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (X)","857301"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","857301"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","857305"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","857305"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","857305"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","857305"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","857305"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (X)","857305"]
["clomipramine hcl","ANAFRANIL","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","857305"]
["clonazepam","KLONOPIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Anxiety","Anxiety (R,X)","1153378"]
["clonazepam","KLONOPIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1153378"]
["clonazepam","KLONOPIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1153378"]
["clonazepam","KLONOPIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (X)","1153378"]
["clonidine","CATAPRES TTS","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1295649"]
["clonidine hcl","CATAPRES, KAPVAY","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Chronic Pain","Chronic Pain (R,NR)","1153385"]
["clonidine hcl","CATAPRES, KAPVAY","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Low Back Disorders","Low Back Disorders (X, NR)","1153385"]
["clotrimazole antifungal","LOTRIMIN AF","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1153923"]
["codeine phosphate/acetaminophen","TYLENOL #3, TYLENOL #4","ORAL","ALL ORAL TABLET DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1155599"]
["codeine phosphate/acetaminophen","TYLENOL #3, TYLENOL #4","ORAL","ALL ORAL TABLET DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1155599"]
["codeine phosphate/acetaminophen","TYLENOL #3, TYLENOL #4","ORAL","ALL ORAL TABLET DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1155599"]
["codeine phosphate/acetaminophen","TYLENOL #3, TYLENOL #4","ORAL","ALL ORAL TABLET DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1155599"]
["codeine phosphate/acetaminophen","TYLENOL #3, TYLENOL #4","ORAL","ALL ORAL TABLET DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1155599"]
["codeine phosphate/acetaminophen","TYLENOL #3, TYLENOL #4","ORAL","ALL ORAL TABLET DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1155599"]
["codeine phosphate/acetaminophen","TYLENOL #3, TYLENOL #4","ORAL","ALL ORAL TABLET DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1155599"]
["codeine phosphate/acetaminophen","TYLENOL #3, TYLENOL #4","ORAL","ALL ORAL TABLET DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1155599"]
["codeine phosphate/acetaminophen","TYLENOL #3, TYLENOL #4","ORAL","ALL ORAL TABLET DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1155599"]
["codeine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1155185"]
["codeine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1155185"]
["codeine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1155185"]
["codeine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1155185"]
["codeine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1155185"]
["codeine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1155185"]
["codeine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1155185"]
["codeine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1155185"]
["codeine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1155185"]
["coenzyme q10","COQ10","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative  Medicines","Chronic Pain","Chronic Pain (NR)","1159381"]
["colchicine","COLCRYS, MITIGARE, GLOPERBA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Gout Agents","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1155484"]
["colchicine","COLCRYS, MITIGARE, GLOPERBA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Gout Agents","Low Back Disorders","Low Back Disorders (X)","1155484"]
["cortisone acetate","CORTONE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","1155528"]
["cortisone acetate","CORTONE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1155528"]
["cortisone acetate","CORTONE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","1155528"]
["cortisone acetate","CORTONE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","1155528"]
["cortisone acetate","CORTONE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,NR)","1155528"]
["cortisone acetate","CORTONE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","1155528"]
["cortisone acetate","CORTONE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","1155528"]
["cortisone acetate","CORTONE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","1155528"]
["creatine monohydrate","Not Applicable","BULK","BULK DRUG","Not Applicable","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Chemicals","Chronic Pain","Chronic Pain (NR)","1310467"]
["cromolyn sodium","INTAL","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1155844"]
["cromolyn sodium (ophthalmic)","OPTICROM","OPHTHALMIC","Solution","4%","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","831109"]
["cyclobenzaprine hcl","AMRIX, FLEXERIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1156628"]
["cyclobenzaprine hcl","AMRIX, FLEXERIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Chronic Pain","Chronic Pain (R,X,NR)","1156628"]
["cyclobenzaprine hcl","AMRIX, FLEXERIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1156628"]
["cyclobenzaprine hcl","AMRIX, FLEXERIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Knee Disorders","Knee Disorders (X, NR)","1156628"]
["cyclobenzaprine hcl","AMRIX, FLEXERIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Low Back Disorders","Low Back Disorders (R,X)","1156628"]
["cyclobenzaprine hcl","AMRIX, FLEXERIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Shoulder","Shoulder (R,X)","1156628"]
["cyclopentolate hcl","CYCLOGYL","OPHTHALMIC","Solution","0.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anticholinergics)","Eye","Eye (X)","1298072"]
["cyclopentolate hcl","CYCLOGYL","OPHTHALMIC","Solution","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anticholinergics)","Eye","Eye (X)","1298066"]
["cyclopentolate hcl","CYCLOGYL","OPHTHALMIC","Solution","2%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anticholinergics)","Eye","Eye (X)","1298070"]
["cyclosporine","SANDIMMUNE, GENGRAF, NEORAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Miscellaneous Therapeutic Classes","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1156189"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","10,000 IU/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","978755"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","10,000 IU/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","978755"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","10,000 IU/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","978755"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","12,500 IU/0.5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","978740"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","12,500 IU/0.5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","978740"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","12,500 IU/0.5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","978740"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","15,000 IU/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","978744"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","15,000 IU/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","978744"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","15,000 IU/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","978744"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","18,000 IU/0.72 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","978746"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","18,000 IU/0.72 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","978746"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","18,000 IU/0.72 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","978746"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","2,500 IU/0.2 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","978725"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","2,500 IU/0.2 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","978725"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","2,500 IU/0.2 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","978725"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","5,000 IU/0.2 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","978733"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","5,000 IU/0.2 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","978733"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","5,000 IU/0.2 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","978733"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","7,500 IU/0.3 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","978736"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","7,500 IU/0.3 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","978736"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","7,500 IU/0.3 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","978736"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","95,000 IU/3.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","978777"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","95,000 IU/3.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","978777"]
["dalteparin","FRAGMIN","INJECTABLE","Solution","95,000 IU/3.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","978777"]
["dantrolene sodium","DANTRIUM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1151850"]
["dantrolene sodium","DANTRIUM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Chronic Pain","Chronic Pain (X)","1151850"]
["dantrolene sodium","DANTRIUM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1151850"]
["dantrolene sodium","DANTRIUM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Knee Disorders","Knee Disorders (X)","1151850"]
["dantrolene sodium","DANTRIUM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Low Back Disorders","Low Back Disorders (X)","1151850"]
["dantrolene sodium","DANTRIUM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Shoulder","Shoulder (X)","1151850"]
["dantrolene sodium","DANTRIUM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Traumatic Brain Injury","Traumatic Brain Injury (R)","1151850"]
["dehydroepiandrosterone (dhea)","Not Applicable","BULK","BULK DRUG","Not Applicable","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Chemicals","Chronic Pain","Chronic Pain (NR)","1747869"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1099288"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","1099288"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1099288"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1099288"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","1099288"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1099288"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1099288"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1099288"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury","Traumatic Brain Injury (R)","1099288"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1099292"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","1099292"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1099292"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1099292"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","1099292"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1099292"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1099292"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1099292"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury","Traumatic Brain Injury (R)","1099292"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1099296"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","1099296"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1099296"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1099296"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","1099296"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1099296"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1099296"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1099296"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury","Traumatic Brain Injury (R)","1099296"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1099300"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","1099300"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1099300"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1099300"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","1099300"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1099300"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1099300"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1099300"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury","Traumatic Brain Injury (R)","1099300"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1099304"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","1099304"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1099304"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1099304"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","1099304"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1099304"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1099304"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1099304"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury","Traumatic Brain Injury (R)","1099304"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1099316"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","1099316"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1099316"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1099316"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","1099316"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1099316"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1099316"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1099316"]
["desipramine hcl","NORPRAMIN","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Traumatic Brain Injury","Traumatic Brain Injury (R)","1099316"]
["desloratadine","CLARINEX","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","349420"]
["desloratadine","CLARINEX","ORAL","Tablet, Disintegrating","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","577080"]
["desloratadine","CLARINEX","ORAL","Tablet, Disintegrating","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","403841"]
["desmopressin acetate","DDAVP","NASAL","Solution","0.01 MG/ACTUATION","Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","849520"]
["desmopressin acetate","DDAVP","ORAL","Tablet","0.1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","849515"]
["desmopressin acetate","DDAVP","ORAL","Tablet","0.2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","833008"]
["desmopressin acetate","NOCDURNA","ORAL","Tablet, Sublingual","0.0277 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","2048716"]
["desmopressin acetate","NOCDURNA","ORAL","Tablet, Sublingual","0.0553 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","2048720"]
["desonide","DESOWEN, VERDESO","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1154230"]
["desoximetasone","TOPICORT","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1154232"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","790264"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","790264"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","790264"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","790264"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","790264"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X, NR)","790264"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","790264"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","790288"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","790288"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","790288"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","790288"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","790288"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X, NR)","790288"]
["desvenlafaxine","KHEDEZLA","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","790288"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1874553"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","1874553"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","1874553"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1874553"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","1874553"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X, NR)","1874553"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","1874553"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1607617"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","1607617"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","1607617"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1607617"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","1607617"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X, NR)","1607617"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","1607617"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1874559"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","1874559"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","1874559"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1874559"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","1874559"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X, NR)","1874559"]
["desvenlafaxine succinate","PRISTIQ","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","1874559"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","309684"]
["dexamethasone","DECADRON","ORAL","Concentrate","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","309684"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","309686"]
["dexamethasone","DECADRON","ORAL","Solution","0.5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","309686"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","197577"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","0.75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","343033"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","197579"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","197580"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197581"]
["dexamethasone","DECADRON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","197581"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","2261802"]
["dexamethasone","HEMADY","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","2261802"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","197582"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (R,NR)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (R,NR)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197583"]
["dexamethasone","DECADRON","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","197583"]
["dexamethasone sodium phosphate ophthalmic","DECADRON","OPHTHALMIC","Solution","0.1%","Non-Exempt","YES","4 days","NO","Not Applicable","Ophthalmic Agents (Steroid)","Eye","Eye (R,X,NR)","226343"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","833204"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","833204"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","833204"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","833204"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","833204"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","833204"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","833213"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","833213"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","833213"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","833213"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","833213"]
["dexlansoprazole","DEXILANT","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","833213"]
["dextromethorphan hydrobromide - quinidine sulfate","NUEDEXTA","ORAL","Capsule","20 MG ; 10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1040054"]
["dextromethorphan polistirex","DELSYM","ORAL","Suspension","6 MG/ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Cough/Cold/Allergy (NMDA Receptor Antagonist)","Chronic Pain","Chronic Pain (R,X,NR)","1373045"]
["dextromethorphan polistirex","DELSYM","ORAL","Suspension","6 MG/ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Cough/Cold/Allergy (NMDA Receptor Antagonist)","Low Back Disorders","Low Back Disorders (X)","1373045"]
["dextromethorphan polistirex","DELSYM","ORAL","Suspension","6 MG/ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Cough/Cold/Allergy (NMDA Receptor Antagonist)","Shoulder","Shoulder (R)","1373045"]
["diazepam","VALIUM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antianxiety Agents (Muscle relaxant)","Chronic Pain","Chronic Pain (X)","1155861"]
["diclofenac epolamine","EMLA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Shoulder","Shoulder (X)","2663267"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","81997"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","81997"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (NR)","81997"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","81997"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","81997"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","81997"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","81997"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","81997"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","81997"]
["diclofenac potassium","CATAFLAM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","81997"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","203214"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","203214"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (NR)","203214"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","203214"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","203214"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","203214"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","203214"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","203214"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","203214"]
["diclofenac sodium","VOLTAREN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","203214"]
["diclofenac sodium  (topical)","VOLTAREN ARTHRITIS PAIN","TOPICAL","Gel","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X,NR)","855633"]
["diclofenac sodium  (topical)","VOLTAREN ARTHRITIS PAIN","TOPICAL","Gel","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (NR)","855633"]
["diclofenac sodium  (topical)","VOLTAREN ARTHRITIS PAIN","TOPICAL","Gel","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Chronic Pain","Chronic Pain (R)","855633"]
["diclofenac sodium  (topical)","VOLTAREN ARTHRITIS PAIN","TOPICAL","Gel","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Elbow Disorders","Elbow Disorders (R,NR)","855633"]
["diclofenac sodium  (topical)","VOLTAREN ARTHRITIS PAIN","TOPICAL","Gel","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","855633"]
["diclofenac sodium  (topical)","VOLTAREN ARTHRITIS PAIN","TOPICAL","Gel","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hip and Groin Disorders","Hip and Groin Disorders (X)","855633"]
["diclofenac sodium  (topical)","VOLTAREN ARTHRITIS PAIN","TOPICAL","Gel","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Low Back Disorders","Low Back Disorders (NR)","855633"]
["diclofenac sodium  (topical)","VOLTAREN ARTHRITIS PAIN","TOPICAL","Gel","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Shoulder","Shoulder (R,X,NR)","855633"]
["diclofenac sodium ophthalmic","VOLTAREN","OPHTHALMIC","Solution","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (NSAID)","Eye","Eye (R,X)","854801"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1151144"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1151144"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Chronic Pain","Chronic Pain (X)","1151144"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Elbow Disorders","Elbow Disorders (R)","1151144"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1151144"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1151144"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Knee Disorders","Knee Disorders (R)","1151144"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Low Back Disorders","Low Back Disorders (R)","1151144"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Shoulder","Shoulder (R)","1151144"]
["diclofenac sodium/misoprostol","ARTHROTEC","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID/ Ulcer drug)","Traumatic Brain Injury","Traumatic Brain Injury (X)","1151144"]
["dicloxacillin sodium","PATHOCIL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","197595"]
["dicloxacillin sodium","PATHOCIL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","197595"]
["dicloxacillin sodium","PATHOCIL","ORAL","Capsule","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","197596"]
["dicloxacillin sodium","PATHOCIL","ORAL","Capsule","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","197596"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197603"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197603"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197603"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197603"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197603"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197603"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197603"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197603"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197603"]
["diflunisal","DOLOBID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197603"]
["dihydroergotamine mesylate","MIGRANAL","NASAL","Spray","0.5 MG/SPRAY","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","861668"]
["dihydroergotamine mesylate","TRUDHESA","NASAL","Spray","0.725 MG/SPRAY","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","2569836"]
["dimenhydrinate","DRAMAMINE","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","198603"]
["dimethyl sulfoxide","DMSO","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Genitourinary - Misc. (Ointments and topical agents)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1152196"]
["dimethyl sulfoxide","DMSO","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Genitourinary - Misc. (Ointments and topical agents)","Chronic Pain","Chronic Pain (R)","1152196"]
["dimethyl sulfoxide","DMSO","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Genitourinary - Misc. (Ointments and topical agents)","Hip and Groin Disorders","Hip and Groin Disorders (X, NR)","1152196"]
["dimethyl sulfoxide","DMSO","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Genitourinary - Misc. (Ointments and topical agents)","Low Back Disorders","Low Back Disorders (X)","1152196"]
["divalproex sodium","DEPAKOTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (X)","266856"]
["divalproex sodium","DEPAKOTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","266856"]
["divalproex sodium","DEPAKOTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","266856"]
["divalproex sodium","DEPAKOTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (X)","266856"]
["divalproex sodium","DEPAKOTE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Traumatic Brain Injury","Traumatic Brain Injury (X, NR)","266856"]
["dolasetron mesylate","Anzemet","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","310007"]
["dolasetron mesylate","Anzemet","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Chronic Pain","Chronic Pain (NR)","310007"]
["donepezil hcl","ARICEPT","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","997223"]
["donepezil hcl","ARICEPT","ORAL","Tablet","23 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","1100184"]
["donepezil hcl","ARICEPT","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","997229"]
["donepezil hcl","ARICEPT","ORAL","Tablet, Orally Disintegrating","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","997220"]
["donepezil hcl","ARICEPT","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents-Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","997226"]
["doxazosin mesylate","CARDURA. CARDUARA XL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1160764"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1000048"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","1000048"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1000048"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1000048"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","1000048"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1000048"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1000048"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1000058"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","1000058"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1000058"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1000058"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","1000058"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1000058"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1000058"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1000064"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","1000064"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1000064"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1000064"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","1000064"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1000064"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1000064"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1000070"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","1000070"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1000070"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1000070"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","1000070"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1000070"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1000070"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1000076"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","1000076"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1000076"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1000076"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","1000076"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1000076"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1000076"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1000097"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","1000097"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1000097"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1000097"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","1000097"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1000097"]
["doxepin hcl","SINEQUAN","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1000097"]
["doxepin hcl","SINEQUAN","ORAL","Solution","10 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1000054"]
["doxepin hcl","SINEQUAN","ORAL","Solution","10 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","1000054"]
["doxepin hcl","SINEQUAN","ORAL","Solution","10 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","1000054"]
["doxepin hcl","SINEQUAN","ORAL","Solution","10 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1000054"]
["doxepin hcl","SINEQUAN","ORAL","Solution","10 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X, NR)","1000054"]
["doxepin hcl","SINEQUAN","ORAL","Solution","10 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","1000054"]
["doxepin hcl","SINEQUAN","ORAL","Solution","10 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","1000054"]
["doxycycline (monohydrate)","MONODOX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1649990"]
["doxycycline (monohydrate)","MONODOX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1649990"]
["doxycycline (monohydrate)","MONODOX","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1649990"]
["doxycycline (monohydrate)","ADOXA","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","728207"]
["doxycycline (monohydrate)","ADOXA","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","728207"]
["doxycycline (monohydrate)","ADOXA","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hip and Groin Disorders","Hip and Groin Disorders (R)","728207"]
["doxycycline (monohydrate)","MONODOX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1649401"]
["doxycycline (monohydrate)","MONODOX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1649401"]
["doxycycline (monohydrate)","MONODOX","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1649401"]
["doxycycline (monohydrate)","MONODOX","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","700408"]
["doxycycline (monohydrate)","MONODOX","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","700408"]
["doxycycline (monohydrate)","MONODOX","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hip and Groin Disorders","Hip and Groin Disorders (R)","700408"]
["doxycycline (monohydrate)","VIBRAMYCIN","ORAL","Powder for Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1650030"]
["doxycycline (monohydrate)","VIBRAMYCIN","ORAL","Powder for Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1650030"]
["doxycycline (monohydrate)","VIBRAMYCIN","ORAL","Powder for Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1650030"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1650142"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1650142"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1650142"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1650444"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1650444"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1650444"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1652673"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1652673"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1652673"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1649429"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1649429"]
["doxycycline (monohydrate)","ADOXA","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1649429"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","596926"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","596926"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","596926"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","596926"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","596926"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","596926"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X,NR)","596926"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","596930"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","596930"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","596930"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","596930"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","596930"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","596930"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X,NR)","596930"]
["duloxetine hcl","DRIZALMA SPRINKLE","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","616402"]
["duloxetine hcl","DRIZALMA SPRINKLE","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","616402"]
["duloxetine hcl","DRIZALMA SPRINKLE","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","616402"]
["duloxetine hcl","DRIZALMA SPRINKLE","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","616402"]
["duloxetine hcl","DRIZALMA SPRINKLE","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","616402"]
["duloxetine hcl","DRIZALMA SPRINKLE","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","616402"]
["duloxetine hcl","DRIZALMA SPRINKLE","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X,NR)","616402"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","596934"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","596934"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","596934"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","596934"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","596934"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","596934"]
