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Temajûn ‘New Deal tusken Boeren en Mienskip’ – Wommels.nl\n27 november 2019 19:30 - 23:00\n« Ledenvergadering Winterwille\nDigitaal Café »\nWoansdei 27 novimber is der yn It Dielshûs in temajûn mei as titel ‘New Deal tusken Boeren en Mienskip’. Fanôf 19.30 oere bin der earst twa sprekkers en dêrnei diskusje en fragen stelle mei in foarum. Eltsenien is wolkom.\nRijksbouwmeester Floris van Alkemade is de earste sprekker. Syn foardracht giet ûnder oare oer de ynrjochting fan ús lânskip en gebrûk fan ús grûn. Hy is bekend fan de ‘New Deal tusken Boeren en Mienskip’. Hy nimt dêrby in earlik ynkommen foar boeren, in sûne boaiem en in oantreklik lânskip as útgongspunt.\nDe twadde sprekker is Theo Mulder. Syn boadskip is ‘Boerderijen binne de apoteken fan de takomst’. Hy leit ek de relaasje tusken sûne grûn, sûn iten en de sûnens fan minsk, plan en bist.\nNei beide sprekkers is der diskusje en kinne der fragen steld wurde oan in foarum dat foarme wurdt troch beide sprekkers en arzitekt Nynke Rixt Jukema ek bekend fan it projekt ‘Feel the Night’. Gerben Gerbrandy, ûnder oare 1e Keamerlid en bestjoerfoarsitter fan de Freonen fan Fossylfrij Fryslân, is gesprekslieder.\nDe organisaasje fan de temajûn is yn hannen fan FNP Súdwest-Fryslân.\nWommels, 8731CK + Google Maps\n27 oktober 19:30 - 21:30\nGas besparen met de Hydrobag\n28 oktober 20:30 - 22:00\n31 oktober 13:30 - 16:00\nKerstconcert Harmonieorkest Euphonia\n19 december 15:30 - 18:00


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or Generic $75.00 $187.50 Q:30\nACLOVATE 0.05% CREAM 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nACLOVATE ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT(GM) TOPICAL 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nACTHIB VACCINE VIAL 10-24UNT/5ML 2 Tier 2 Preferred Brand $35.00 $87.50 None\nACTICIN 5% CREAM 1 Tier 1 Preferred Generic $9.00 $13.50 None\nACTIGALL 300MG CAPSULE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nACTIMMUNE SOLUTION FOR INJECTION 100MCG 5 Tier 5. 33% N/A P\nACTIQ 1200MCG LOZENGE 5 Tier 5. 33% N/A P Q:120\nACTIQ 1600MCG LOZENGE 5 Tier 5. 33% N/A P Q:120\nACTIQ 200MCG LOZENGE 5 Tier 5. 33% N/A P Q:120\nACTIQ 400MCG LOZENGE 5 Tier 5. 33% N/A P Q:120\nACTIQ 600MCG LOZENGE 5 Tier 5. 33% N/A P Q:120\nACTIQ 800MCG LOZENGE 5 Tier 5. 33% N/A P Q:120\nACTIVELLA 0.5-0.1MG TABLET 28 DLPK 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nACTIVELLA 1-0.5MG TABLET 28 DLPK 