["duloxetine hcl","CYMBALTA","ORAL","Capsule, Delayed Release","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X,NR)","596934"]
["econazole nitrate","SPECTAZOLE, ECOZA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1162623"]
["edoxaban tosylate","SAVAYSA","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1599543"]
["edoxaban tosylate","SAVAYSA","ORAL","Tablet","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1599551"]
["edoxaban tosylate","SAVAYSA","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1599555"]
["eletriptan hydrobromide","RELPAX","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","359493"]
["eletriptan hydrobromide","RELPAX","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","359494"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","854255"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","854255"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","854255"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","100 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","854255"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","120 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","854245"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","120 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","854245"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","120 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","854245"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","120 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","854245"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","150 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","854252"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","150 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","854252"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","150 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","854252"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","150 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","854252"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","30 MG/0.3 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","854228"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","30 MG/0.3 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","854228"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","30 MG/0.3 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","854228"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","30 MG/0.3 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","854228"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","40 MG/0.4 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","854235"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","40 MG/0.4 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","854235"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","40 MG/0.4 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","854235"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","40 MG/0.4 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","854235"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","60 MG/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","854238"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","60 MG/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","854238"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","60 MG/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","854238"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","60 MG/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","854238"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","80 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","854241"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","80 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","854241"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","80 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","854241"]
["enoxaparin sodium","LOVENOX","INJECTABLE","Solution","80 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","854241"]
["epinastine hcl","ELESTAT","OPHTHALMIC","Solution","0.05%","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","860654"]
["erythromycin","ERYC, ERY-TAB","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Macrolides)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1164504"]
["erythromycin ophthalmic ointment","ILOTYCIN","OPHTHALMIC","Ointment","5 MG/GM","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Antibiotics)","Eye","Eye (R,X,NR)","310149"]
["escitalopram oxalate","LEXAPRO","ORAL","Solution","1MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","351285"]
["escitalopram oxalate","LEXAPRO","ORAL","Solution","1MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","351285"]
["escitalopram oxalate","LEXAPRO","ORAL","Solution","1MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","351285"]
["escitalopram oxalate","LEXAPRO","ORAL","Solution","1MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","351285"]
["escitalopram oxalate","LEXAPRO","ORAL","Solution","1MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","351285"]
["escitalopram oxalate","LEXAPRO","ORAL","Solution","1MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","351285"]
["escitalopram oxalate","LEXAPRO","ORAL","Solution","1MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","351285"]
["escitalopram oxalate","LEXAPRO","ORAL","Solution","1MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","351285"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","349332"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","349332"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","349332"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","349332"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","349332"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","349332"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","349332"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","349332"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","351250"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","351250"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","351250"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","351250"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","351250"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","351250"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","351250"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","351250"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","351249"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","351249"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","351249"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","351249"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","351249"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","351249"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","351249"]
["escitalopram oxalate","LEXAPRO","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","351249"]
["esketamine","SPRAVATO","NASAL","ALL NASAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Depressive Disorders","Depressive Disorders (NR)","2119379"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","606726"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","606726"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","606726"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","606726"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","606726"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","606726"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","606726"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","606730"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","606730"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","606730"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","606730"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","606730"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","606730"]
["esomeprazole magnesium","NEXIUM","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","606730"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","20 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","692576"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","20 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","692576"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","20 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","692576"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","20 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","692576"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","20 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","692576"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","20 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","692576"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","20 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","692576"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","40 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","692578"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","40 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","692578"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","40 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","692578"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","40 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","692578"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","40 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","692578"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","40 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","692578"]
["esomeprazole magnesium","NEXIUM","ORAL","Granules for Suspension","40 MG/PACKET","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","692578"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1164523"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1164523"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Chronic Pain","Chronic Pain (X)","1164523"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Elbow Disorders","Elbow Disorders (X)","1164523"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1164523"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1164523"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Knee Disorders","Knee Disorders (X)","1164523"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Low Back Disorders","Low Back Disorders (X)","1164523"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Shoulder","Shoulder (X)","1164523"]
["esomeprazole/naproxen","VIMOVO","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (Proton Pump Inhibitor /NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (X)","1164523"]
["estradiol","ALORA, CLIMARA, MINIVELLE, MENOSTAR, VIVELLE DOT","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Estrogens","Chronic Pain","Chronic Pain (X)","1294793"]
["eszopiclone","LUNESTA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Hypnotics / Sedatives / Sleep Disorder Agents","Depressive Disorders","Depressive Disorders (R)","1156807"]
["etanercept","ENBREL","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1156809"]
["etanercept","ENBREL","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","1156809"]
["etanercept","ENBREL","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","1156809"]
["etanercept","ENBREL","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Shoulder","Shoulder (X)","1156809"]
["etidronate disodium","DIDRONEL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1157389"]
["etidronate disodium","DIDRONEL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Knee Disorders","Knee Disorders (NR)","1157389"]
["etidronate disodium","DIDRONEL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Low Back Disorders","Low Back Disorders (X)","1157389"]
["etidronate disodium","DIDRONEL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Shoulder","Shoulder (R)","1157389"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197684"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197684"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197684"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197684"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197684"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197684"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197684"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197684"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197684"]
["etodolac","LODINE","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197684"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197685"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197685"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197685"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197685"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197685"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197685"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197685"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197685"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197685"]
["etodolac","LODINE","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197685"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197686"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197686"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197686"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197686"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197686"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197686"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197686"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197686"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197686"]
["etodolac","LODINE","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197686"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","199390"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","199390"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","199390"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","199390"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","199390"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","199390"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","199390"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","199390"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","199390"]
["etodolac","LODINE","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","199390"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","310245"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","359500"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","310247"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","310247"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","310247"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","310247"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","310247"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","310247"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","310247"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","310247"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","310247"]
["etodolac","LODINE XL","ORAL","Tablet, Extended Release","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","310247"]
["famciclovir","FAMVIR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antivirals","Chronic Pain","Chronic Pain (NR)","1163801"]
["famotidine","PEPCID","ORAL","Powder for Suspension","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","310274"]
["famotidine","PEPCID","ORAL","Powder for Suspension","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","310274"]
["famotidine","PEPCID","ORAL","Powder for Suspension","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","310274"]
["famotidine","PEPCID","ORAL","Powder for Suspension","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","310274"]
["famotidine","PEPCID","ORAL","Powder for Suspension","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","310274"]
["famotidine","PEPCID","ORAL","Powder for Suspension","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","310274"]
["famotidine","PEPCID","ORAL","Powder for Suspension","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","310274"]
["famotidine","PEPCID","ORAL","Powder for Suspension","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury","Traumatic Brain Injury (R)","310274"]
["famotidine","PEPCID","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","199047"]
["famotidine","PEPCID","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","199047"]
["famotidine","PEPCID","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","199047"]
["famotidine","PEPCID","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","199047"]
["famotidine","PEPCID","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","199047"]
["famotidine","PEPCID","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","199047"]
["famotidine","PEPCID","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","199047"]
["famotidine","PEPCID","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury","Traumatic Brain Injury (R)","199047"]
["famotidine","PEPCID","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","310273"]
["famotidine","PEPCID","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","310273"]
["famotidine","PEPCID","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","310273"]
["famotidine","PEPCID","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","310273"]
["famotidine","PEPCID","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","310273"]
["famotidine","PEPCID","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","310273"]
["famotidine","PEPCID","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","310273"]
["famotidine","PEPCID","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury","Traumatic Brain Injury (R)","310273"]
["famotidine","PEPCID","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","284245"]
["famotidine","PEPCID","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","284245"]
["famotidine","PEPCID","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","284245"]
["famotidine","PEPCID","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","284245"]
["famotidine","PEPCID","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","284245"]
["famotidine","PEPCID","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","284245"]
["famotidine","PEPCID","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","284245"]
["famotidine","PEPCID","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Traumatic Brain Injury","Traumatic Brain Injury (R)","284245"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1100066"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1100066"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Chronic Pain","Chronic Pain (X)","1100066"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Elbow Disorders","Elbow Disorders (X)","1100066"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1100066"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1100066"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Knee Disorders","Knee Disorders (X)","1100066"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Low Back Disorders","Low Back Disorders (X)","1100066"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Shoulder","Shoulder (X)","1100066"]
["famotidine/ibuprofen","DUEXIS","ORAL","Tablet","26.6 MG-800 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (H2 Receptor Blocker /NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (X)","1100066"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197694"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","858116"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","858116"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","858116"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","858116"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","858116"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","858116"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","858116"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","858116"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","858116"]
["fenoprofen calcium","NALFON","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","858116"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","310291"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","310291"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","310291"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","310291"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","310291"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","310291"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","310291"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","310291"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","310291"]
["fenoprofen calcium","NALFON","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","310291"]
["fentanyl","DURAGESIC","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1294794"]
["fentanyl","DURAGESIC","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1294794"]
["fentanyl","DURAGESIC","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1294794"]
["fentanyl","DURAGESIC","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1294794"]
["fentanyl","DURAGESIC","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1294794"]
["fentanyl","DURAGESIC","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1294794"]
["fentanyl","DURAGESIC","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1294794"]
["fentanyl","DURAGESIC","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1294794"]
["fentanyl","DURAGESIC","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1294794"]
["fentanyl citrate oral transmucosal","FENTORA","ORAL","ALL ORAL BUCCAL/SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1295170"]
["fentanyl citrate oral transmucosal","FENTORA","ORAL","ALL ORAL BUCCAL/SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1295170"]
["fentanyl citrate oral transmucosal","FENTORA","ORAL","ALL ORAL BUCCAL/SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1295170"]
["fentanyl citrate oral transmucosal","FENTORA","ORAL","ALL ORAL BUCCAL/SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1295170"]
["fentanyl citrate oral transmucosal","FENTORA","ORAL","ALL ORAL BUCCAL/SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1295170"]
["fentanyl citrate oral transmucosal","FENTORA","ORAL","ALL ORAL BUCCAL/SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1295170"]
["fentanyl citrate oral transmucosal","FENTORA","ORAL","ALL ORAL BUCCAL/SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1295170"]
["fentanyl citrate oral transmucosal","FENTORA","ORAL","ALL ORAL BUCCAL/SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1295170"]
["fentanyl citrate oral transmucosal","FENTORA","ORAL","ALL ORAL BUCCAL/SUBLINGUAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1295170"]
["fentanyl citrate oral transmucosal","SUBSYS","ORAL","ALL ORAL MUCOSAL SPRAY DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1237048"]
["fentanyl citrate oral transmucosal","SUBSYS","ORAL","ALL ORAL MUCOSAL SPRAY DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1237048"]
["fentanyl citrate oral transmucosal","SUBSYS","ORAL","ALL ORAL MUCOSAL SPRAY DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1237048"]
["fentanyl citrate oral transmucosal","SUBSYS","ORAL","ALL ORAL MUCOSAL SPRAY DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1237048"]
["fentanyl citrate oral transmucosal","SUBSYS","ORAL","ALL ORAL MUCOSAL SPRAY DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1237048"]
["fentanyl citrate oral transmucosal","SUBSYS","ORAL","ALL ORAL MUCOSAL SPRAY DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1237048"]
["fentanyl citrate oral transmucosal","SUBSYS","ORAL","ALL ORAL MUCOSAL SPRAY DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1237048"]
["fentanyl citrate oral transmucosal","SUBSYS","ORAL","ALL ORAL MUCOSAL SPRAY DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1237048"]
["fentanyl citrate oral transmucosal","SUBSYS","ORAL","ALL ORAL MUCOSAL SPRAY DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1237048"]
["fentanyl citrate oral transmucosal","ACTIQ","ORAL","ALL ORAL TROCHE/LOZENGE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1294774"]
["fentanyl citrate oral transmucosal","ACTIQ","ORAL","ALL ORAL TROCHE/LOZENGE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1294774"]
["fentanyl citrate oral transmucosal","ACTIQ","ORAL","ALL ORAL TROCHE/LOZENGE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1294774"]
["fentanyl citrate oral transmucosal","ACTIQ","ORAL","ALL ORAL TROCHE/LOZENGE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1294774"]
["fentanyl citrate oral transmucosal","ACTIQ","ORAL","ALL ORAL TROCHE/LOZENGE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1294774"]
["fentanyl citrate oral transmucosal","ACTIQ","ORAL","ALL ORAL TROCHE/LOZENGE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1294774"]
["fentanyl citrate oral transmucosal","ACTIQ","ORAL","ALL ORAL TROCHE/LOZENGE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1294774"]
["fentanyl citrate oral transmucosal","ACTIQ","ORAL","ALL ORAL TROCHE/LOZENGE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1294774"]
["fentanyl citrate oral transmucosal","ACTIQ","ORAL","ALL ORAL TROCHE/LOZENGE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1294774"]
["fluconazole","DIFLUCAN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antifungals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1160236"]
["flunisolide","AEROSPAN HFA","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1165050"]
["fluocinolone acetonide","SYNALAR","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1165646"]
["fluocinonide","LIDEX","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Elbow Disorders","Elbow Disorders (X, NR)","1160817"]
["fluorometholone","FML","OPHTHALMIC","ALL OPHTHALMIC DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Ophthalmic Agents","Eye","Eye (R,X,NR)","1160828"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","310384"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","310384"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","310384"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","310384"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","310384"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","310384"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","310384"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","310384"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","310385"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","310385"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","310385"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","310385"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","310385"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","310385"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","310385"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","310385"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","313989"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","313989"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","313989"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","313989"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","313989"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","313989"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313989"]
["fluoxetine hcl","PROZAC","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","313989"]
["fluoxetine hcl","PROZAC","ORAL","Capsule, Delayed Release","90 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","313995"]
["fluoxetine hcl","PROZAC","ORAL","Capsule, Delayed Release","90 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","313995"]
["fluoxetine hcl","PROZAC","ORAL","Capsule, Delayed Release","90 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","313995"]
["fluoxetine hcl","PROZAC","ORAL","Capsule, Delayed Release","90 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","313995"]
["fluoxetine hcl","PROZAC","ORAL","Capsule, Delayed Release","90 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","313995"]
["fluoxetine hcl","PROZAC","ORAL","Capsule, Delayed Release","90 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","313995"]
["fluoxetine hcl","PROZAC","ORAL","Capsule, Delayed Release","90 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313995"]
["fluoxetine hcl","PROZAC","ORAL","Capsule, Delayed Release","90 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","313995"]
["fluoxetine hcl","PROZAC","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","310386"]
["fluoxetine hcl","PROZAC","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","310386"]
["fluoxetine hcl","PROZAC","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","310386"]
["fluoxetine hcl","PROZAC","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","310386"]
["fluoxetine hcl","PROZAC","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","310386"]
["fluoxetine hcl","PROZAC","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","310386"]
["fluoxetine hcl","PROZAC","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","310386"]
["fluoxetine hcl","PROZAC","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","310386"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","313990"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","313990"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","313990"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","313990"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","313990"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","313990"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313990"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","313990"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","248642"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","248642"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","248642"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","248642"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","248642"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","248642"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","248642"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","248642"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1190110"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","1190110"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1190110"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1190110"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","1190110"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1190110"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1190110"]
["fluoxetine hcl","PROZAC","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","1190110"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197724"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197724"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197724"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197724"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197724"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197724"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197724"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197724"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197724"]
["flurbiprofen","ANSAID","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197724"]
["flurbiprofen sodium","OCUFEN","OPHTHALMIC","Solution","0.03%","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Inflammatory (NSAID) Ophthalmic Drops","Eye","Eye (R,X)","1243585"]
["fluticasone propionate","FLOVENT","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1165655"]
["fluticasone propionate (topical)","CUTIVATE","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1165657"]
["fluticasone-salmeterol","ADVAIR DISKUS, ADVAIR HFA, AIRDUO RESPICLICK, \nAIRDUO DIGIHALER","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1165654"]
["fluvastatin sodium er","LESCOL XL","ORAL","Tablet","80 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlipidemics","Shoulder","Shoulder (NR)","360507"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","903873"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","903873"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","903873"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","903873"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","903873"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","903873"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","903873"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","903873"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","903879"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","903879"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","903879"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","903879"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","903879"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","903879"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","903879"]
["fluvoxamine maleate","LUVOX CR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","903879"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","903884"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","903884"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","903884"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","903884"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","903884"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","903884"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","903884"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","903884"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","903887"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","903887"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","903887"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","903887"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","903887"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","903887"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","903887"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","903887"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","903891"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","903891"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","903891"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","903891"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","903891"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","903891"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","903891"]
["fluvoxamine maleate","LUVOX","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","903891"]
["folic acid","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Hematopoietic Agents","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1162058"]
["folic acid","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Hematopoietic Agents","Depressive Disorders","Depressive Disorders (NR)","1162058"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","10 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","861356"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","10 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","861356"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","10 MG/0.8 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","861356"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","2.5 MG/0.5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","861360"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","2.5 MG/0.5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","861360"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","2.5 MG/0.5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","861360"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","5 MG/0.4 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","861363"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","5 MG/0.4 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","861363"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","5 MG/0.4 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","861363"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","7.5 MG/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","861365"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","7.5 MG/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","861365"]
["fondaparinux sodium","ARIXTRA","INJECTABLE","Solution","7.5 MG/0.6 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","861365"]
["formoterol fumarate","PERFOROMIST","INHALATION","Solution","20 MCG/2 ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1246319"]
["formoterol/mometasone","DULERA","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1165644"]
["frovatriptan succinate","FROVA","ORAL","Tablet","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","349462"]
["gabapentin","NEURONTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","4 days","Anticonvulsants","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X,NR)","1156681"]
["gabapentin","NEURONTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","4 days","Anticonvulsants","Chronic Pain","Chronic Pain (R)","1156681"]
["gabapentin","NEURONTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","4 days","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1156681"]
["gabapentin","NEURONTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","4 days","Anticonvulsants","Knee Disorders","Knee Disorders (R,X,NR)","1156681"]
["gabapentin","NEURONTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","4 days","Anticonvulsants","Low Back Disorders","Low Back Disorders (R,NR)","1156681"]
["gabapentin","NEURONTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","4 days","Anticonvulsants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1156681"]
["gabapentin","NEURONTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","4 days","Anticonvulsants","Shoulder","Shoulder (R,X,NR)","1156681"]
["gabapentin (once-daily)","GRALISE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc","Chronic Pain","Chronic Pain (X)","1156681"]
["gabapentin (once-daily)","GRALISE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc","Hip and Groin Disorders","Hip and Groin Disorders (X)","1156681"]
["gabapentin (once-daily)","GRALISE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1156681"]
["gabapentin enacarbil","HORIZANT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc","Chronic Pain","Chronic Pain (R,X)","1101333"]
["gabapentin enacarbil","HORIZANT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc","Hip and Groin Disorders","Hip and Groin Disorders (X)","1101333"]
["gabapentin enacarbil","HORIZANT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1101333"]
["gabapentin enacarbil","HORIZANT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc","Shoulder","Shoulder (R)","1101333"]
["gatifloxacin","ZYMAR","OPHTHALMIC","Solution","0.3%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anti-bacterial)","Eye","Eye (R,X)","402089"]
["gatifloxacin","ZYMAXID","OPHTHALMIC","Solution","0.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anti-bacterial)","Eye","Eye (R,X)","992395"]
["gentamicin sulfate (topical)","Not Applicable","TOPICAL","Cream","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197735"]
["gentamicin sulfate (topical)","Not Applicable","TOPICAL","Ointment","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","310465"]
["gentamicin sulfate ophthalmic","GENTAK","OPHTHALMIC","Ointment","0.3%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anti-bacterial)","Eye","Eye (R,X,NR)","310466"]
["gentamicin sulfate ophthalmic","GENTAK","OPHTHALMIC","Solution","0.3%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anti-bacterial)","Eye","Eye (R,X,NR)","310467"]
["glucosamine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative Medicines (OTC nutraceutical)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (NR)","1165223"]
["glucosamine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative Medicines (OTC nutraceutical)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1165223"]
["glucosamine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative Medicines (OTC nutraceutical)","Knee Disorders","Knee Disorders (X)","1165223"]
["glucosamine sulfate","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative Medicines (OTC nutraceutical)","Shoulder","Shoulder (NR)","1165223"]
["golimumab","SIMPONI","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1157808"]
["golimumab","SIMPONI","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Knee Disorders","Knee Disorders (X)","1157808"]
["golimumab","SIMPONI","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (TNF-alpha blocker)","Low Back Disorders","Low Back Disorders (X)","1157808"]
["granisetron hcl","SANCUSO","TRANSDERMAL","Film, Transdermal","3.1 MG/24 HR","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","825003"]
["granisetron hcl","KYTRIL","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","310599"]
["guanfacine hcl","TENEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1159714"]
["guanfacine hcl er","INTUNIV","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1159714"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","1,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (X, NR)","1361225"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","1,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1361225"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","1,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","1361225"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","10,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (X, NR)","1361852"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","10,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1361852"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","10,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","1361852"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","20,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (X, NR)","1361573"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","20,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1361573"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","20,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","1361573"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","5,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (X, NR)","1361614"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","5,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1361614"]
["heparin sodium","Not Applicable","INJECTABLE","Solution","5,000 U/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","1361614"]
["homatropine hbr ophthalmic","ISOPTO HOMATROPINE","OPHTHALMIC","Solution","5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anticholinergics)","Eye","Eye (X)","992757"]
["hydrochlorothiazide","MICROZIDE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Diuretics","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1162786"]
["hydrochlorothiazide","MICROZIDE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Diuretics","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1162786"]
["hydrocodone bitartrate","HYSINGLA ER, ZOHYDRO ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1163405"]
["hydrocodone bitartrate","HYSINGLA ER, ZOHYDRO ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1163405"]
["hydrocodone bitartrate","HYSINGLA ER, ZOHYDRO ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1163405"]
["hydrocodone bitartrate","HYSINGLA ER, ZOHYDRO ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1163405"]
["hydrocodone bitartrate","HYSINGLA ER, ZOHYDRO ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1163405"]
["hydrocodone bitartrate","HYSINGLA ER, ZOHYDRO ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1163405"]
["hydrocodone bitartrate","HYSINGLA ER, ZOHYDRO ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1163405"]
["hydrocodone bitartrate","HYSINGLA ER, ZOHYDRO ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1163405"]
["hydrocodone bitartrate","HYSINGLA ER, ZOHYDRO ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1163405"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 300MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1044427"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 300MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1044427"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 300MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1044427"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 300MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1044427"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 300MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1044427"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 300MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1044427"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 300MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1044427"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 300MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1044427"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 300MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","1044427"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 325MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","856944"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 325MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856944"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 325MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","856944"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 325MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","856944"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 325MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","856944"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 325MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","856944"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 325MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","856944"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 325MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","856944"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","10 MG/15 ML; 325MG/15 ML","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","856944"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","7.5 MG/15 ML; 325 MG/15 ML","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","856940"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","7.5 MG/15 ML; 325 MG/15 ML","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856940"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","7.5 MG/15 ML; 325 MG/15 ML","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","856940"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","7.5 MG/15 ML; 325 MG/15 ML","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","856940"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","7.5 MG/15 ML; 325 MG/15 ML","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","856940"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","7.5 MG/15 ML; 325 MG/15 ML","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","856940"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","7.5 MG/15 ML; 325 MG/15 ML","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","856940"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","7.5 MG/15 ML; 325 MG/15 ML","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","856940"]
["hydrocodone bitartrate /acetaminophen","Not Applicable","ORAL","Solution","7.5 MG/15 ML; 325 MG/15 ML","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","856940"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","10 MG- 300 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","856980"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","10 MG- 300 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856980"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","10 MG- 300 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","856980"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","10 MG- 300 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","856980"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","10 MG- 300 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","856980"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","10 MG- 300 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","856980"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","10 MG- 300 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","856980"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","10 MG- 300 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","856980"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","10 MG- 300 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","856980"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","10 MG-325 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","856999"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","10 MG-325 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856999"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","10 MG-325 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","856999"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","10 MG-325 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","856999"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","10 MG-325 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","856999"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","10 MG-325 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","856999"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","10 MG-325 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","856999"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","10 MG-325 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","856999"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","10 MG-325 MG","Non-Exempt","YES","4 days = \n20 tablets","YES","4 days = \n20 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","856999"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","2.5 MG-325 MG","Non-Exempt","YES","4 days = \n80 tablets","YES","4 days = \n80 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","857391"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","2.5 MG-325 MG","Non-Exempt","YES","4 days = \n80 tablets","YES","4 days = \n80 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","857391"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","2.5 MG-325 MG","Non-Exempt","YES","4 days = \n80 tablets","YES","4 days = \n80 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","857391"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","2.5 MG-325 MG","Non-Exempt","YES","4 days = \n80 tablets","YES","4 days = \n80 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","857391"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","2.5 MG-325 MG","Non-Exempt","YES","4 days = \n80 tablets","YES","4 days = \n80 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","857391"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","2.5 MG-325 MG","Non-Exempt","YES","4 days = \n80 tablets","YES","4 days = \n80 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","857391"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","2.5 MG-325 MG","Non-Exempt","YES","4 days = \n80 tablets","YES","4 days = \n80 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","857391"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","2.5 MG-325 MG","Non-Exempt","YES","4 days = \n80 tablets","YES","4 days = \n80 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","857391"]
["hydrocodone bitartrate /acetaminophen","NORCO","ORAL","Tablet","2.5 MG-325 MG","Non-Exempt","YES","4 days = \n80 tablets","YES","4 days = \n80 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","857391"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","5 MG-300 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","856987"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","5 MG-300 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856987"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","5 MG-300 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","856987"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","5 MG-300 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","856987"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","5 MG-300 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","856987"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","5 MG-300 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","856987"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","5 MG-300 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","856987"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","5 MG-300 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","856987"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","5 MG-300 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","856987"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","5 MG-325 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","857002"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","5 MG-325 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","857002"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","5 MG-325 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","857002"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","5 MG-325 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","857002"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","5 MG-325 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","857002"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","5 MG-325 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","857002"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","5 MG-325 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","857002"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","5 MG-325 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","857002"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","5 MG-325 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","857002"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","7.5 MG-300 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","856992"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","7.5 MG-300 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","856992"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","7.5 MG-300 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","856992"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","7.5 MG-300 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","856992"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","7.5 MG-300 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","856992"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","7.5 MG-300 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","856992"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","7.5 MG-300 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","856992"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","7.5 MG-300 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","856992"]
["hydrocodone bitartrate /acetaminophen","VICODIN, XODOL","ORAL","Tablet","7.5 MG-300 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","856992"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","7.5 MG-325 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","857005"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","7.5 MG-325 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","857005"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","7.5 MG-325 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","857005"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","7.5 MG-325 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","857005"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","7.5 MG-325 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","857005"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","7.5 MG-325 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","857005"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","7.5 MG-325 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","857005"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","7.5 MG-325 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","857005"]
["hydrocodone bitartrate /acetaminophen","NORCO, ANEXSIA","ORAL","Tablet","7.5 MG-325 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","857005"]
["hydrocodone bitartrate /ibuprofen","VICOPROFEN,REPREXAIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1162788"]
["hydrocodone bitartrate /ibuprofen","VICOPROFEN,REPREXAIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1162788"]
["hydrocodone bitartrate /ibuprofen","VICOPROFEN,REPREXAIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1162788"]
["hydrocodone bitartrate /ibuprofen","VICOPROFEN,REPREXAIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1162788"]
["hydrocodone bitartrate /ibuprofen","VICOPROFEN,REPREXAIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1162788"]
["hydrocodone bitartrate /ibuprofen","VICOPROFEN,REPREXAIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1162788"]
["hydrocodone bitartrate /ibuprofen","VICOPROFEN,REPREXAIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1162788"]
["hydrocodone bitartrate /ibuprofen","VICOPROFEN,REPREXAIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1162788"]
["hydrocodone bitartrate /ibuprofen","VICOPROFEN,REPREXAIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1162788"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (NR)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","2399644"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (NR)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","2399652"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (NR)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","2399656"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (NR)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","2399659"]
["hydrocortisone","ALKINDI SPRINKLE","ORAL","GRANULES","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","2399659"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (NR)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197782"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (NR)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197783"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Knee Disorders","Knee Disorders (NR)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","197787"]
["hydrocortisone","CORTEF","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197787"]
["hydrocortisone (topical)","Not Applicable","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1164013"]
["hydrocortisone valerate","WESTCORT","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1164013"]
["hydromorphone hcl","DILAUDID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1164620"]
["hydromorphone hcl","DILAUDID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1164620"]
["hydromorphone hcl","DILAUDID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1164620"]
["hydromorphone hcl","DILAUDID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1164620"]
["hydromorphone hcl","DILAUDID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1164620"]
["hydromorphone hcl","DILAUDID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1164620"]
["hydromorphone hcl","DILAUDID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1164620"]
["hydromorphone hcl","DILAUDID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1164620"]
["hydromorphone hcl","DILAUDID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1164620"]
["hydroxychloroquine sulfate","PLAQUENIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antimalarials","COVID-19 Coronavirus","COVID-19 Coronavirus (R,X,NR)","979092"]
["ibandronate sodium","BONIVA","ORAL","Tablet","150 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","904932"]
["ibandronate sodium","BONIVA","ORAL","Tablet","150 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Knee Disorders","Knee Disorders (NR)","904932"]
["ibandronate sodium","BONIVA","ORAL","Tablet","150 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Low Back Disorders","Low Back Disorders (X)","904932"]
["ibandronate sodium","BONIVA","ORAL","Tablet","150 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Shoulder","Shoulder (R)","904932"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","310964"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","310964"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","310964"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","310964"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","310964"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","310964"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,X,NR)","310964"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","310964"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","310964"]
["ibuprofen","MOTRIN","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","310964"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197803"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197803"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197803"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197803"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197803"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197803"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,X,NR)","197803"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197803"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197803"]
["ibuprofen","MOTRIN","ORAL","Suspension","100 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197803"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","310965"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","310965"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","310965"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","310965"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","310965"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","310965"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,X,NR)","310965"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","310965"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","310965"]
["ibuprofen","ADVIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","310965"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,X,NR)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197804"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,X,NR)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197805"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,X,NR)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197806"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197807"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197807"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197807"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197807"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197807"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197807"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,X,NR)","197807"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197807"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197807"]
["ibuprofen","MOTRIN","ORAL","Tablet","800 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197807"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","835593"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","835593"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","835593"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","835593"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X)","835593"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","835593"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","835593"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","835593"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","835564"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","835564"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","835564"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","835564"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X)","835564"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","835564"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","835564"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","835564"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","835568"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","835568"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","835568"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","835568"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X)","835568"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","835568"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","835568"]
["imipramine hcl","TOFRANIL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","835568"]
["imipramine pamoate","TOFRANAL-PM","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","835591"]
["imipramine pamoate","TOFRANIL-PM","ORAL","Capsule","125 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","835589"]
["imipramine pamoate","TOFRANIL-PM","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","835577"]
["imipramine pamoate","TOFRANIL-PM","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","835572"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197817"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197818"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197818"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197818"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197818"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197818"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197818"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197818"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197818"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197818"]
["indomethacin","INDOCIN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197818"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","310992"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","310992"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","310992"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","310992"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","310992"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","310992"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","310992"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","310992"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","310992"]
["indomethacin","INDOCIN SR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","310992"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","310991"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","310991"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","310991"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","310991"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","310991"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","310991"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","310991"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","310991"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","310991"]
["indomethacin","INDOCIN","ORAL","Suspension","25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","310991"]
["inositol","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Nutrients","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1157455"]
["irrigating eye wash","Not Applicable","OPHTHALMIC","Solution","Not Applicable","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents","Eye","Eye (R)","Not Applicable"]
["isocarboxazid","MARPLAN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (MAOIs)","Depressive Disorders","Depressive Disorders (R)","104837"]
["itraconazole","SPORANOX, TOLSURA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antifungals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1159777"]
["ivermectin","STROMECTOL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihelmintics","COVID-19 Coronavirus","COVID-19 Coronavirus (X, NR)","1160344"]
["ketoconazole","EXTINA, NIZORAL, XOLEGEL","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1160957"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197854"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197855"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","197856"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","197856"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","197856"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","197856"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","197856"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","197856"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","197856"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","197856"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","197856"]
["ketoprofen","ORUDIS","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","197856"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","359697"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","359697"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","359697"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","359697"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","359697"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","359697"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","359697"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","359697"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","359697"]
["ketoprofen","ORUVAIL","ORAL","Capsule, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","359697"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1797855"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1797855"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (X)","1797855"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (X)","1797855"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1797855"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1797855"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (X)","1797855"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (X)","1797855"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (X)","1797855"]
["ketorolac tromethamine","TORADOL","NASAL","Spray","15.75MG/SPRAY","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (X)","1797855"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","834022"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","834022"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (X)","834022"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (X)","834022"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","834022"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (X)","834022"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (X)","834022"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (X)","834022"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (X)","834022"]
["ketorolac tromethamine","TORADOL","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (X)","834022"]
["ketorolac tromethamine ophthalmic","ACULAR LS","OPHTHALMIC","Solution","0.4%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (NSAID)","Eye","Eye (R,X)","860103"]
["ketorolac tromethamine ophthalmic","ACUVAIL","OPHTHALMIC","Solution","0.45%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (NSAID)","Eye","Eye (R,X)","858364"]
["ketorolac tromethamine ophthalmic","ACULAR","OPHTHALMIC","Solution","0.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (NSAID)","Eye","Eye (R,X)","860107"]
["ketotifen fumarate","ALAWAY, ZADITOR","OPHTHALMIC","Solution","0.025%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents","Eye","Eye (R)","311237"]
["ketotifen fumarate","ALAWAY","OPHTHALMIC","Solution","0.035% equiv.","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents","Eye","Eye (R)","311237"]
["lamotrigine","LAMICTAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1162535"]
["lamotrigine","LAMICTAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (R)","1162535"]
["lamotrigine","LAMICTAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1162535"]
["lamotrigine","LAMICTAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1162535"]
["lamotrigine","LAMICTAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1162535"]
["lamotrigine","LAMICTAL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (R,X)","1162535"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","596843"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","596843"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","596843"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","596843"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","596843"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","596843"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","596843"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","596843"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","311277"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","311277"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","311277"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","311277"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","311277"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","311277"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","311277"]
["lansoprazole","PREVACID","ORAL","Capsule, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","311277"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","351261"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","351261"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","351261"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","351261"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","351261"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","351261"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","351261"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","351261"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","351260"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","351260"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","351260"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","351260"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","351260"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","351260"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","351260"]
["lansoprazole","PREVACID","ORAL","Tablet Disintegrating, Delayed Release","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","351260"]
["lenalidomide","REVLIMID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Miscellaneous Therapeutic Classes","Chronic Pain","Chronic Pain (X)","1162569"]
["levalbuterol","XOPENEX HFA","INHALATION","MDI, 200 ACTU","0.045 MG/Actuation","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","745791"]
["levalbuterol","XOPENEX HFA","INHALATION","MDI, 80 ACTU","0.045 MG/Actuation","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","996232"]
["levalbuterol","XOPENEX","INHALATION","Solution","0.0103%","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","349590"]
["levalbuterol","XOPENEX","INHALATION","Solution","0.021%","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","311286"]
["levalbuterol","XOPENEX","INHALATION","Solution","0.042%","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","242754"]
["levalbuterol","XOPENEX","INHALATION","Solution","0.25%","Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1855389"]
["levetiracetam","KEPPRA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (X)","1163451"]
["levetiracetam","KEPPRA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (X)","1163451"]
["levetiracetam","KEPPRA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1163451"]
["levetiracetam","KEPPRA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (X)","1163451"]
["levofloxacin","LEVAQUIN","ORAL","Solution","250 MG/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","477391"]
["levofloxacin","LEVAQUIN","ORAL","Solution","250 MG/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","477391"]
["levofloxacin","LEVAQUIN","ORAL","Solution","250 MG/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hip and Groin Disorders","Hip and Groin Disorders (R)","477391"]
["levofloxacin","LEVAQUIN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","199884"]
["levofloxacin","LEVAQUIN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","199884"]
["levofloxacin","LEVAQUIN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hip and Groin Disorders","Hip and Groin Disorders (R)","199884"]
["levofloxacin","LEVAQUIN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","199885"]
["levofloxacin","LEVAQUIN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","199885"]
["levofloxacin","LEVAQUIN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hip and Groin Disorders","Hip and Groin Disorders (R)","199885"]
["levofloxacin","LEVAQUIN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","311296"]
["levofloxacin","LEVAQUIN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","311296"]
["levofloxacin","LEVAQUIN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hip and Groin Disorders","Hip and Groin Disorders (R)","311296"]
["levofloxacin ophthalmic solution","QUIXIN","OPHTHALMIC","Solution","0.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anti-bacterial)","Eye","Eye (R,X,NR)","314080"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1433217"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","1433217"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","1433217"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1433217"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","1433217"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X)","1433217"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","1433217"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1433227"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","1433227"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","1433227"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1433227"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","1433227"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X)","1433227"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","1433227"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1433233"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","1433233"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","1433233"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1433233"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","1433233"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X)","1433233"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","1433233"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1433239"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","1433239"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","1433239"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1433239"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","1433239"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X)","1433239"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","1433239"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release (titration pack)","20 MG / 40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1433249"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release (titration pack)","20 MG / 40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (X)","1433249"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release (titration pack)","20 MG / 40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","1433249"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release (titration pack)","20 MG / 40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1433249"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release (titration pack)","20 MG / 40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (X)","1433249"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release (titration pack)","20 MG / 40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (X)","1433249"]
["levomilnacipran","FETZIMA","ORAL","Capsule, Extended Release (titration pack)","20 MG / 40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (X)","1433249"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","2 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","197873"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","2 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","197873"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","2 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","197873"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","2 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","197873"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","2 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","197873"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","2 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","197873"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","2 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","197873"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","2 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","197873"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","2 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","197873"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","3 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","2058845"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","3 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","2058845"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","3 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","2058845"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","3 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","2058845"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","3 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","2058845"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","3 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","2058845"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","3 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","2058845"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","3 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","2058845"]
["levorphanol tartrate","LEVO-DROMORAN","ORAL","Tablet","3 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","2058845"]
["lidocaine","LIDODERM","TOPICAL","Ointment","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1543069"]
["lidocaine","LIDODERM","TOPICAL","Ointment","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1543069"]
["lidocaine","LIDODERM","TOPICAL","Ointment","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Chronic Pain","Chronic Pain (R,NR)","1543069"]
["lidocaine","LIDODERM","TOPICAL","Ointment","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Elbow Disorders","Elbow Disorders (NR)","1543069"]
["lidocaine","LIDODERM","TOPICAL","Ointment","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1543069"]
["lidocaine","LIDODERM","TOPICAL","Ointment","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hip and Groin Disorders","Hip and Groin Disorders (X, NR)","1543069"]
["lidocaine","LIDODERM","TOPICAL","Ointment","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Low Back Disorders","Low Back Disorders (X, NR)","1543069"]
["lidocaine","LIDODERM","TOPICAL","Ointment","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Shoulder","Shoulder (R,X,NR)","1543069"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","4%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1872886"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","4%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1872886"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","4%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Chronic Pain","Chronic Pain (R,NR)","1872886"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","4%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Elbow Disorders","Elbow Disorders (NR)","1872886"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","4%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1872886"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","4%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hip and Groin Disorders","Hip and Groin Disorders (X, NR)","1872886"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","4%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Low Back Disorders","Low Back Disorders (X, NR)","1872886"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","4%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Shoulder","Shoulder (R,X,NR)","1872886"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1745091"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1745091"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Chronic Pain","Chronic Pain (R,NR)","1745091"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Elbow Disorders","Elbow Disorders (NR)","1745091"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1745091"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hip and Groin Disorders","Hip and Groin Disorders (X, NR)","1745091"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Low Back Disorders","Low Back Disorders (X, NR)","1745091"]
["lidocaine","LIDODERM","TRANSDERMAL","Patch, Extended Release","5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Shoulder","Shoulder (R,X,NR)","1745091"]
["lidocaine hcl","Not Applicable","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1164666"]
["lidocaine hcl ophth","AKTEN","OPHTHALMIC","Gel","3.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents","Eye","Eye (R)","1009462"]
["lidocaine/prilocaine","EMLA","TOPICAL","Cream","2.5%-2.5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","197877"]
["lidocaine/prilocaine","EMLA","TOPICAL","Cream","2.5%-2.5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Chronic Pain","Chronic Pain (NR)","197877"]
["lidocaine/prilocaine","EMLA","TOPICAL","Cream","2.5%-2.5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","197877"]
["lidocaine/prilocaine","EMLA","TOPICAL","Cream","2.5%-2.5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hip and Groin Disorders","Hip and Groin Disorders (X)","197877"]
["lidocaine/prilocaine","EMLA","TOPICAL","Cream","2.5%-2.5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Low Back Disorders","Low Back Disorders (X)","197877"]
["lidocaine/prilocaine","EMLA","TOPICAL","Cream","2.5%-2.5%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Shoulder","Shoulder (X, NR)","197877"]
["lithium carbonate","ESKALITH, LITHOBID, LITHOTABS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1164698"]
["lodoxamide tromethamine ophth","ALOMIDE","OPHTHALMIC","Solution","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","311361"]
["lopinavir/ritonavir","KALETRA","ORAL","Solution","80 MG-20MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antivirals","COVID-19 Coronavirus","COVID-19 Coronavirus (R,X)","311369"]
["lopinavir/ritonavir","KALETRA","ORAL","Tablet","100 MG-25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antivirals","COVID-19 Coronavirus","COVID-19 Coronavirus (R,X)","746645"]
["lopinavir/ritonavir","KALETRA","ORAL","Tablet","200 MG-50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antivirals","COVID-19 Coronavirus","COVID-19 Coronavirus (R,X)","597730"]
["loratadine","CLARITIN","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","828269"]
["loratadine","CLARITIN","ORAL","Suspension","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","608013"]
["loratadine","CLARITIN","ORAL","Syrup","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","692783"]
["loratadine","CLARITIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","311372"]
["loratadine","CLARITIN","ORAL","Tablet, Chewable","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","2265266"]
["loratadine","CLARITIN","ORAL","Tablet, Chewable","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","665078"]
["loratadine","CLARITIN","ORAL","Tablet, Disintegrating","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","311373"]
["loratadine","CLARITIN","ORAL","Tablet, Disintegrating","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","672558"]
["lorazepam","ATIVAN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antianxiety Agents","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1165340"]
["loteprednol etabonate ophthalmic","ALREX","OPHTHALMIC","ALL OPHTHALMIC DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Ophthalmic Agents (Steroid)","Eye","Eye (R,X,NR)","1163869"]
["lovastatin","MEVACOR","ORAL","Tablet","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlipidemics","Shoulder","Shoulder (NR)","197903"]
["lovastatin","MEVACOR","ORAL","Tablet","20 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlipidemics","Shoulder","Shoulder (NR)","197904"]
["lovastatin","MEVACOR","ORAL","Tablet","40 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlipidemics","Shoulder","Shoulder (NR)","197905"]
["lovastatin","ALTOPREV","ORAL","Tablet, extended release","20 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlipidemics","Shoulder","Shoulder (NR)","433849"]
["lovastatin","ALTOPREV","ORAL","Tablet, extended release","40 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlipidemics","Shoulder","Shoulder (NR)","359731"]
["lovastatin","ALTOPREV","ORAL","Tablet, extended release","60 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlipidemics","Shoulder","Shoulder (NR)","359732"]
["lurasidone","LATUDA","ORAL","Tablet","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","1297278"]
["lurasidone","LATUDA","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","1235247"]
["lurasidone","LATUDA","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","1040031"]
["lurasidone","LATUDA","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","1431235"]
["lurasidone","LATUDA","ORAL","Tablet","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","1040041"]
["magnesium","Not Applicable","BULK","BULK CHEMICAL","Not Applicable","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Minerals & Electrolytes","Chronic Pain","Chronic Pain (X)","6574"]
["meclizine hcl","ANTIVERT","ORAL","Tablet","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","995624"]
["meclizine hcl","ANTIVERT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","995666"]
["meclizine hcl","ANTIVERT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","995686"]
["meclizine hcl","ANTIVERT","ORAL","Tablet, Chewable","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","995632"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","618552"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","618557"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","618557"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","618557"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","618557"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","618557"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","618557"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","618557"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","618557"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","618557"]
["meclofenamate sodium","MECLOMEN","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","618557"]
["medroxyprogesterone acetate","PROVERA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Progestins","Traumatic Brain Injury","Traumatic Brain Injury (X)","1159194"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","829500"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","829500"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","829500"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","829500"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","829500"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","829500"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","829500"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","829500"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","829500"]
["mefenamic acid","PONSTEL","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","829500"]
["melatonin","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative  Medicines","Chronic Pain","Chronic Pain (R)","1159785"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","10 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1722357"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1722349"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1722349"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","1722349"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","1722349"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","1722349"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1722349"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","1722349"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","1722349"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","1722349"]
["meloxicam","VIVLODEX","ORAL","Capsule","5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1722349"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","152695"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","311486"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","311486"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","311486"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","311486"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","311486"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","311486"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","311486"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","311486"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","311486"]
["meloxicam","MOBIC","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","311486"]
["memantine hcl","NAMENDA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.\n(NDMA Receptor Antagonist)","Chronic Pain","Chronic Pain (X, NR)","1159792"]
["memantine hcl","NAMENDA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.\n(NDMA Receptor Antagonist)","Low Back Disorders","Low Back Disorders (X)","1159792"]
["memantine hcl","NAMENDA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.\n(NDMA Receptor Antagonist)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1159792"]
["menthol","BIOFREEZE","TOPICAL","CREAM","10%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","253020"]
["menthol","BIOFREEZE","TOPICAL","CREAM","10%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (NR)","253020"]
["menthol","BIOFREEZE","TOPICAL","CREAM","10%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Chronic Pain","Chronic Pain (NR)","253020"]
["menthol","BIOFREEZE","TOPICAL","CREAM","10%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","253020"]
["menthol","BIOFREEZE","TOPICAL","CREAM","10%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hip and Groin Disorders","Hip and Groin Disorders (X)","253020"]
["menthol","BIOFREEZE","TOPICAL","CREAM","10%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Low Back Disorders","Low Back Disorders (NR)","253020"]
["menthol","BIOFREEZE","TOPICAL","CREAM","10%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Shoulder","Shoulder (NR)","253020"]
["meperidine hcl","DEMEROL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1160385"]
["meperidine hcl","DEMEROL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1160385"]
["meperidine hcl","DEMEROL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1160385"]
["meperidine hcl","DEMEROL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1160385"]
["meperidine hcl","DEMEROL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1160385"]
["meperidine hcl","DEMEROL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1160385"]
["meperidine hcl","DEMEROL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1160385"]
["meperidine hcl","DEMEROL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1160385"]
["meperidine hcl","DEMEROL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1160385"]
["metaxalone","SKELAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1156711"]
["metaxalone","SKELAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Chronic Pain","Chronic Pain (X)","1156711"]
["metaxalone","SKELAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1156711"]
["metaxalone","SKELAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Knee Disorders","Knee Disorders (X)","1156711"]
["metaxalone","SKELAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Low Back Disorders","Low Back Disorders (X)","1156711"]
["metaxalone","SKELAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Shoulder","Shoulder (X)","1156711"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1161621"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1161621"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1161621"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1161621"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1161621"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1161621"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1161621"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1161621"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Opioid","Opioid (R)","1161621"]
["methadone hcl","DOLOPHINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1161621"]
["methocarbamol","ROBAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1162231"]
["methocarbamol","ROBAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Chronic Pain","Chronic Pain (X)","1162231"]
["methocarbamol","ROBAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1162231"]
["methocarbamol","ROBAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Knee Disorders","Knee Disorders (X)","1162231"]
["methocarbamol","ROBAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Low Back Disorders","Low Back Disorders (X)","1162231"]
["methocarbamol","ROBAXIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Shoulder","Shoulder (X)","1162231"]
["methyl salicylate","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (NR)","115673"]
["methyl salicylate","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Chronic Pain","Chronic Pain (NR)","115673"]
["methyl salicylate","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","115673"]
["methyl salicylate","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hip and Groin Disorders","Hip and Groin Disorders (X)","115673"]
["methyl salicylate","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Low Back Disorders","Low Back Disorders (NR)","115673"]
["methyl salicylate","BENGAY ULTRA","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Shoulder","Shoulder (NR)","115673"]
["methylphenidate hcl","CONCERTA, RITALIN (VARIOUS OTHER)","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (R)","1163482"]
["methylphenidate hcl","METHYLIN","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 Days","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (R)","1091133"]
["methylphenidate hcl","METHYLIN","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 Days","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (R)","1091341"]
["methylphenidate hcl","RITALIN","ORAL","Tablet","10 MG","Non-Exempt","YES","4 Days","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (R)","1091150"]
["methylphenidate hcl","RITALIN","ORAL","Tablet","20 MG","Non-Exempt","YES","4 Days","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (R)","1091392"]
["methylphenidate hcl","RITALIN","ORAL","Tablet","5 MG","Non-Exempt","YES","4 Days","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (R)","1091497"]
["methylphenidate hcl","METHYLIN","ORAL","Tablet, Chewable","10 MG","Non-Exempt","YES","4 Days","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (R)","1091152"]
["methylphenidate hcl","METHYLIN","ORAL","Tablet, Chewable","2.5 MG","Non-Exempt","YES","4 Days","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (R)","1091389"]
["methylphenidate hcl","METHYLIN","ORAL","Tablet, Chewable","5 MG","Non-Exempt","YES","4 Days","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (R)","1091322"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,NR)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Work Related Asthma","Work Related Asthma (R)","328161"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,NR)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Work Related Asthma","Work Related Asthma (R)","197969"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,NR)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","32 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Work Related Asthma","Work Related Asthma (R)","197971"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,NR)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Work Related Asthma","Work Related Asthma (R)","259966"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,NR)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Traumatic Brain Injury","Traumatic Brain Injury (X)","197973"]
["methylprednisolone","MEDROL","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Corticosteroids","Work Related Asthma","Work Related Asthma (R)","197973"]
["methylsulfonylmethane","MSM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Chemicals (OTC nutraceuticals)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1156745"]
["methylsulfonylmethane","MSM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Chemicals (OTC nutraceuticals)","Knee Disorders","Knee Disorders (NR)","1156745"]
["methylsulfonylmethane","MSM","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Chemicals (OTC nutraceuticals)","Shoulder","Shoulder (NR)","1156745"]
["metoclopramide hcl","REGLAN","ORAL","Solution","5 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","104884"]
["metoclopramide hcl","REGLAN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","311666"]
["metoclopramide hcl","REGLAN","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","311668"]
["metronidazole","METROCREAM","TOPICAL","Cream","0.75%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","311680"]
["metronidazole","NORITATE","TOPICAL","Cream","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","311678"]
["metronidazole","METROGEL","TOPICAL","Gel","0.75%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","311679"]
["metronidazole","METROGEL","TOPICAL","Gel","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","577237"]
["metronidazole","METROLOTION","TOPICAL","Lotion","0.75%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","242736"]
["metronidazole oral","FLAGYL","ORAL","Capsule","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","199055"]
["metronidazole oral","FLAGYL","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","314106"]
["metronidazole oral","FLAGYL","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","247673"]
["miconazole nitrate","MICATIN","TOPICAL","Cream","2%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","998483"]
["midazolam hcl","VERSED","ORAL","Syrup","2 MG/ML","Non-Exempt","YES","4 Days","NO","Not Applicable","Hypnotics / Sedatives / Sleep Disorder Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","422410"]
["mifepristone","MIFEPREX","ORAL","Tablet","200 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents - (misc)","Depressive Disorders","Depressive Disorders (X)","311704"]
["milnacipran","SAVELLA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","833135"]
["milnacipran","SAVELLA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Chronic Pain","Chronic Pain (R,X)","833135"]
["milnacipran","SAVELLA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Depressive Disorders","Depressive Disorders (R)","833135"]
["milnacipran","SAVELLA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Hip and Groin Disorders","Hip and Groin Disorders (X)","833135"]
["milnacipran","SAVELLA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Knee Disorders","Knee Disorders (X)","833135"]
["milnacipran","SAVELLA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Low Back Disorders","Low Back Disorders (X)","833135"]
["milnacipran","SAVELLA","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Shoulder","Shoulder (X)","833135"]
["milnacipran","SAVELLA","ORAL","Tablet","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","833141"]
["milnacipran","SAVELLA","ORAL","Tablet","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Chronic Pain","Chronic Pain (R,X)","833141"]
["milnacipran","SAVELLA","ORAL","Tablet","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Depressive Disorders","Depressive Disorders (R)","833141"]
["milnacipran","SAVELLA","ORAL","Tablet","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Hip and Groin Disorders","Hip and Groin Disorders (X)","833141"]
["milnacipran","SAVELLA","ORAL","Tablet","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Knee Disorders","Knee Disorders (X)","833141"]
["milnacipran","SAVELLA","ORAL","Tablet","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Low Back Disorders","Low Back Disorders (X)","833141"]
["milnacipran","SAVELLA","ORAL","Tablet","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Shoulder","Shoulder (X)","833141"]
["milnacipran","SAVELLA","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","833147"]
["milnacipran","SAVELLA","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Chronic Pain","Chronic Pain (R,X)","833147"]
["milnacipran","SAVELLA","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Depressive Disorders","Depressive Disorders (R)","833147"]
["milnacipran","SAVELLA","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Hip and Groin Disorders","Hip and Groin Disorders (X)","833147"]
["milnacipran","SAVELLA","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Knee Disorders","Knee Disorders (X)","833147"]
["milnacipran","SAVELLA","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Low Back Disorders","Low Back Disorders (X)","833147"]
["milnacipran","SAVELLA","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Shoulder","Shoulder (X)","833147"]
["milnacipran","SAVELLA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","833144"]
["milnacipran","SAVELLA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Chronic Pain","Chronic Pain (R,X)","833144"]
["milnacipran","SAVELLA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Depressive Disorders","Depressive Disorders (R)","833144"]
["milnacipran","SAVELLA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Hip and Groin Disorders","Hip and Groin Disorders (X)","833144"]
["milnacipran","SAVELLA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Knee Disorders","Knee Disorders (X)","833144"]
["milnacipran","SAVELLA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Low Back Disorders","Low Back Disorders (X)","833144"]
["milnacipran","SAVELLA","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Shoulder","Shoulder (X)","833144"]
["milnacipran","SAVELLA","ORAL","Tablet (combo pack)","12.5mg/25mg/50mg","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","833150"]
["milnacipran","SAVELLA","ORAL","Tablet (combo pack)","12.5mg/25mg/50mg","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Chronic Pain","Chronic Pain (R,X)","833150"]
["milnacipran","SAVELLA","ORAL","Tablet (combo pack)","12.5mg/25mg/50mg","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Depressive Disorders","Depressive Disorders (R)","833150"]
["milnacipran","SAVELLA","ORAL","Tablet (combo pack)","12.5mg/25mg/50mg","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Hip and Groin Disorders","Hip and Groin Disorders (X)","833150"]
["milnacipran","SAVELLA","ORAL","Tablet (combo pack)","12.5mg/25mg/50mg","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Knee Disorders","Knee Disorders (X)","833150"]
["milnacipran","SAVELLA","ORAL","Tablet (combo pack)","12.5mg/25mg/50mg","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Low Back Disorders","Low Back Disorders (X)","833150"]
["milnacipran","SAVELLA","ORAL","Tablet (combo pack)","12.5mg/25mg/50mg","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc. (Anti-depressant)","Shoulder","Shoulder (X)","833150"]
["minocycline hcl","MINOCIN, XIMINO, MINOURA, SOLODYN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1164754"]
["minocycline hcl","MINOCIN, XIMINO, MINOURA, SOLODYN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Depressive Disorders","Depressive Disorders (X)","1164754"]
["mirtazapine","REMERON","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Chronic Pain","Chronic Pain (R)","1165364"]
["mirtazapine","REMERON","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Depressive Disorders","Depressive Disorders (R)","1165364"]
["mirtazapine","REMERON","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1165364"]
["mirtazapine","REMERON","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Shoulder","Shoulder (R)","1165364"]
["misoprostol","CYTOTEC","ORAL","Tablet","100 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","311727"]
["misoprostol","CYTOTEC","ORAL","Tablet","100 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Elbow Disorders","Elbow Disorders (R)","311727"]
["misoprostol","CYTOTEC","ORAL","Tablet","100 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","311727"]
["misoprostol","CYTOTEC","ORAL","Tablet","100 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Hip and Groin Disorders","Hip and Groin Disorders (R)","311727"]
["misoprostol","CYTOTEC","ORAL","Tablet","100 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Knee Disorders","Knee Disorders (R)","311727"]
["misoprostol","CYTOTEC","ORAL","Tablet","100 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Low Back Disorders","Low Back Disorders (R)","311727"]
["misoprostol","CYTOTEC","ORAL","Tablet","100 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Shoulder","Shoulder (R)","311727"]
["misoprostol","CYTOTEC","ORAL","Tablet","100 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Traumatic Brain Injury","Traumatic Brain Injury (R)","311727"]
["misoprostol","CYTOTEC","ORAL","Tablet","200 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","317128"]
["misoprostol","CYTOTEC","ORAL","Tablet","200 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Elbow Disorders","Elbow Disorders (R)","317128"]
["misoprostol","CYTOTEC","ORAL","Tablet","200 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","317128"]
["misoprostol","CYTOTEC","ORAL","Tablet","200 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Hip and Groin Disorders","Hip and Groin Disorders (R)","317128"]
["misoprostol","CYTOTEC","ORAL","Tablet","200 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Knee Disorders","Knee Disorders (R)","317128"]
["misoprostol","CYTOTEC","ORAL","Tablet","200 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Low Back Disorders","Low Back Disorders (R)","317128"]
["misoprostol","CYTOTEC","ORAL","Tablet","200 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Shoulder","Shoulder (R)","317128"]
["misoprostol","CYTOTEC","ORAL","Tablet","200 MCG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Traumatic Brain Injury","Traumatic Brain Injury (R)","317128"]
["modafinil","PROVIGIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","ADHD / Anti-narcolepsy / Anti-Obesity / Anorexiants","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1157285"]
["mometasone furoate","ASMANEX, ASMANEX HFA","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1165391"]
["mometasone furoate (topical)","ELOCON","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1165393"]
["montelukast sodium","SINGLUAIR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1157311"]
["morphine sulfate","Not Applicable","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 days = \n100 ml","YES","4 days = \n100 ml","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","892589"]
["morphine sulfate","Not Applicable","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 days = \n100 ml","YES","4 days = \n100 ml","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","892589"]
["morphine sulfate","Not Applicable","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 days = \n100 ml","YES","4 days = \n100 ml","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","892589"]
["morphine sulfate","Not Applicable","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 days = \n100 ml","YES","4 days = \n100 ml","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","892589"]
["morphine sulfate","Not Applicable","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 days = \n100 ml","YES","4 days = \n100 ml","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","892589"]
["morphine sulfate","Not Applicable","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 days = \n100 ml","YES","4 days = \n100 ml","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","892589"]
["morphine sulfate","Not Applicable","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 days = \n100 ml","YES","4 days = \n100 ml","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","892589"]
["morphine sulfate","Not Applicable","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 days = \n100 ml","YES","4 days = \n100 ml","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","892589"]
["morphine sulfate","Not Applicable","ORAL","Solution","10 MG/5 ML","Non-Exempt","YES","4 days = \n100 ml","YES","4 days = \n100 ml","Analgesics - Opioid","Shoulder","Shoulder (R,X)","892589"]
["morphine sulfate","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n10 ml","YES","4 days = \n10 ml","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","892625"]
["morphine sulfate","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n10 ml","YES","4 days = \n10 ml","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","892625"]
["morphine sulfate","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n10 ml","YES","4 days = \n10 ml","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","892625"]
["morphine sulfate","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n10 ml","YES","4 days = \n10 ml","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","892625"]
["morphine sulfate","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n10 ml","YES","4 days = \n10 ml","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","892625"]
["morphine sulfate","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n10 ml","YES","4 days = \n10 ml","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","892625"]
["morphine sulfate","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n10 ml","YES","4 days = \n10 ml","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","892625"]
["morphine sulfate","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n10 ml","YES","4 days = \n10 ml","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","892625"]
["morphine sulfate","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n10 ml","YES","4 days = \n10 ml","Analgesics - Opioid","Shoulder","Shoulder (R,X)","892625"]
["morphine sulfate","Not Applicable","ORAL","Solution","20 MG/5 ML","Non-Exempt","YES","4 days = \n50 ml","YES","4 days = \n50 ml","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","894780"]
["morphine sulfate","Not Applicable","ORAL","Solution","20 MG/5 ML","Non-Exempt","YES","4 days = \n50 ml","YES","4 days = \n50 ml","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","894780"]
["morphine sulfate","Not Applicable","ORAL","Solution","20 MG/5 ML","Non-Exempt","YES","4 days = \n50 ml","YES","4 days = \n50 ml","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","894780"]
["morphine sulfate","Not Applicable","ORAL","Solution","20 MG/5 ML","Non-Exempt","YES","4 days = \n50 ml","YES","4 days = \n50 ml","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","894780"]
["morphine sulfate","Not Applicable","ORAL","Solution","20 MG/5 ML","Non-Exempt","YES","4 days = \n50 ml","YES","4 days = \n50 ml","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","894780"]
["morphine sulfate","Not Applicable","ORAL","Solution","20 MG/5 ML","Non-Exempt","YES","4 days = \n50 ml","YES","4 days = \n50 ml","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","894780"]
["morphine sulfate","Not Applicable","ORAL","Solution","20 MG/5 ML","Non-Exempt","YES","4 days = \n50 ml","YES","4 days = \n50 ml","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","894780"]
["morphine sulfate","Not Applicable","ORAL","Solution","20 MG/5 ML","Non-Exempt","YES","4 days = \n50 ml","YES","4 days = \n50 ml","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","894780"]
["morphine sulfate","Not Applicable","ORAL","Solution","20 MG/5 ML","Non-Exempt","YES","4 days = \n50 ml","YES","4 days = \n50 ml","Analgesics - Opioid","Shoulder","Shoulder (R,X)","894780"]
["morphine sulfate","Not Applicable","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","892582"]
["morphine sulfate","Not Applicable","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","892582"]
["morphine sulfate","Not Applicable","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","892582"]
["morphine sulfate","Not Applicable","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","892582"]
["morphine sulfate","Not Applicable","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","892582"]
["morphine sulfate","Not Applicable","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","892582"]
["morphine sulfate","Not Applicable","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","892582"]
["morphine sulfate","Not Applicable","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","892582"]
["morphine sulfate","Not Applicable","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Shoulder","Shoulder (R,X)","892582"]
["morphine sulfate","Not Applicable","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","893672"]
["morphine sulfate","Not Applicable","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","893672"]
["morphine sulfate","Not Applicable","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","893672"]
["morphine sulfate","Not Applicable","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","893672"]
["morphine sulfate","Not Applicable","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","893672"]
["morphine sulfate","Not Applicable","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","893672"]
["morphine sulfate","Not Applicable","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","893672"]
["morphine sulfate","Not Applicable","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","893672"]
["morphine sulfate","Not Applicable","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Shoulder","Shoulder (R,X)","893672"]
["morphine sulfate extended release","KADIAN, AVINZA, MS CONTIN","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1156364"]
["morphine sulfate extended release","KADIAN, AVINZA, MS CONTIN","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1156364"]
["morphine sulfate extended release","KADIAN, AVINZA, MS CONTIN","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1156364"]
["morphine sulfate extended release","KADIAN, AVINZA, MS CONTIN","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1156364"]
["morphine sulfate extended release","KADIAN, AVINZA, MS CONTIN","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1156364"]
["morphine sulfate extended release","KADIAN, AVINZA, MS CONTIN","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1156364"]
["morphine sulfate extended release","KADIAN, AVINZA, MS CONTIN","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1156364"]
["morphine sulfate extended release","KADIAN, AVINZA, MS CONTIN","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1156364"]
["morphine sulfate extended release","KADIAN, AVINZA, MS CONTIN","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1156364"]
["moxifloxacin hcl","AVELOX","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","311787"]
["moxifloxacin hcl","AVELOX","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","311787"]
["moxifloxacin hcl ophthalmic","VIGAMOX, MOXEZA","OPHTHALMIC","Solution","0.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Antibiotics)","Eye","Eye (R,X,NR)","403818"]
["mupirocin","BACTROBAN","TOPICAL","Cream","2%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","311877"]
["mupirocin","BACTROBAN","TOPICAL","Ointment","2%","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","106346"]
["nabilone","CESAMET","ORAL","Capsule","1 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Depressive Disorders","Depressive Disorders (X)","311891"]
["nabilone","CESAMET","ORAL","Capsule","1 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","311891"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","427726"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","311892"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","311893"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","311893"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","311893"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","311893"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","311893"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","311893"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","311893"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","311893"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","311893"]
["nabumetone","RELAFEN","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","311893"]
["n-acetyl-l-cysteine","NAC","ORAL","Tablet","600 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Nutrients","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","606971"]
["n-acetyl-l-cysteine","NAC","ORAL","Tablet","600 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Nutrients","Chronic Pain","Chronic Pain (R,X)","606971"]
["n-acetyl-l-cysteine","NAC","ORAL","Tablet","600 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Nutrients","Low Back Disorders","Low Back Disorders (X)","606971"]
["naloxone hcl","EVZIO","INJECTABLE","Autoinjector","2 MG/ 0.4ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antidotes and Specific Antagonists","Opioid","Opioid (R)","1855730"]
["naloxone hcl","NARCAN","INJECTABLE","Prefilled Syringe, 2 ML","0.4 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidotes and Specific Antagonists","Opioid","Opioid (R)","1191245"]
["naloxone hcl","NARCAN","INJECTABLE","Prefilled syringe, 2 ML","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidotes and Specific Antagonists","Opioid","Opioid (R)","1191250"]
["naloxone hcl","NARCAN","NASAL","Spray","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidotes and Specific Antagonists","Opioid","Opioid (R)","1870933"]
["naloxone hcl","NARCAN","NASAL","Spray","40 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidotes and Specific Antagonists","Opioid","Opioid (R)","1725059"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","311913"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","311913"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","311913"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","311913"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","311913"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","311913"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","311913"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","311913"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","311913"]
["naproxen","NAPROSYN","ORAL","Suspension","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","311913"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","198013"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","198012"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","198014"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","198014"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","198014"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","198014"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198014"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","198014"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","198014"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","198014"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","198014"]
["naproxen","NAPROSYN","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","198014"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","105918"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","311915"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","311915"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","311915"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","311915"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","311915"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","311915"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","311915"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","311915"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","311915"]
["naproxen","EC-NAPROSYN","ORAL","Tablet, Enteric Coated (Delayed Release)","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","311915"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1112231"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1112231"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","1112231"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","1112231"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","1112231"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1112231"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","1112231"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","1112231"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","1112231"]
["naproxen sodium","ALEVE","ORAL","Capsule","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1112231"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","849574"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","849574"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","849574"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","849574"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","849574"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","849574"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","849574"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","849574"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","849574"]
["naproxen sodium","ALEVE","ORAL","Tablet","220 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","849574"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","849398"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","849398"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","849398"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","849398"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","849398"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","849398"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","849398"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","849398"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","849398"]
["naproxen sodium","ANAPROX","ORAL","Tablet","275 mg\n(250 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","849398"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","849431"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","849431"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","849431"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","849431"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","849431"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","849431"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","849431"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","849431"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","849431"]
["naproxen sodium","ANAPROX DS","ORAL","Tablet","550 MG\n(500 MG BASE)","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","849431"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","375 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1116320"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1116339"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1116349"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1116349"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","1116349"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","1116349"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","1116349"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1116349"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","1116349"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R,NR)","1116349"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,NR)","1116349"]
["naproxen sodium","NAPRELAN","ORAL","Tablet, Extended Release","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","1116349"]
["naratriptan hcl","AMERGE","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","311918"]
["naratriptan hcl","AMERGE","ORAL","Tablet","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","314135"]
["natamycin ophth","NATACYN","OPHTHALMIC","Suspension","5%","Exempt","NO","Not Applicable","NO","Not Applicable","Antifungals","Eye","Eye (R,X)","204451"]
["nedocromil","ALOCRIL","OPHTHALMIC","Solution","2%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents","Eye","Eye (R)","897292"]
["nefazodone hcl","SERZONE","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Depressive Disorders","Depressive Disorders (R)","1098649"]
["nefazodone hcl","SERZONE","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1098649"]
["nefazodone hcl","SERZONE","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Depressive Disorders","Depressive Disorders (R)","1098666"]
["nefazodone hcl","SERZONE","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1098666"]
["nefazodone hcl","SERZONE","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Depressive Disorders","Depressive Disorders (R)","1098670"]
["nefazodone hcl","SERZONE","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1098670"]
["nefazodone hcl","SERZONE","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Depressive Disorders","Depressive Disorders (R)","1098674"]
["nefazodone hcl","SERZONE","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1098674"]
["nefazodone hcl","SERZONE","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Depressive Disorders","Depressive Disorders (R)","1098678"]
["nefazodone hcl","SERZONE","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1098678"]
["neomycin sulfate","Not Applicable","ORAL","Tablet","500 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (NR)","866042"]
["neomycin/polymyxin b/bacitracin","NEOSPORIN","TOPICAL","Ointment","Neo 3.5MG/Poly 5000U/Bacit 400U","Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","204602"]
["nifedipine","ADALAT CC, PROCARDIA, PROCARDIA XL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Calcium Channel Blockers","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","1158688"]
["nitroglycerin transdermal","NITRO-DUR","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antianginal Agents (Glyceril trinitrate patches)","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","1295573"]
["nitroglycerin transdermal","NITRO-DUR","TRANSDERMAL","ALL TRANSDERMAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antianginal Agents (Glyceril trinitrate patches)","Shoulder","Shoulder (X, NR)","1295573"]
["nizatidine","AXID","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","312025"]
["nizatidine","AXID","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","312025"]
["nizatidine","AXID","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","312025"]
["nizatidine","AXID","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","312025"]
["nizatidine","AXID","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","312025"]
["nizatidine","AXID","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","312025"]
["nizatidine","AXID","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","312025"]
["nizatidine","AXID","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198041"]
["nizatidine","AXID","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Elbow Disorders","Elbow Disorders (R)","198041"]
["nizatidine","AXID","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","198041"]
["nizatidine","AXID","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Hip and Groin Disorders","Hip and Groin Disorders (R)","198041"]
["nizatidine","AXID","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Knee Disorders","Knee Disorders (R)","198041"]
["nizatidine","AXID","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Low Back Disorders","Low Back Disorders (R)","198041"]
["nizatidine","AXID","ORAL","Capsule","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (H2 receptor blocker)","Shoulder","Shoulder (R)","198041"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","198045"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","198045"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","198045"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","198045"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","198045"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","198045"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","198045"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","198045"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","317136"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","317136"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","317136"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","317136"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","317136"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","317136"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","317136"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","317136"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","198046"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","198046"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","198046"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","198046"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","198046"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","198046"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","198046"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","198046"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","198047"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","198047"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","198047"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","198047"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","198047"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","198047"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","198047"]
["nortriptyline hcl","PAMELOR","ORAL","Capsule","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","198047"]
["nortriptyline hcl","PAMELOR","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","312036"]
["nortriptyline hcl","PAMELOR","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (R)","312036"]
["nortriptyline hcl","PAMELOR","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","312036"]
["nortriptyline hcl","PAMELOR","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","312036"]
["nortriptyline hcl","PAMELOR","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (R,X,NR)","312036"]
["nortriptyline hcl","PAMELOR","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Low Back Disorders","Low Back Disorders (R,NR)","312036"]
["nortriptyline hcl","PAMELOR","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","312036"]
["nortriptyline hcl","PAMELOR","ORAL","Solution","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Shoulder","Shoulder (R,X)","312036"]
["nystatin/triamcinolone","MYCOLOG II","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1160432"]
["ofloxacin","FLOXIN","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hip and Groin Disorders","Hip and Groin Disorders (R)","198048"]
["ofloxacin","FLOXIN","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hip and Groin Disorders","Hip and Groin Disorders (R)","198049"]
["ofloxacin","FLOXIN","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Fluoroquinolones)","Hip and Groin Disorders","Hip and Groin Disorders (R)","198050"]
["ofloxacin ophthalmic solution","OCUFLOX","OPHTHALMIC","Solution","0.3%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anti-bacterial)","Eye","Eye (R,X,NR)","312075"]
["olanzapine","ZYPREXA","ORAL","Tablet","10 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","314154"]
["olanzapine","ZYPREXA","ORAL","Tablet","10 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","314154"]
["olanzapine","ZYPREXA","ORAL","Tablet","10 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","314154"]
["olanzapine","ZYPREXA","ORAL","Tablet","15 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312077"]
["olanzapine","ZYPREXA","ORAL","Tablet","15 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312077"]
["olanzapine","ZYPREXA","ORAL","Tablet","15 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312077"]
["olanzapine","ZYPREXA","ORAL","Tablet","2.5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","200034"]
["olanzapine","ZYPREXA","ORAL","Tablet","2.5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","200034"]
["olanzapine","ZYPREXA","ORAL","Tablet","2.5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","200034"]
["olanzapine","ZYPREXA","ORAL","Tablet","20 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","283639"]
["olanzapine","ZYPREXA","ORAL","Tablet","20 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","283639"]
["olanzapine","ZYPREXA","ORAL","Tablet","20 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","283639"]
["olanzapine","ZYPREXA","ORAL","Tablet","5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312078"]
["olanzapine","ZYPREXA","ORAL","Tablet","5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312078"]
["olanzapine","ZYPREXA","ORAL","Tablet","5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312078"]
["olanzapine","ZYPREXA","ORAL","Tablet","7.5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312079"]
["olanzapine","ZYPREXA","ORAL","Tablet","7.5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312079"]
["olanzapine","ZYPREXA","ORAL","Tablet","7.5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312079"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","10 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312076"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","10 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312076"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","10 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312076"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","15 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","351107"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","15 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","351107"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","15 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","351107"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","351108"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","351108"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","351108"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","314155"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","314155"]
["olanzapine","ZYPREXA","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","YES","4 Days","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","314155"]
["olanzapine/fluoxetine","Symbyax","ORAL","Capsule","12 MG/25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurologic Agents - Misc.","Depressive Disorders","Depressive Disorders (R)","403970"]
["olanzapine/fluoxetine","Symbyax","ORAL","Capsule","12 MG/50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurologic Agents - Misc.","Depressive Disorders","Depressive Disorders (R)","403971"]
["olanzapine/fluoxetine","Symbyax","ORAL","Capsule","3 MG/25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurologic Agents - Misc.","Depressive Disorders","Depressive Disorders (R)","721787"]
["olanzapine/fluoxetine","Symbyax","ORAL","Capsule","6 MG/25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurologic Agents - Misc.","Depressive Disorders","Depressive Disorders (R)","403969"]
["olanzapine/fluoxetine","Symbyax","ORAL","Capsule","6 MG/50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurologic Agents - Misc.","Depressive Disorders","Depressive Disorders (R)","403972"]
["olopatadine hcl","PATADAY TWICE DAILY RELIEF","OPHTHALMIC","Solution","0.1%","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","1111339"]
["olopatadine hcl","PATADAY ONCE DAILY RELIEF","OPHTHALMIC","Solution","0.2%","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","1111343"]
["olopatadine hcl","PATADAY ONCE DAILY RELIEF, PAZEO","OPHTHALMIC","Solution","0.7%","Exempt","NO","Not Applicable","NO","Not Applicable","Antihistamine and/or mast cell stabilization","Eye","Eye (R)","1601086"]
["omega-3","OMEGA-3 FATTY ACIDS","BULK","BULK INGREDIENT","Not Applicable","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Nutrients","Depressive Disorders","Depressive Disorders (NR)","4301"]
["omega-3","OMEGA-3 FATTY ACIDS","BULK","BULK INGREDIENT","Not Applicable","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Nutrients","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","4301"]
["omega-3","OMEGA-3 FATTY ACIDS","BULK","BULK INGREDIENT","Not Applicable","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Nutrients","Shoulder","Shoulder (X)","4301"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","199119"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","199119"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","199119"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","199119"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","199119"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","199119"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","199119"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","199119"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198051"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","198051"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","198051"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","198051"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","198051"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","198051"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","198051"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","198051"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","200329"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","200329"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","200329"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","200329"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","200329"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","200329"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","200329"]
["omeprazole","PRILOSEC","ORAL","Capsule, Delayed Release","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","200329"]
["omeprazole","PRILOSEC","ORAL","Tablet, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","402014"]
["omeprazole","PRILOSEC","ORAL","Tablet, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","402014"]
["omeprazole","PRILOSEC","ORAL","Tablet, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","402014"]
["omeprazole","PRILOSEC","ORAL","Tablet, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","402014"]
["omeprazole","PRILOSEC","ORAL","Tablet, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","402014"]
["omeprazole","PRILOSEC","ORAL","Tablet, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","402014"]
["omeprazole","PRILOSEC","ORAL","Tablet, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","402014"]
["omeprazole","PRILOSEC","ORAL","Tablet, Delayed Release","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","402014"]
["omeprazole","PRILOSEC","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","2003656"]
["omeprazole","PRILOSEC","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","2003656"]
["omeprazole","PRILOSEC","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","2003656"]
["omeprazole","PRILOSEC","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","2003656"]
["omeprazole","PRILOSEC","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","2003656"]
["omeprazole","PRILOSEC","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","2003656"]
["omeprazole","PRILOSEC","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","2003656"]
["omeprazole","PRILOSEC","ORAL","Tablet, Orally Disintegrating","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","2003656"]
["ondansetron","ZOFRAN ODT","ORAL","Tablet, Orally Disintegrating","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","Not Applicable"]
["ondansetron","ZOFRAN ODT","ORAL","Tablet, Orally Disintegrating","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Chronic Pain","Chronic Pain (NR)","Not Applicable"]
["ondansetron","ZOFRAN ODT","ORAL","Tablet, Orally Disintegrating","24 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","Not Applicable"]
["ondansetron","ZOFRAN ODT","ORAL","Tablet, Orally Disintegrating","24 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Chronic Pain","Chronic Pain (NR)","Not Applicable"]
["ondansetron","ZOFRAN ODT","ORAL","Tablet, Orally Disintegrating","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","104894"]
["ondansetron","ZOFRAN ODT","ORAL","Tablet, Orally Disintegrating","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Chronic Pain","Chronic Pain (NR)","104894"]
["ondansetron","ZOFRAN ODT","ORAL","Tablet, Orally Disintegrating","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","312087"]
["ondansetron","ZOFRAN ODT","ORAL","Tablet, Orally Disintegrating","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Chronic Pain","Chronic Pain (NR)","312087"]
["ondansetron hcl","ZOFRAN","ORAL","Solution","4 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","312085"]
["ondansetron hcl","ZOFRAN","ORAL","Solution","4 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Chronic Pain","Chronic Pain (NR)","312085"]
["ondansetron hcl","ZOFRAN","ORAL","Tablet","24 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","312084"]
["ondansetron hcl","ZOFRAN","ORAL","Tablet","24 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Chronic Pain","Chronic Pain (NR)","312084"]
["ondansetron hcl","ZOFRAN","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","998033"]
["ondansetron hcl","ZOFRAN","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Chronic Pain","Chronic Pain (NR)","998033"]
["ondansetron hcl","ZOFRAN","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","998028"]
["ondansetron hcl","ZOFRAN","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Chronic Pain","Chronic Pain (NR)","998028"]
["orphenadrine citrate","NORFLEX","ORAL","Tablet, Extended Release","100 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","994521"]
["orphenadrine citrate","NORFLEX","ORAL","Tablet, Extended Release","100 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Chronic Pain","Chronic Pain (X)","994521"]
["orphenadrine citrate","NORFLEX","ORAL","Tablet, Extended Release","100 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Hip and Groin Disorders","Hip and Groin Disorders (X)","994521"]
["orphenadrine citrate","NORFLEX","ORAL","Tablet, Extended Release","100 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Knee Disorders","Knee Disorders (X)","994521"]
["orphenadrine citrate","NORFLEX","ORAL","Tablet, Extended Release","100 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Low Back Disorders","Low Back Disorders (X)","994521"]
["orphenadrine citrate","NORFLEX","ORAL","Tablet, Extended Release","100 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Shoulder","Shoulder (X)","994521"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","312132"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","312132"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","312132"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","312132"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","312132"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","312132"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","312132"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","312132"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","312132"]
["oxaprozin","DAYPRO","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","312132"]
["oxcarbazepine","TRILEPTAL, OXTELLAR XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","1160129"]
["oxcarbazepine","TRILEPTAL, OXTELLAR XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (R)","1160129"]
["oxcarbazepine","TRILEPTAL, OXTELLAR XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1160129"]
["oxcarbazepine","TRILEPTAL, OXTELLAR XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1160129"]
["oxcarbazepine","TRILEPTAL, OXTELLAR XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (R,X)","1160129"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Solution","325MG - 5MG / 5 ML","Non-Exempt","YES","4 days = \n130 ml","YES","4 days = \n130 ml","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049580"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Solution","325MG - 5MG / 5 ML","Non-Exempt","YES","4 days = \n130 ml","YES","4 days = \n130 ml","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049580"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Solution","325MG - 5MG / 5 ML","Non-Exempt","YES","4 days = \n130 ml","YES","4 days = \n130 ml","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049580"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Solution","325MG - 5MG / 5 ML","Non-Exempt","YES","4 days = \n130 ml","YES","4 days = \n130 ml","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049580"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Solution","325MG - 5MG / 5 ML","Non-Exempt","YES","4 days = \n130 ml","YES","4 days = \n130 ml","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049580"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Solution","325MG - 5MG / 5 ML","Non-Exempt","YES","4 days = \n130 ml","YES","4 days = \n130 ml","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049580"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Solution","325MG - 5MG / 5 ML","Non-Exempt","YES","4 days = \n130 ml","YES","4 days = \n130 ml","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049580"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Solution","325MG - 5MG / 5 ML","Non-Exempt","YES","4 days = \n130 ml","YES","4 days = \n130 ml","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049580"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Solution","325MG - 5MG / 5 ML","Non-Exempt","YES","4 days = \n130 ml","YES","4 days = \n130 ml","Analgesics - Opioid","Shoulder","Shoulder (R)","1049580"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1014599"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1014599"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1014599"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1014599"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1014599"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1014599"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1014599"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1014599"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","1014599"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1037259"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1037259"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1037259"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1037259"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1037259"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1037259"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1037259"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1037259"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","1037259"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1014615"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1014615"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1014615"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1014615"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1014615"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1014615"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1014615"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1014615"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","1014615"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1014632"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1014632"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1014632"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1014632"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1014632"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1014632"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1014632"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1014632"]
["oxycodone  hcl /acetaminophen","Not Applicable","ORAL","Tablet","300 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","1014632"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049214"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049214"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049214"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049214"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049214"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049214"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049214"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049214"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-10 MG","Non-Exempt","YES","4 days = \n14 tablets","YES","4 days = \n14 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","1049214"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049635"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049635"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049635"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049635"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049635"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049635"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049635"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049635"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-2.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","1049635"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049221"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049221"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049221"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049221"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049221"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049221"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049221"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049221"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","1049221"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049225"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049225"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049225"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049225"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049225"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049225"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049225"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049225"]
["oxycodone  hcl /acetaminophen","PERCOCET","ORAL","Tablet","325 MG-7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Shoulder","Shoulder (R)","1049225"]
["oxycodone hcl","OXYCONTIN, ROXICODONE","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1161682"]
["oxycodone hcl","OXYCONTIN, ROXICODONE","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1161682"]
["oxycodone hcl","OXYCONTIN, ROXICODONE","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1161682"]
["oxycodone hcl","OXYCONTIN, ROXICODONE","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1161682"]
["oxycodone hcl","OXYCONTIN, ROXICODONE","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1161682"]
["oxycodone hcl","OXYCONTIN, ROXICODONE","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1161682"]
["oxycodone hcl","OXYCONTIN, ROXICODONE","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1161682"]
["oxycodone hcl","OXYCONTIN, ROXICODONE","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1161682"]
["oxycodone hcl","OXYCONTIN, ROXICODONE","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (R,X)","1161682"]
["oxycodone hcl","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n20 ML","YES","4 days = \n20 ML","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049615"]
["oxycodone hcl","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n20 ML","YES","4 days = \n20 ML","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049615"]
["oxycodone hcl","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n20 ML","YES","4 days = \n20 ML","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049615"]
["oxycodone hcl","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n20 ML","YES","4 days = \n20 ML","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049615"]
["oxycodone hcl","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n20 ML","YES","4 days = \n20 ML","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049615"]
["oxycodone hcl","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n20 ML","YES","4 days = \n20 ML","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049615"]
["oxycodone hcl","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n20 ML","YES","4 days = \n20 ML","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049615"]
["oxycodone hcl","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n20 ML","YES","4 days = \n20 ML","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049615"]
["oxycodone hcl","Not Applicable","ORAL","Solution","100 MG/5 ML","Non-Exempt","YES","4 days = \n20 ML","YES","4 days = \n20 ML","Analgesics - Opioid","Shoulder","Shoulder (R,X)","1049615"]
["oxycodone hcl","Not Applicable","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 days = \n140 ML","YES","4 days = \n140 ML","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049604"]
["oxycodone hcl","Not Applicable","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 days = \n140 ML","YES","4 days = \n140 ML","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049604"]
["oxycodone hcl","Not Applicable","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 days = \n140 ML","YES","4 days = \n140 ML","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049604"]
["oxycodone hcl","Not Applicable","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 days = \n140 ML","YES","4 days = \n140 ML","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049604"]
["oxycodone hcl","Not Applicable","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 days = \n140 ML","YES","4 days = \n140 ML","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049604"]
["oxycodone hcl","Not Applicable","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 days = \n140 ML","YES","4 days = \n140 ML","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049604"]
["oxycodone hcl","Not Applicable","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 days = \n140 ML","YES","4 days = \n140 ML","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049604"]
["oxycodone hcl","Not Applicable","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 days = \n140 ML","YES","4 days = \n140 ML","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049604"]
["oxycodone hcl","Not Applicable","ORAL","Solution","5 MG/5 ML","Non-Exempt","YES","4 days = \n140 ML","YES","4 days = \n140 ML","Analgesics - Opioid","Shoulder","Shoulder (R,X)","1049604"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n10 tablets","YES","4 days = \n10 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049611"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n10 tablets","YES","4 days = \n10 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049611"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n10 tablets","YES","4 days = \n10 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049611"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n10 tablets","YES","4 days = \n10 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049611"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n10 tablets","YES","4 days = \n10 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049611"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n10 tablets","YES","4 days = \n10 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049611"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n10 tablets","YES","4 days = \n10 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049611"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n10 tablets","YES","4 days = \n10 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049611"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","15 MG","Non-Exempt","YES","4 days = \n10 tablets","YES","4 days = \n10 tablets","Analgesics - Opioid","Shoulder","Shoulder (R,X)","1049611"]
["oxycodone hcl","Not Applicable","ORAL","Tablet","20 MG","Non-Exempt","YES","4 days = \n8 tablets","YES","4 days = \n8 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049686"]
["oxycodone hcl","Not Applicable","ORAL","Tablet","20 MG","Non-Exempt","YES","4 days = \n8 tablets","YES","4 days = \n8 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049686"]
["oxycodone hcl","Not Applicable","ORAL","Tablet","20 MG","Non-Exempt","YES","4 days = \n8 tablets","YES","4 days = \n8 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049686"]
["oxycodone hcl","Not Applicable","ORAL","Tablet","20 MG","Non-Exempt","YES","4 days = \n8 tablets","YES","4 days = \n8 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049686"]
["oxycodone hcl","Not Applicable","ORAL","Tablet","20 MG","Non-Exempt","YES","4 days = \n8 tablets","YES","4 days = \n8 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049686"]
["oxycodone hcl","Not Applicable","ORAL","Tablet","20 MG","Non-Exempt","YES","4 days = \n8 tablets","YES","4 days = \n8 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049686"]
["oxycodone hcl","Not Applicable","ORAL","Tablet","20 MG","Non-Exempt","YES","4 days = \n8 tablets","YES","4 days = \n8 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049686"]
["oxycodone hcl","Not Applicable","ORAL","Tablet","20 MG","Non-Exempt","YES","4 days = \n8 tablets","YES","4 days = \n8 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049686"]
["oxycodone hcl","Not Applicable","ORAL","Tablet","20 MG","Non-Exempt","YES","4 days = \n8 tablets","YES","4 days = \n8 tablets","Analgesics - Opioid","Shoulder","Shoulder (R,X)","1049686"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049618"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049618"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049618"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049618"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049618"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049618"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049618"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049618"]
["oxycodone hcl","ROXICODONE","ORAL","Tablet","30 MG","Non-Exempt","YES","4 days = \n6 tablets","YES","4 days = \n6 tablets","Analgesics - Opioid","Shoulder","Shoulder (R,X)","1049618"]
["oxycodone hcl","OXAYDO, ROXICODONE","ORAL","Tablet","5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1049621"]
["oxycodone hcl","OXAYDO, ROXICODONE","ORAL","Tablet","5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1049621"]
["oxycodone hcl","OXAYDO, ROXICODONE","ORAL","Tablet","5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1049621"]
["oxycodone hcl","OXAYDO, ROXICODONE","ORAL","Tablet","5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1049621"]
["oxycodone hcl","OXAYDO, ROXICODONE","ORAL","Tablet","5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1049621"]
["oxycodone hcl","OXAYDO, ROXICODONE","ORAL","Tablet","5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1049621"]
["oxycodone hcl","OXAYDO, ROXICODONE","ORAL","Tablet","5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1049621"]
["oxycodone hcl","OXAYDO, ROXICODONE","ORAL","Tablet","5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1049621"]
["oxycodone hcl","OXAYDO, ROXICODONE","ORAL","Tablet","5 MG","Non-Exempt","YES","4 days = \n26 tablets","YES","4 days = \n26 tablets","Analgesics - Opioid","Shoulder","Shoulder (R,X)","1049621"]
["oxycodone hcl","OXAYDO","ORAL","Tablet","7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1113314"]
["oxycodone hcl","OXAYDO","ORAL","Tablet","7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1113314"]
["oxycodone hcl","OXAYDO","ORAL","Tablet","7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1113314"]
["oxycodone hcl","OXAYDO","ORAL","Tablet","7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1113314"]
["oxycodone hcl","OXAYDO","ORAL","Tablet","7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1113314"]
["oxycodone hcl","OXAYDO","ORAL","Tablet","7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1113314"]
["oxycodone hcl","OXAYDO","ORAL","Tablet","7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1113314"]
["oxycodone hcl","OXAYDO","ORAL","Tablet","7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1113314"]
["oxycodone hcl","OXAYDO","ORAL","Tablet","7.5 MG","Non-Exempt","YES","4 days = \n18 tablets","YES","4 days = \n18 tablets","Analgesics - Opioid","Shoulder","Shoulder (R,X)","1113314"]
["oxycodone hcl /aspirin","PERCODAN","ORAL","Tablet","325 MG-4.8355 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","848768"]
["oxycodone hcl /aspirin","PERCODAN","ORAL","Tablet","325 MG-4.8355 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","848768"]
["oxycodone hcl /aspirin","PERCODAN","ORAL","Tablet","325 MG-4.8355 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","848768"]
["oxycodone hcl /aspirin","PERCODAN","ORAL","Tablet","325 MG-4.8355 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","848768"]
["oxycodone hcl /aspirin","PERCODAN","ORAL","Tablet","325 MG-4.8355 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","848768"]
["oxycodone hcl /aspirin","PERCODAN","ORAL","Tablet","325 MG-4.8355 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","848768"]
["oxycodone hcl /aspirin","PERCODAN","ORAL","Tablet","325 MG-4.8355 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","848768"]
["oxycodone hcl /aspirin","PERCODAN","ORAL","Tablet","325 MG-4.8355 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","848768"]
["oxymorphone hcl","OPANA, OPANA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1162252"]
["oxymorphone hcl","OPANA, OPANA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1162252"]
["oxymorphone hcl","OPANA, OPANA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1162252"]
["oxymorphone hcl","OPANA, OPANA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1162252"]
["oxymorphone hcl","OPANA, OPANA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1162252"]
["oxymorphone hcl","OPANA, OPANA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1162252"]
["oxymorphone hcl","OPANA, OPANA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1162252"]
["oxymorphone hcl","OPANA, OPANA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1162252"]
["oxymorphone hcl","OPANA, OPANA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1162252"]
["pantoprazole sodium","PROTONIX","ORAL","For Suspension - Delayed Release","40 MG/Packet","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","763306"]
["pantoprazole sodium","PROTONIX","ORAL","For Suspension - Delayed Release","40 MG/Packet","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","763306"]
["pantoprazole sodium","PROTONIX","ORAL","For Suspension - Delayed Release","40 MG/Packet","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","763306"]
["pantoprazole sodium","PROTONIX","ORAL","For Suspension - Delayed Release","40 MG/Packet","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","763306"]
["pantoprazole sodium","PROTONIX","ORAL","For Suspension - Delayed Release","40 MG/Packet","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","763306"]
["pantoprazole sodium","PROTONIX","ORAL","For Suspension - Delayed Release","40 MG/Packet","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","763306"]
["pantoprazole sodium","PROTONIX","ORAL","For Suspension - Delayed Release","40 MG/Packet","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","763306"]
["pantoprazole sodium","PROTONIX","ORAL","For Suspension - Delayed Release","40 MG/Packet","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","763306"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","2511872"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","2511872"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","2511872"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","2511872"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","2511872"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","2511872"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","2511872"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","2511872"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","314200"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","314200"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","314200"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","314200"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","314200"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","314200"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","314200"]
["pantoprazole sodium","PROTONIX","ORAL","Tablet, Enteric Coated","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","314200"]
["paroxetine hcl","PAXIL","ORAL","Suspension","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","312242"]
["paroxetine hcl","PAXIL","ORAL","Suspension","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","312242"]
["paroxetine hcl","PAXIL","ORAL","Suspension","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","312242"]
["paroxetine hcl","PAXIL","ORAL","Suspension","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","312242"]
["paroxetine hcl","PAXIL","ORAL","Suspension","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","312242"]
["paroxetine hcl","PAXIL","ORAL","Suspension","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","312242"]
["paroxetine hcl","PAXIL","ORAL","Suspension","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312242"]
["paroxetine hcl","PAXIL","ORAL","Suspension","10 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","312242"]
["paroxetine hcl","PAXIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1738483"]
["paroxetine hcl","PAXIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","1738483"]
["paroxetine hcl","PAXIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1738483"]
["paroxetine hcl","PAXIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1738483"]
["paroxetine hcl","PAXIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","1738483"]
["paroxetine hcl","PAXIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1738483"]
["paroxetine hcl","PAXIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1738483"]
["paroxetine hcl","PAXIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1738483"]
["paroxetine hcl","PAXIL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1738495"]
["paroxetine hcl","PAXIL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","1738495"]
["paroxetine hcl","PAXIL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1738495"]
["paroxetine hcl","PAXIL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1738495"]
["paroxetine hcl","PAXIL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","1738495"]
["paroxetine hcl","PAXIL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1738495"]
["paroxetine hcl","PAXIL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1738495"]
["paroxetine hcl","PAXIL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1738495"]
["paroxetine hcl","PAXIL","ORAL","Tablet","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1738503"]
["paroxetine hcl","PAXIL","ORAL","Tablet","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","1738503"]
["paroxetine hcl","PAXIL","ORAL","Tablet","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1738503"]
["paroxetine hcl","PAXIL","ORAL","Tablet","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1738503"]
["paroxetine hcl","PAXIL","ORAL","Tablet","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","1738503"]
["paroxetine hcl","PAXIL","ORAL","Tablet","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1738503"]
["paroxetine hcl","PAXIL","ORAL","Tablet","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1738503"]
["paroxetine hcl","PAXIL","ORAL","Tablet","30 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1738503"]
["paroxetine hcl","PAXIL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1738511"]
["paroxetine hcl","PAXIL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","1738511"]
["paroxetine hcl","PAXIL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1738511"]
["paroxetine hcl","PAXIL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1738511"]
["paroxetine hcl","PAXIL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","1738511"]
["paroxetine hcl","PAXIL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1738511"]
["paroxetine hcl","PAXIL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1738511"]
["paroxetine hcl","PAXIL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1738511"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1738803"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","1738803"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1738803"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1738803"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","1738803"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1738803"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1738803"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1738803"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1738805"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","1738805"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1738805"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1738805"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","1738805"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1738805"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1738805"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1738805"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1738807"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","1738807"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1738807"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1738807"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","1738807"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1738807"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","1738807"]
["paroxetine hcl","PAXIL CR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1738807"]
["paroxetine mesylate","BRISDELLE","ORAL","Capsule","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1430122"]
["penicillin v potassium","Not Applicable","ORAL","Powder for Solution","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","834046"]
["penicillin v potassium","Not Applicable","ORAL","Powder for Solution","125 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","834046"]
["penicillin v potassium","Not Applicable","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","834061"]
["penicillin v potassium","Not Applicable","ORAL","Tablet","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","834061"]
["penicillin v potassium","Not Applicable","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","834102"]
["penicillin v potassium","Not Applicable","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Penicillins)","Hip and Groin Disorders","Hip and Groin Disorders (R)","834102"]
["pentazocine/naloxone hcl","TALWIN NX","ORAL","Tablet","50 MG/0.5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","312289"]
["pentazocine/naloxone hcl","TALWIN NX","ORAL","Tablet","50 MG/0.5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","312289"]
["pentazocine/naloxone hcl","TALWIN NX","ORAL","Tablet","50 MG/0.5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","312289"]
["pentazocine/naloxone hcl","TALWIN NX","ORAL","Tablet","50 MG/0.5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","312289"]
["pentazocine/naloxone hcl","TALWIN NX","ORAL","Tablet","50 MG/0.5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","312289"]
["pentazocine/naloxone hcl","TALWIN NX","ORAL","Tablet","50 MG/0.5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","312289"]
["pentazocine/naloxone hcl","TALWIN NX","ORAL","Tablet","50 MG/0.5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","312289"]
["pentazocine/naloxone hcl","TALWIN NX","ORAL","Tablet","50 MG/0.5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","312289"]
["pentazocine/naloxone hcl","TALWIN NX","ORAL","Tablet","50 MG/0.5 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","312289"]
["pentoxifylline","TRENTAL","ORAL","Tablet, Extended Release","400 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Hematological Agents  - Misc.","Depressive Disorders","Depressive Disorders (X)","312301"]
["perphenazine","TRILAFON","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Antiemetics","Antiemetics (R)","198075"]
["perphenazine","TRILAFON","ORAL","Tablet","16 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","198075"]
["perphenazine","TRILAFON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Antiemetics","Antiemetics (R)","198076"]
["perphenazine","TRILAFON","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","198076"]
["perphenazine","TRILAFON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Antiemetics","Antiemetics (R)","198077"]
["perphenazine","TRILAFON","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","198077"]
["perphenazine","TRILAFON","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Antiemetics","Antiemetics (R)","198078"]
["perphenazine","TRILAFON","ORAL","Tablet","8 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","198078"]
["phenelzine sulfate","NARDIL","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (MAOIs)","Depressive Disorders","Depressive Disorders (R)","312347"]
["phenelzine sulfate","NARDIL","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (MAOIs)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312347"]
["phenobarbital","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Hypnotics / Sedatives / Sleep Disorder Agents","Traumatic Brain Injury","Traumatic Brain Injury (X, NR)","1157038"]
["phenytoin; \nphenytoin sodium","DILANTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (X)","1158167"]
["phenytoin; \nphenytoin sodium","DILANTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (X)","1158167"]
["phenytoin; \nphenytoin sodium","DILANTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1158167"]
["phenytoin; \nphenytoin sodium","DILANTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (X)","1158167"]
["phenytoin; \nphenytoin sodium","DILANTIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Traumatic Brain Injury","Traumatic Brain Injury (X, NR)","1158167"]
["pioglitazone hcl","ACTOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antidiabetics","Depressive Disorders","Depressive Disorders (X)","1163231"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1159304"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1159304"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (X)","1159304"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (X)","1159304"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1159304"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1159304"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (X)","1159304"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (X)","1159304"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R,X)","1159304"]
["piroxicam","FELDENE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (X)","1159304"]
["pitavastatin calcium","Livalo","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlidemics","Shoulder","Shoulder (NR)","2661588"]
["pitavastatin magnesium","Zypitamag","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlidemics","Shoulder","Shoulder (NR)","2663401"]
["pramipexole dihydrochloride","MIRAPEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiparkinson and Related Therapy Agents","Chronic Pain","Chronic Pain (NR)","1161097"]
["pravastatin sodium","PRAVACHOL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlidemics","Shoulder","Shoulder (NR)","2662846"]
["prazosin hcl","MINIPRESS","ORAL","Capsule","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312593"]
["prazosin hcl","MINIPRESS","ORAL","Capsule","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312594"]
["prazosin hcl","MINIPRESS","ORAL","Capsule","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antihypertensives","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","198141"]
["prednicarbate","DERMATOP","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1165748"]
["prednisolone","Orapred","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1165759"]
["prednisolone","Orapred","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1165759"]
["prednisolone","Orapred","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","1165759"]
["prednisolone","Orapred","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","1165759"]
["prednisolone","Orapred","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,NR)","1165759"]
["prednisolone","Orapred","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","1165759"]
["prednisolone","Orapred","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","1165759"]
["prednisolone","Orapred","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","1165759"]
["prednisolone","Orapred","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 Days","NO","Not Applicable","Corticosteroids","Work Related Asthma","Work Related Asthma (R)","1165759"]
["prednisolone acetate","PRED MILD, PRED FORTE, OMNIPRED","OPHTHALMIC","ALL OPHTHALMIC DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Steroid)","Eye","Eye (R,X,NR)","1165757"]
["prednisolone sodium phosphate","ORAPRED ODT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Anti-Inflammatory Agents","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1165759"]
["prednisolone sodium phosphate","ORAPRED ODT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Anti-Inflammatory Agents","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1165759"]
["prednisolone sodium phosphate","ORAPRED ODT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Anti-Inflammatory Agents","Chronic Pain","Chronic Pain (R,X)","1165759"]
["prednisolone sodium phosphate","ORAPRED ODT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Anti-Inflammatory Agents","Elbow Disorders","Elbow Disorders (NR)","1165759"]
["prednisolone sodium phosphate","ORAPRED ODT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Anti-Inflammatory Agents","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,NR)","1165759"]
["prednisolone sodium phosphate","ORAPRED ODT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Anti-Inflammatory Agents","Hip and Groin Disorders","Hip and Groin Disorders (X)","1165759"]
["prednisolone sodium phosphate","ORAPRED ODT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Anti-Inflammatory Agents","Low Back Disorders","Low Back Disorders (R,X,NR)","1165759"]
["prednisolone sodium phosphate","ORAPRED ODT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Anti-Inflammatory Agents","Shoulder","Shoulder (R,X,NR)","1165759"]
["prednisolone sodium phosphate","ORAPRED ODT","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Anti-Inflammatory Agents","Work Related Asthma","Work Related Asthma (R)","1165759"]
["prednisolone sodium phosphate ophth","INFLAMASE FORTE","OPHTHALMIC","Solution","1%","Non-Exempt","YES","4 days","NO","Not Applicable","Ophthalmic Agents (Steroid)","Eye","Eye (R,X,NR)","314165"]
["prednisone","DELTASONE, METICORTEN, PARACORT, RAYOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1161705"]
["prednisone","DELTASONE, METICORTEN, PARACORT, RAYOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1161705"]
["prednisone","DELTASONE, METICORTEN, PARACORT, RAYOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Chronic Pain","Chronic Pain (R,X)","1161705"]
["prednisone","DELTASONE, METICORTEN, PARACORT, RAYOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Elbow Disorders","Elbow Disorders (NR)","1161705"]
["prednisone","DELTASONE, METICORTEN, PARACORT, RAYOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,NR)","1161705"]
["prednisone","DELTASONE, METICORTEN, PARACORT, RAYOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Hip and Groin Disorders","Hip and Groin Disorders (X)","1161705"]
["prednisone","DELTASONE, METICORTEN, PARACORT, RAYOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Low Back Disorders","Low Back Disorders (R,X,NR)","1161705"]
["prednisone","DELTASONE, METICORTEN, PARACORT, RAYOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Shoulder","Shoulder (R,X,NR)","1161705"]
["prednisone","DELTASONE, METICORTEN, PARACORT, RAYOS","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Corticosteroids","Work Related Asthma","Work Related Asthma (R)","1161705"]
["pregabalin","LYRICA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (NR)","1156764"]
["pregabalin","LYRICA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (R)","1156764"]
["pregabalin","LYRICA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1156764"]
["pregabalin","LYRICA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (R,NR)","1156764"]
["pregabalin","LYRICA","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (R,X,NR)","1156764"]
["pregabalin (once-daily)","LYRICA CR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (X)","1156764"]
["pregabalin (once-daily)","LYRICA CR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (X)","1156764"]
["probenecid","Not Applicable","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Gout Agents","Hip and Groin Disorders","Hip and Groin Disorders (R)","198152"]
["prochlorperazine maleate","COMPAZINE","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","198365"]
["prochlorperazine maleate","COMPAZINE","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","312635"]
["progesterone","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Progestins","Traumatic Brain Injury","Traumatic Brain Injury (X)","1162289"]
["promethazine hcl","PHENERGAN","RECTAL","Suppository","12.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","992441"]
["promethazine hcl","PHENERGAN","RECTAL","Suppository","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","992454"]
["promethazine hcl","PHENERGAN","RECTAL","Suppository","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","992478"]
["promethazine hcl","PHENERGAN","ORAL","Syrup","6.25 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","992432"]
["promethazine hcl","PHENERGAN","ORAL","Tablet","12. MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","992438"]
["promethazine hcl","PHENERGAN","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","992447"]
["promethazine hcl","PHENERGAN","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","992475"]
["proparacaine hcl","ALCAINE","OPHTHALMIC","Solution","0.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anesthetic)","Eye","Eye (R)","1191013"]
["propranolol hcl","INDERAL LA","ORAL","Capsule, Extended","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856460"]
["propranolol hcl","INDERAL LA","ORAL","Capsule, Extended","120 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856460"]
["propranolol hcl","INDERAL LA","ORAL","Capsule, Extended","160 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856481"]
["propranolol hcl","INDERAL LA","ORAL","Capsule, Extended","160 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856481"]
["propranolol hcl","INDERAL LA","ORAL","Capsule, Extended","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856535"]
["propranolol hcl","INDERAL LA","ORAL","Capsule, Extended","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856535"]
["propranolol hcl","INDERAL LA","ORAL","Capsule, Extended","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856569"]
["propranolol hcl","INDERAL LA","ORAL","Capsule, Extended","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856569"]
["propranolol hcl","INDERAL","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856724"]
["propranolol hcl","INDERAL","ORAL","Solution","20 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856724"]
["propranolol hcl","HEMANGEOL","ORAL","Solution","4.28 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1495058"]
["propranolol hcl","HEMANGEOL","ORAL","Solution","4.28 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","1495058"]
["propranolol hcl","INDERAL","ORAL","Solution","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856733"]
["propranolol hcl","INDERAL","ORAL","Solution","40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856733"]
["propranolol hcl","INDERAL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856448"]
["propranolol hcl","INDERAL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856448"]
["propranolol hcl","INDERAL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856457"]
["propranolol hcl","INDERAL","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856457"]
["propranolol hcl","INDERAL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856519"]
["propranolol hcl","INDERAL","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856519"]
["propranolol hcl","INDERAL","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856556"]
["propranolol hcl","INDERAL","ORAL","Tablet","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856556"]
["propranolol hcl","INDERAL","ORAL","Tablet","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856578"]
["propranolol hcl","INDERAL","ORAL","Tablet","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Beta Blockers","Traumatic Brain Injury","Traumatic Brain Injury (R)","856578"]
["protriptyline hcl","VIVACTIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","905168"]
["protriptyline hcl","VIVACTIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","905168"]
["protriptyline hcl","VIVACTIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","905168"]
["protriptyline hcl","VIVACTIL","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X)","905168"]
["protriptyline hcl","VIVACTIL","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Chronic Pain","Chronic Pain (X)","905172"]
["protriptyline hcl","VIVACTIL","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","905172"]
["protriptyline hcl","VIVACTIL","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","905172"]
["protriptyline hcl","VIVACTIL","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Knee Disorders","Knee Disorders (X)","905172"]
["pyridostigmine bromide","MESTINON","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antimyasthenic / Cholinergic Agents","Chronic Pain","Chronic Pain (X)","1163606"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","312743"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312743"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312743"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312743"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","389201"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","389201"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","389201"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","389201"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","317174"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","317174"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","317174"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","317174"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","312744"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312744"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312744"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312744"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","312745"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312745"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312745"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312745"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","616483"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","616483"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","616483"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","616483"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","616487"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","616487"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","616487"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","616487"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","895670"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","895670"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","895670"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","895670"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","721791"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","721791"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","721791"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","721791"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","721794"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","721794"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","721794"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","721794"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","721796"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","721796"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","721796"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","721796"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Chronic Pain","Chronic Pain (NR)","853201"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","853201"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","853201"]
["quetiapine fumarate","SEROQUEL","ORAL","Tablet, Extended Release","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","853201"]
["rabeprazole sodium","ACIPHEX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","854868"]
["rabeprazole sodium","ACIPHEX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Elbow Disorders","Elbow Disorders (R)","854868"]
["rabeprazole sodium","ACIPHEX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","854868"]
["rabeprazole sodium","ACIPHEX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Hip and Groin Disorders","Hip and Groin Disorders (R)","854868"]
["rabeprazole sodium","ACIPHEX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Knee Disorders","Knee Disorders (R)","854868"]
["rabeprazole sodium","ACIPHEX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Low Back Disorders","Low Back Disorders (R)","854868"]
["rabeprazole sodium","ACIPHEX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Shoulder","Shoulder (R)","854868"]
["rabeprazole sodium","ACIPHEX","ORAL","Tablet, Enteric Coated","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs (Proton pump inhibitor)","Traumatic Brain Injury","Traumatic Brain Injury (R)","854868"]
["raloxifene hcl","EVISTA","ORAL","Tablet","60 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.","Chronic Pain","Chronic Pain (X)","1490065"]
["regular insulin (human)","HUMULIN R ; NOVOLIN R","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antidiabetics","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1164824"]
["regular insulin (human)","HUMULIN R ; NOVOLIN R","INJECTABLE","ALL INJECTABLE DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antidiabetics","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1164824"]
["ribavirin","REBETOL","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antivirals","COVID-19 Coronavirus","COVID-19 Coronavirus (R,NR)","312817"]
["ribavirin","COPEGUS","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antivirals","COVID-19 Coronavirus","COVID-19 Coronavirus (R,NR)","248109"]
["riboflavin","Vitamin B-2","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Depressive Disorders","Depressive Disorders (NR)","1165456"]
["risedronate sodium","ACTONEL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","1165476"]
["risedronate sodium","ACTONEL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Knee Disorders","Knee Disorders (NR)","1165476"]
["risedronate sodium","ACTONEL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Low Back Disorders","Low Back Disorders (X)","1165476"]
["risedronate sodium","ACTONEL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Endocrine and Metabolic Agents- Misc.  (Bisphosphonate)","Shoulder","Shoulder (R)","1165476"]
["risperidone","RISPERDAL","ORAL","Solution","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","199387"]
["risperidone","RISPERDAL","ORAL","Solution","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","199387"]
["risperidone","RISPERDAL","ORAL","Solution","1 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","199387"]
["risperidone","RISPERDAL","ORAL","Tablet","0.25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312828"]
["risperidone","RISPERDAL","ORAL","Tablet","0.25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","312828"]
["risperidone","RISPERDAL","ORAL","Tablet","0.25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312828"]
["risperidone","RISPERDAL","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312829"]
["risperidone","RISPERDAL","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","312829"]
["risperidone","RISPERDAL","ORAL","Tablet","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312829"]
["risperidone","RISPERDAL","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312830"]
["risperidone","RISPERDAL","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","312830"]
["risperidone","RISPERDAL","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312830"]
["risperidone","RISPERDAL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312831"]
["risperidone","RISPERDAL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","312831"]
["risperidone","RISPERDAL","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312831"]
["risperidone","RISPERDAL","ORAL","Tablet","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","312832"]
["risperidone","RISPERDAL","ORAL","Tablet","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","312832"]
["risperidone","RISPERDAL","ORAL","Tablet","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","312832"]
["risperidone","RISPERDAL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","314211"]
["risperidone","RISPERDAL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","314211"]
["risperidone","RISPERDAL","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","314211"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","0.25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","645037"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","0.25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","645037"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","0.25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","645037"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","403825"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","403825"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","0.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","403825"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","401953"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","401953"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","401953"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","401954"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","401954"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","401954"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","616698"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","616698"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","616698"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","616705"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","616705"]
["risperidone","RISPERDAL","ORAL","Tablet, Orally Disintegrating","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","616705"]
["rivaroxaban","XARELTO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","1114198"]
["rivaroxaban","XARELTO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1114198"]
["rivaroxaban","XARELTO","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","1114198"]
["rivaroxaban","XARELTO","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","1232082"]
["rivaroxaban","XARELTO","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1232082"]
["rivaroxaban","XARELTO","ORAL","Tablet","15 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","1232082"]
["rivaroxaban","XARELTO","ORAL","Tablet","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","2059015"]
["rivaroxaban","XARELTO","ORAL","Tablet","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","2059015"]
["rivaroxaban","XARELTO","ORAL","Tablet","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","2059015"]
["rivaroxaban","XARELTO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","1232086"]
["rivaroxaban","XARELTO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","1232086"]
["rivaroxaban","XARELTO","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","1232086"]
["rivastigmine","EXELON","TRANSDERMAL","Film, Extended Release","13.3 MG/24 HR","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","1308569"]
["rivastigmine","EXELON","TRANSDERMAL","Film, Extended Release","4.6 MG/24 HR","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","725021"]
["rivastigmine","EXELON","TRANSDERMAL","Film, Extended Release","9.5 MG/24 HR","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","725023"]
["rivastigmine tartrate","EXELON","ORAL","Capsule","1.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","314214"]
["rivastigmine tartrate","EXELON","ORAL","Capsule","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","312835"]
["rivastigmine tartrate","EXELON","ORAL","Capsule","4.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","314215"]
["rivastigmine tartrate","EXELON","ORAL","Capsule","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Traumatic Brain Injury","Traumatic Brain Injury (R)","312836"]
["rizatriptan benzoate","MAXALT","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","314209"]
["rizatriptan benzoate","MAXALT","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","312840"]
["rizatriptan benzoate","MAXALT","ORAL","Tablet, Orally Disintegrating","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","312837"]
["rizatriptan benzoate","MAXALT","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","312839"]
["rolapitant","VARUBI","ORAL","Tablet","90 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","1665503"]
["rosuvastatin calcium","Crestor","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlidemics","Shoulder","Shoulder (NR)","2661537"]
["s-adenosylmethionine","SAM E","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Alternative  Medicines","Chronic Pain","Chronic Pain (X)","1156461"]
["salmeterol","SEREVENT","INHALATION","ALL INHALATION DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1158502"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","312899"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","312899"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Chronic Pain","Chronic Pain (R)","312899"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","312899"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","312899"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","312899"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Knee Disorders","Knee Disorders (R,NR)","312899"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Low Back Disorders","Low Back Disorders (R)","312899"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Shoulder","Shoulder (R)","312899"]
["salsalate","DISALCID","ORAL","Tablet","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","312899"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","583170"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","583170"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Chronic Pain","Chronic Pain (R)","583170"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","583170"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","583170"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","583170"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Knee Disorders","Knee Disorders (R,NR)","583170"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Low Back Disorders","Low Back Disorders (R)","583170"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Shoulder","Shoulder (R)","583170"]
["salsalate","DISALCID","ORAL","Tablet","750 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - NonNarcotic (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","583170"]
["scopolamine","TRANSDERM SCOP","TRANSDERMAL","Patch, transdermal","1.5 MG/72 HR","Exempt","NO","Not Applicable","NO","Not Applicable","Antiemetics","Antiemetics","Antiemetics (R)","226552"]
["selegiline","EMSAM","TRANSDERMAL","Film, Extended Release","12 MG/24 HR","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (MAOIs)","Depressive Disorders","Depressive Disorders (R)","865214"]
["selegiline","EMSAM","TRANSDERMAL","Film, Extended Release","6 MG/24 HR","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (MAOIs)","Depressive Disorders","Depressive Disorders (R)","865206"]
["selegiline","EMSAM","TRANSDERMAL","Film, Extended Release","9 MG/24 HR","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (MAOIs)","Depressive Disorders","Depressive Disorders (R)","865210"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","410584"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","410584"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","410584"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","410584"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","410584"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","410584"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","410584"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","410584"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury","Traumatic Brain Injury (R)","410584"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","251201"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","251201"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","251201"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","251201"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","251201"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","251201"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","251201"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","251201"]
["sertraline hcl","ZOLOFT","ORAL","Capsule","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury","Traumatic Brain Injury (R)","251201"]
["sertraline hcl","ZOLOFT","ORAL","Concentrate","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","861064"]
["sertraline hcl","ZOLOFT","ORAL","Concentrate","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","861064"]
["sertraline hcl","ZOLOFT","ORAL","Concentrate","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","861064"]
["sertraline hcl","ZOLOFT","ORAL","Concentrate","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","861064"]
["sertraline hcl","ZOLOFT","ORAL","Concentrate","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","861064"]
["sertraline hcl","ZOLOFT","ORAL","Concentrate","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","861064"]
["sertraline hcl","ZOLOFT","ORAL","Concentrate","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","861064"]
["sertraline hcl","ZOLOFT","ORAL","Concentrate","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","861064"]
["sertraline hcl","ZOLOFT","ORAL","Concentrate","20 MG/ML","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury","Traumatic Brain Injury (R)","861064"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","312938"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","312938"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","312938"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","312938"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","312938"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","312938"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312938"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","312938"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury","Traumatic Brain Injury (R)","312938"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","312940"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","312940"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","312940"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","312940"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","312940"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","312940"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312940"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","312940"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury","Traumatic Brain Injury (R)","312940"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","312941"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X)","312941"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","312941"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","312941"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (R,X)","312941"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","312941"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","312941"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","312941"]
["sertraline hcl","ZOLOFT","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Traumatic Brain Injury","Traumatic Brain Injury (R)","312941"]
["silver sulfadiazine","SILVADENE","TOPICAL","Cream","1%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (NR)","106351"]
["simvastatin","ZOCOR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlidemics","Depressive Disorders","Depressive Disorders (X)","1158753"]
["simvastatin","ZOCOR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antihyperlidemics","Shoulder","Shoulder (NR)","1158753"]
["sodium chloride ophthalmic","MURO-128","OPHTHALMIC","Ointment","5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents","Eye","Eye (R)","1298435"]
["sodium chloride ophthalmic","MURO","OPHTHALMIC","Solution","2%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents","Eye","Eye (R)","750121"]
["sodium chloride ophthalmic","MURO-128","OPHTHALMIC","Solution","5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents","Eye","Eye (R)","730780"]
["sodium oxybate","XYREM","ORAL","Solution","500 MG/ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Psychotherapeutic and Neurological Agents - Misc.","Chronic Pain","Chronic Pain (R)","349482"]
["sucralfate","CARAFATE","ORAL","Suspension","1 GM/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","313123"]
["sucralfate","CARAFATE","ORAL","Suspension","1 GM/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Elbow Disorders","Elbow Disorders (R)","313123"]
["sucralfate","CARAFATE","ORAL","Suspension","1 GM/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Hip and Groin Disorders","Hip and Groin Disorders (R)","313123"]
["sucralfate","CARAFATE","ORAL","Suspension","1 GM/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Knee Disorders","Knee Disorders (R)","313123"]
["sucralfate","CARAFATE","ORAL","Suspension","1 GM/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Low Back Disorders","Low Back Disorders (R)","313123"]
["sucralfate","CARAFATE","ORAL","Suspension","1 GM/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Shoulder","Shoulder (R)","313123"]
["sucralfate","CARAFATE","ORAL","Suspension","1 GM/10 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Traumatic Brain Injury","Traumatic Brain Injury (R)","313123"]
["sucralfate","CARAFATE","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","314234"]
["sucralfate","CARAFATE","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Elbow Disorders","Elbow Disorders (R)","314234"]
["sucralfate","CARAFATE","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Hip and Groin Disorders","Hip and Groin Disorders (R)","314234"]
["sucralfate","CARAFATE","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Knee Disorders","Knee Disorders (R)","314234"]
["sucralfate","CARAFATE","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Low Back Disorders","Low Back Disorders (R)","314234"]
["sucralfate","CARAFATE","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Shoulder","Shoulder (R)","314234"]
["sucralfate","CARAFATE","ORAL","Tablet","1 GM","Exempt","NO","Not Applicable","NO","Not Applicable","Ulcer Drugs","Traumatic Brain Injury","Traumatic Brain Injury (R)","314234"]
["sulfamethoxazole/trimethoprim","BACTRIM, SEPTRA","ORAL","Suspension","200 MG/5 ML-40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","313134"]
["sulfamethoxazole/trimethoprim","BACTRIM, SEPTRA","ORAL","Suspension","200 MG/5 ML-40 MG/5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","313134"]
["sulfamethoxazole/trimethoprim","BACTRIM, SEPTRA","ORAL","Tablet","400 MG-80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","198334"]
["sulfamethoxazole/trimethoprim","BACTRIM, SEPTRA","ORAL","Tablet","400 MG-80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198334"]
["sulfamethoxazole/trimethoprim","BACTRIM DS, SEPTRA DS","ORAL","Tablet","800 MG-160 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Ankle and Foot Disorders","Ankle and Foot Disorders (R,NR)","198335"]
["sulfamethoxazole/trimethoprim","BACTRIM DS, SEPTRA DS","ORAL","Tablet","800 MG-160 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anti-Infective Agents - Misc.","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198335"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","198238"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","198239"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198239"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","198239"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","198239"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198239"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","198239"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","198239"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","198239"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","198239"]
["sulindac","CLINORIL","ORAL","Tablet","200 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","198239"]
["sumatriptan succinate","ONZETRA XSAIL","NASAL","Powder","11 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","1739332"]
["sumatriptan succinate","ZEMBRACE SYMTOUCH","INJECTABLE","Solution, Subcutaneous","3 MG/05 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","1738576"]
["sumatriptan succinate","IMITREX","INJECTABLE","Solution, Subcutaneous, cartridge","4 MG/0.5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","1657173"]
["sumatriptan succinate","IMITREX","INJECTABLE","Solution, Subcutaneous, cartridge","6 MG/0.5 ML","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","1657160"]
["sumatriptan succinate","TOSYMRA","NASAL","Spray","10 MG/SPRAY","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","401978"]
["sumatriptan succinate","IMITREX","NASAL","Spray","20 MG/SPRAY","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","314227"]
["sumatriptan succinate","IMITREX","NASAL","Spray","5 MG/SPRAY","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","313159"]
["sumatriptan succinate","IMITREX","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","313160"]
["sumatriptan succinate","IMITREX","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","315223"]
["sumatriptan succinate","IMITREX","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","313161"]
["tacrolimus","PROTOPIC","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1164204"]
["tapentadol","NUCYNTA, NUCYNTA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","1160875"]
["tapentadol","NUCYNTA, NUCYNTA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1160875"]
["tapentadol","NUCYNTA, NUCYNTA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (X)","1160875"]
["tapentadol","NUCYNTA, NUCYNTA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (X)","1160875"]
["tapentadol","NUCYNTA, NUCYNTA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1160875"]
["tapentadol","NUCYNTA, NUCYNTA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (X)","1160875"]
["tapentadol","NUCYNTA, NUCYNTA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (X)","1160875"]
["tapentadol","NUCYNTA, NUCYNTA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (X)","1160875"]
["tapentadol","NUCYNTA, NUCYNTA ER","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (X)","1160875"]
["temazepam","RESTORIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Hypnotics / Sedatives / Sleep Disorder Agents","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1164228"]
["terbinafine hcl","LAMISIL","ORAL","Tablet","250 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antifungals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","313222"]
["terbinafine hcl (topical)","LAMISIL","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1161497"]
["tetracaine hcl","TETCAINE","OPHTHALMIC","Solution","0.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anesthetic)","Eye","Eye (R)","1547771"]
["tetracycline hcl","Not Applicable","ORAL","Capsule","250 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Eye","Eye (R)","198250"]
["tetracycline hcl","Not Applicable","ORAL","Capsule","500 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antibiotics (Tetracyclines)","Eye","Eye (R)","198252"]
["thalidomide","THALOMID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Assorted Classes","Chronic Pain","Chronic Pain (X)","1164873"]
["thalidomide","THALOMID","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Assorted Classes","Low Back Disorders","Low Back Disorders (X)","1164873"]
["theophylline","THEO-24, THEO-DUR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1164877"]
["tiagabine hcl","GABITRIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (X)","1162089"]
["tiagabine hcl","GABITRIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (X)","1162089"]
["tiagabine hcl","GABITRIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1162089"]
["tiagabine hcl","GABITRIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1162089"]
["tiagabine hcl","GABITRIL","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (X)","1162089"]
["tizanidine hcl","ZANAFLEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1162724"]
["tizanidine hcl","ZANAFLEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Chronic Pain","Chronic Pain (R,X,NR)","1162724"]
["tizanidine hcl","ZANAFLEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Hip and Groin Disorders","Hip and Groin Disorders (R)","1162724"]
["tizanidine hcl","ZANAFLEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Knee Disorders","Knee Disorders (X, NR)","1162724"]
["tizanidine hcl","ZANAFLEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Low Back Disorders","Low Back Disorders (R,X)","1162724"]
["tizanidine hcl","ZANAFLEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Shoulder","Shoulder (R,X)","1162724"]
["tizanidine hcl","ZANAFLEX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","YES","4 days","NO","Not Applicable","Musculoskeletal Therapy Agents (Muscle Relaxants)","Traumatic Brain Injury","Traumatic Brain Injury (R)","1162724"]
["tobramycin ophthalmic","TOBREX","OPHTHALMIC","Ointment","0.3%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anti-bacterial)","Eye","Eye (R,X,NR)","313414"]
["tobramycin ophthalmic","TOBREX","OPHTHALMIC","Solution","0.3%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anti-bacterial)","Eye","Eye (R,X,NR)","313415"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","198296"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198296"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","198296"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","198296"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198296"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","198296"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","198296"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","198296"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","198296"]
["tolmetin sodium","Tolectin","ORAL","Capsule","400 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","198296"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","198297"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R)","198297"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Chronic Pain","Chronic Pain (R)","198297"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Elbow Disorders","Elbow Disorders (R,X,NR)","198297"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X,NR)","198297"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Hip and Groin Disorders","Hip and Groin Disorders (R,NR)","198297"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Knee Disorders","Knee Disorders (R,NR)","198297"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Low Back Disorders","Low Back Disorders (R)","198297"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Shoulder","Shoulder (R)","198297"]
["tolmetin sodium","Tolectin","ORAL","Tablet","600 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Anti-Inflammatory (NSAID)","Traumatic Brain Injury","Traumatic Brain Injury (NR)","198297"]
["tolnaftate","TINACTIN","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1157650"]
["topiramate","TOPAMAX, TROKENDI XR, QUDEXY XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1162749"]
["topiramate","TOPAMAX, TROKENDI XR, QUDEXY XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (R)","1162749"]
["topiramate","TOPAMAX, TROKENDI XR, QUDEXY XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (NR)","1162749"]
["topiramate","TOPAMAX, TROKENDI XR, QUDEXY XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Knee Disorders","Knee Disorders (X, NR)","1162749"]
["topiramate","TOPAMAX, TROKENDI XR, QUDEXY XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (R,NR)","1162749"]
["topiramate","TOPAMAX, TROKENDI XR, QUDEXY XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","1162749"]
["topiramate","TOPAMAX, TROKENDI XR, QUDEXY XR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (R,X,NR)","1162749"]
["tramadol hcl","CONZIP, ULTRAM ER, RYZOLT","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","1157662"]
["tramadol hcl","CONZIP, ULTRAM ER, RYZOLT","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","1157662"]
["tramadol hcl","CONZIP, ULTRAM ER, RYZOLT","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","1157662"]
["tramadol hcl","CONZIP, ULTRAM ER, RYZOLT","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","1157662"]
["tramadol hcl","CONZIP, ULTRAM ER, RYZOLT","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","1157662"]
["tramadol hcl","CONZIP, ULTRAM ER, RYZOLT","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","1157662"]
["tramadol hcl","CONZIP, ULTRAM ER, RYZOLT","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","1157662"]
["tramadol hcl","CONZIP, ULTRAM ER, RYZOLT","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","1157662"]
["tramadol hcl","CONZIP, ULTRAM ER, RYZOLT","ORAL","ALL EXTENDED RELEASE ORAL PRODUCTS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Analgesics - Opioid","Shoulder","Shoulder (R,X)","1157662"]
["tramadol hcl","QDOLO","ORAL","Solution","5 MG/ML","Non-Exempt","YES","4 days = \n400 ML","YES","4 days = \n400 ML","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","2395808"]
["tramadol hcl","QDOLO","ORAL","Solution","5 MG/ML","Non-Exempt","YES","4 days = \n400 ML","YES","4 days = \n400 ML","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","2395808"]
["tramadol hcl","QDOLO","ORAL","Solution","5 MG/ML","Non-Exempt","YES","4 days = \n400 ML","YES","4 days = \n400 ML","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","2395808"]
["tramadol hcl","QDOLO","ORAL","Solution","5 MG/ML","Non-Exempt","YES","4 days = \n400 ML","YES","4 days = \n400 ML","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","2395808"]
["tramadol hcl","QDOLO","ORAL","Solution","5 MG/ML","Non-Exempt","YES","4 days = \n400 ML","YES","4 days = \n400 ML","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","2395808"]
["tramadol hcl","QDOLO","ORAL","Solution","5 MG/ML","Non-Exempt","YES","4 days = \n400 ML","YES","4 days = \n400 ML","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","2395808"]
["tramadol hcl","QDOLO","ORAL","Solution","5 MG/ML","Non-Exempt","YES","4 days = \n400 ML","YES","4 days = \n400 ML","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","2395808"]
["tramadol hcl","QDOLO","ORAL","Solution","5 MG/ML","Non-Exempt","YES","4 days = \n400 ML","YES","4 days = \n400 ML","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","2395808"]
["tramadol hcl","QDOLO","ORAL","Solution","5 MG/ML","Non-Exempt","YES","4 days = \n400 ML","YES","4 days = \n400 ML","Analgesics - Opioid","Shoulder","Shoulder (R,X)","2395808"]
["tramadol hcl","ULTRAM","ORAL","Tablet","100 MG","Non-Exempt","YES","4 days = \n20 tablet","YES","4 days = \n20 tablet","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","2179635"]
["tramadol hcl","ULTRAM","ORAL","Tablet","100 MG","Non-Exempt","YES","4 days = \n20 tablet","YES","4 days = \n20 tablet","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","2179635"]
["tramadol hcl","ULTRAM","ORAL","Tablet","100 MG","Non-Exempt","YES","4 days = \n20 tablet","YES","4 days = \n20 tablet","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","2179635"]
["tramadol hcl","ULTRAM","ORAL","Tablet","100 MG","Non-Exempt","YES","4 days = \n20 tablet","YES","4 days = \n20 tablet","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","2179635"]
["tramadol hcl","ULTRAM","ORAL","Tablet","100 MG","Non-Exempt","YES","4 days = \n20 tablet","YES","4 days = \n20 tablet","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","2179635"]
["tramadol hcl","ULTRAM","ORAL","Tablet","100 MG","Non-Exempt","YES","4 days = \n20 tablet","YES","4 days = \n20 tablet","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","2179635"]
["tramadol hcl","ULTRAM","ORAL","Tablet","100 MG","Non-Exempt","YES","4 days = \n20 tablet","YES","4 days = \n20 tablet","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","2179635"]
["tramadol hcl","ULTRAM","ORAL","Tablet","100 MG","Non-Exempt","YES","4 days = \n20 tablet","YES","4 days = \n20 tablet","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","2179635"]
["tramadol hcl","ULTRAM","ORAL","Tablet","100 MG","Non-Exempt","YES","4 days = \n20 tablet","YES","4 days = \n20 tablet","Analgesics - Opioid","Shoulder","Shoulder (R,X)","2179635"]
["tramadol hcl","ULTRAM","ORAL","Tablet","50 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","835603"]
["tramadol hcl","ULTRAM","ORAL","Tablet","50 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","835603"]
["tramadol hcl","ULTRAM","ORAL","Tablet","50 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","835603"]
["tramadol hcl","ULTRAM","ORAL","Tablet","50 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","835603"]
["tramadol hcl","ULTRAM","ORAL","Tablet","50 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","835603"]
["tramadol hcl","ULTRAM","ORAL","Tablet","50 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","835603"]
["tramadol hcl","ULTRAM","ORAL","Tablet","50 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","835603"]
["tramadol hcl","ULTRAM","ORAL","Tablet","50 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","835603"]
["tramadol hcl","ULTRAM","ORAL","Tablet","50 MG","Non-Exempt","YES","4 days = \n40 tablets","YES","4 days = \n40 tablets","Analgesics - Opioid","Shoulder","Shoulder (R,X)","835603"]
["tramadol hcl/acetaminophen","ULTRACET","ORAL","Tablet","325 MG-37.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Ankle and Foot Disorders","Ankle and Foot Disorders (R,X)","836395"]
["tramadol hcl/acetaminophen","ULTRACET","ORAL","Tablet","325 MG-37.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","836395"]
["tramadol hcl/acetaminophen","ULTRACET","ORAL","Tablet","325 MG-37.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Chronic Pain","Chronic Pain (R,X)","836395"]
["tramadol hcl/acetaminophen","ULTRACET","ORAL","Tablet","325 MG-37.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Elbow Disorders","Elbow Disorders (R,X)","836395"]
["tramadol hcl/acetaminophen","ULTRACET","ORAL","Tablet","325 MG-37.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R,X)","836395"]
["tramadol hcl/acetaminophen","ULTRACET","ORAL","Tablet","325 MG-37.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Hip and Groin Disorders","Hip and Groin Disorders (R,X)","836395"]
["tramadol hcl/acetaminophen","ULTRACET","ORAL","Tablet","325 MG-37.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Knee Disorders","Knee Disorders (R)","836395"]
["tramadol hcl/acetaminophen","ULTRACET","ORAL","Tablet","325 MG-37.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Low Back Disorders","Low Back Disorders (R,X)","836395"]
["tramadol hcl/acetaminophen","ULTRACET","ORAL","Tablet","325 MG-37.5 MG","Non-Exempt","YES","4 days = \n54 tablets","YES","4 days = \n54 tablets","Analgesics - Opioid","Shoulder","Shoulder (R,X)","836395"]
["tranexamic acid","LYSTEDA","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Hemostatics","Eye","Eye (R)","883826"]
["tranexamic acid","LYSTEDA","ORAL","Tablet","650 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Hemostatics","Traumatic Brain Injury","Traumatic Brain Injury (R)","883826"]
["tranylcypromine","PARNATE","ORAL","Tablet","10  MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (MAOIs)","Depressive Disorders","Depressive Disorders (R)","313447"]
["trazodone hcl","DESYREL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","856373"]
["trazodone hcl","DESYREL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","856373"]
["trazodone hcl","DESYREL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","856373"]
["trazodone hcl","DESYREL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","856373"]
["trazodone hcl","DESYREL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","856373"]
["trazodone hcl","DESYREL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","856373"]
["trazodone hcl","DESYREL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856373"]
["trazodone hcl","DESYREL","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","856373"]
["trazodone hcl","DESYREL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","856364"]
["trazodone hcl","DESYREL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","856364"]
["trazodone hcl","DESYREL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","856364"]
["trazodone hcl","DESYREL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","856364"]
["trazodone hcl","DESYREL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","856364"]
["trazodone hcl","DESYREL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","856364"]
["trazodone hcl","DESYREL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856364"]
["trazodone hcl","DESYREL","ORAL","Tablet","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","856364"]
["trazodone hcl","DESYREL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","856369"]
["trazodone hcl","DESYREL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","856369"]
["trazodone hcl","DESYREL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","856369"]
["trazodone hcl","DESYREL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","856369"]
["trazodone hcl","DESYREL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","856369"]
["trazodone hcl","DESYREL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","856369"]
["trazodone hcl","DESYREL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856369"]
["trazodone hcl","DESYREL","ORAL","Tablet","300 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","856369"]
["trazodone hcl","DESYREL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","856377"]
["trazodone hcl","DESYREL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (R,X,NR)","856377"]
["trazodone hcl","DESYREL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","856377"]
["trazodone hcl","DESYREL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","856377"]
["trazodone hcl","DESYREL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","856377"]
["trazodone hcl","DESYREL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","856377"]
["trazodone hcl","DESYREL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (NR)","856377"]
["trazodone hcl","DESYREL","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (R,X)","856377"]
["triamcinolone acetonide","Not Applicable","TOPICAL","ALL TOPICAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Ankle and Foot Disorders","Ankle and Foot Disorders (R)","1158231"]
["trimipramine maleate","SURMONTIL","ORAL","Capsule","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","313496"]
["trimipramine maleate","SURMONTIL","ORAL","Capsule","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","313498"]
["trimipramine maleate","SURMONTIL","ORAL","Capsule","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (TCAs)","Depressive Disorders","Depressive Disorders (R)","313499"]
["trolamine salicylate","ARTHRICREAM","TOPICAL","Cream","10%","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Dermatologicals","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (R)","313518"]
["tropicamide ophthalmic","MYDRIACYL","OPHTHALMIC","Solution","0.5%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anticholinergics)","Eye","Eye (X)","313521"]
["tropicamide ophthalmic","MYDRIACYL","OPHTHALMIC","Solution","1%","Exempt","NO","Not Applicable","NO","Not Applicable","Ophthalmic Agents (Anticholinergics)","Eye","Eye (X)","314238"]
["trypsin","Not Applicable","BULK","BULK DRUG","Not Applicable","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Chemicals (Proteolytic enzyme)","Ankle and Foot Disorders","Ankle and Foot Disorders (X)","10890"]
["valacyclovir hcl","VALTREX","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antivirals","Chronic Pain","Chronic Pain (X, NR)","1163984"]
["valproic acid","DEPAKENE","ORAL","Capsule","250 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (X)","1099681"]
["valproic acid","DEPAKENE","ORAL","Capsule","250 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (X)","1099681"]
["valproic acid","DEPAKENE","ORAL","Capsule","250 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1099681"]
["valproic acid","DEPAKENE","ORAL","Capsule","250 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1099681"]
["valproic acid","DEPAKENE","ORAL","Capsule","250 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (X)","1099681"]
["valproic acid","DEPAKENE","ORAL","Capsule","250 MG","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Traumatic Brain Injury","Traumatic Brain Injury (X, NR)","1099681"]
["valproic acid","DEPAKENE","ORAL","Solution","250 MG/5 ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (X)","1099687"]
["valproic acid","DEPAKENE","ORAL","Solution","250 MG/5 ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (X)","1099687"]
["valproic acid","DEPAKENE","ORAL","Solution","250 MG/5 ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1099687"]
["valproic acid","DEPAKENE","ORAL","Solution","250 MG/5 ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1099687"]
["valproic acid","DEPAKENE","ORAL","Solution","250 MG/5 ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (X)","1099687"]
["valproic acid","DEPAKENE","ORAL","Solution","250 MG/5 ML","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Traumatic Brain Injury","Traumatic Brain Injury (X, NR)","1099687"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","313583"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","313583"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","313583"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","313583"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","313583"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","313583"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313583"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","313583"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","313585"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","313585"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","313585"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","313585"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","313585"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","313585"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313585"]
["venlafaxine hcl","EFFEXOR","ORAL","Capsule, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","313585"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","313580"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","313580"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","313580"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","313580"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","313580"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","313580"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313580"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","100 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","313580"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","313582"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","313582"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","313582"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","313582"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","313582"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","313582"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313582"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","25 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","313582"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","313584"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","313584"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","313584"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","313584"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","313584"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","313584"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313584"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","313584"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","314277"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","314277"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","314277"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","314277"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","314277"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","314277"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","314277"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","50 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","314277"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","313586"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","313586"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","313586"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","313586"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","313586"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","313586"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313586"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","313586"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","150 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","313581"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","225 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","808748"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","225 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","808748"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","225 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","808748"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","225 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","808748"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","225 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","808748"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","225 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","808748"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","225 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","808748"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","225 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","808748"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","808751"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","808751"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","808751"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","808751"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","808751"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","808751"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","808751"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","37.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","808751"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (R,X)","808753"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Chronic Pain","Chronic Pain (R)","808753"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Depressive Disorders","Depressive Disorders (R)","808753"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Hip and Groin Disorders","Hip and Groin Disorders (NR)","808753"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Knee Disorders","Knee Disorders (R,X,NR)","808753"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Low Back Disorders","Low Back Disorders (R,NR)","808753"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (R)","808753"]
["venlafaxine hcl","EFFEXOR","ORAL","Tablet, Extended Release","75 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SNRI)","Shoulder","Shoulder (R,X)","808753"]
["vilazodone","VIIBRYD","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1086772"]
["vilazodone","VIIBRYD","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (X)","1086772"]
["vilazodone","VIIBRYD","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1086772"]
["vilazodone","VIIBRYD","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1086772"]
["vilazodone","VIIBRYD","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","1086772"]
["vilazodone","VIIBRYD","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1086772"]
["vilazodone","VIIBRYD","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1086772"]
["vilazodone","VIIBRYD","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1086772"]
["vilazodone","VIIBRYD","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1086778"]
["vilazodone","VIIBRYD","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (X)","1086778"]
["vilazodone","VIIBRYD","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1086778"]
["vilazodone","VIIBRYD","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1086778"]
["vilazodone","VIIBRYD","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","1086778"]
["vilazodone","VIIBRYD","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1086778"]
["vilazodone","VIIBRYD","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1086778"]
["vilazodone","VIIBRYD","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1086778"]
["vilazodone","VIIBRYD","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1086784"]
["vilazodone","VIIBRYD","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Chronic Pain","Chronic Pain (X)","1086784"]
["vilazodone","VIIBRYD","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1086784"]
["vilazodone","VIIBRYD","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Hip and Groin Disorders","Hip and Groin Disorders (X)","1086784"]
["vilazodone","VIIBRYD","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Knee Disorders","Knee Disorders (X)","1086784"]
["vilazodone","VIIBRYD","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Low Back Disorders","Low Back Disorders (X)","1086784"]
["vilazodone","VIIBRYD","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Post-Traumatic Stress Disorder","Post-Traumatic Stress Disorder (X)","1086784"]
["vilazodone","VIIBRYD","ORAL","Tablet","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Shoulder","Shoulder (X)","1086784"]
["vitamin a","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1161147"]
["vitamin b-1","THIAMINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Depressive Disorders","Depressive Disorders (NR)","1165506"]
["vitamin b-12","CYANOCOBALAMIN, METHYLCOBALAMIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Hematopoietic Agents (Vitamins)","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1161158"]
["vitamin b-12","CYANOCOBALAMIN, METHYLCOBALAMIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Hematopoietic Agents (Vitamins)","Depressive Disorders","Depressive Disorders (X)","1161158"]
["vitamin b-12","CYANOCOBALAMIN, METHYLCOBALAMIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Hematopoietic Agents (Vitamins)","Elbow Disorders","Elbow Disorders (NR)","1161158"]
["vitamin b-12","CYANOCOBALAMIN, METHYLCOBALAMIN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Hematopoietic Agents (Vitamins)","Low Back Disorders","Low Back Disorders (X)","1161158"]
["vitamin b-6","PYRIDOXINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Ankle and Foot Disorders","Ankle and Foot Disorders (X, NR)","1157325"]
["vitamin b-6","PYRIDOXINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1157325"]
["vitamin b-6","PYRIDOXINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Elbow Disorders","Elbow Disorders (X)","1157325"]
["vitamin b-6","PYRIDOXINE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Hand, Wrist, and Forearm Disorders","Hand, Wrist, and Forearm Disorders (X)","1157325"]
["vitamin d","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","11253"]
["vitamin d","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Depressive Disorders","Depressive Disorders (X)","11253"]
["vitamin d3","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Chronic Pain","Chronic Pain (R)","1156133"]
["vitamin d3","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","1156133"]
["vitamin e","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Ankle and Foot Disorders","Ankle and Foot Disorders (X, NR)","1161178"]
["vitamin e","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Cervical and Thoracic Spine Disorders","Cervical and Thoracic Spine Disorders (X)","1161178"]
["vitamin e","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Vitamins","Low Back Disorders","Low Back Disorders (X)","1161178"]
["vortioxetine","TRINTELLIX","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1439808"]
["vortioxetine","TRINTELLIX","ORAL","Tablet","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1439810"]
["vortioxetine","TRINTELLIX","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antidepressants (SSRI)","Depressive Disorders","Depressive Disorders (R)","1439812"]
["warfarin sodium","COUMADIN","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","855288"]
["warfarin sodium","COUMADIN","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","855288"]
["warfarin sodium","COUMADIN","ORAL","Tablet","1 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","855288"]
["warfarin sodium","COUMADIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","855296"]
["warfarin sodium","COUMADIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","855296"]
["warfarin sodium","COUMADIN","ORAL","Tablet","10 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","855296"]
["warfarin sodium","COUMADIN","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","855302"]
["warfarin sodium","COUMADIN","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","855302"]
["warfarin sodium","COUMADIN","ORAL","Tablet","2 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","855302"]
["warfarin sodium","COUMADIN","ORAL","Tablet","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","855312"]
["warfarin sodium","COUMADIN","ORAL","Tablet","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","855312"]
["warfarin sodium","COUMADIN","ORAL","Tablet","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","855312"]
["warfarin sodium","COUMADIN","ORAL","Tablet","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","855318"]
["warfarin sodium","COUMADIN","ORAL","Tablet","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","855318"]
["warfarin sodium","COUMADIN","ORAL","Tablet","3 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","855318"]
["warfarin sodium","COUMADIN","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","855324"]
["warfarin sodium","COUMADIN","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","855324"]
["warfarin sodium","COUMADIN","ORAL","Tablet","4 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","855324"]
["warfarin sodium","COUMADIN","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","855332"]
["warfarin sodium","COUMADIN","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","855332"]
["warfarin sodium","COUMADIN","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","855332"]
["warfarin sodium","COUMADIN","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","855338"]
["warfarin sodium","COUMADIN","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","855338"]
["warfarin sodium","COUMADIN","ORAL","Tablet","6 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","855338"]
["warfarin sodium","COUMADIN","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Ankle and Foot Disorders","Ankle and Foot Disorders (NR)","855344"]
["warfarin sodium","COUMADIN","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Hip and Groin Disorders","Hip and Groin Disorders (R)","855344"]
["warfarin sodium","COUMADIN","ORAL","Tablet","7.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Anticoagulants","Knee Disorders","Knee Disorders (R)","855344"]
["zafirlukast","ACCOLATE","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1165263"]
["zileuton","ZYFLO, ZYFLO CR","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Antiasthmatic and Bronchodilator Agents","Work Related Asthma","Work Related Asthma (R)","1156238"]
["zinc","Not Applicable","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Exempt","NO","Not Applicable","NO","Not Applicable","Minerals & Electrolytes","COVID-19 Coronavirus","COVID-19 Coronavirus (R)","11416"]
["ziprasidone hcl","GEODON","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","314286"]
["ziprasidone hcl","GEODON","ORAL","Capsule","20 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","314286"]
["ziprasidone hcl","GEODON","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","313776"]
["ziprasidone hcl","GEODON","ORAL","Capsule","40 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","313776"]
["ziprasidone hcl","GEODON","ORAL","Capsule","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","313777"]
["ziprasidone hcl","GEODON","ORAL","Capsule","60 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","313777"]
["ziprasidone hcl","GEODON","ORAL","Capsule","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Depressive Disorders","Depressive Disorders (R)","313778"]
["ziprasidone hcl","GEODON","ORAL","Capsule","80 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Antipsychotics / Antimanic Agents","Traumatic Brain Injury","Traumatic Brain Injury (R)","313778"]
["zolmitriptan","ZOMIG","NASAL","Spray","2.5 MG/SPRAY","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","1483677"]
["zolmitriptan","ZOMIG","NASAL","Spray","5 MG/SPRAY","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","402000"]
["zolmitriptan","ZOMIG","ORAL","Tablet","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","200193"]
["zolmitriptan","ZOMIG","ORAL","Tablet","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","200194"]
["zolmitriptan","ZOMIG","ORAL","Tablet, Orally Disintegrating","2.5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","284201"]
["zolmitriptan","ZOMIG","ORAL","Tablet, Orally Disintegrating","5 MG","Exempt","NO","Not Applicable","NO","Not Applicable","Migraine Products","Traumatic Brain Injury","Traumatic Brain Injury (R)","351134"]
["zolpidem tartrate","AMBIEN, AMBIEN CR, INTERMEZZO, EDULAR, ZOLPMIST","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","4 days","Hypnotics / Sedatives / Sleep Disorder Agents","Chronic Pain","Chronic Pain (X)","1156259"]
["zolpidem tartrate","AMBIEN, AMBIEN CR, INTERMEZZO, EDULAR, ZOLPMIST","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","YES","4 days","Hypnotics / Sedatives / Sleep Disorder Agents","Depressive Disorders","Depressive Disorders (R)","1156259"]
["zonisamide","ZONEGRAN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Chronic Pain","Chronic Pain (X)","1156263"]
["zonisamide","ZONEGRAN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Hip and Groin Disorders","Hip and Groin Disorders (X)","1156263"]
["zonisamide","ZONEGRAN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Low Back Disorders","Low Back Disorders (NR)","1156263"]
["zonisamide","ZONEGRAN","ORAL","ALL ORAL DOSAGE FORMS","ALL STRENGTHS","Non-Exempt","NO","Not Applicable","NO","Not Applicable","Anticonvulsants","Shoulder","Shoulder (X)","1156263"]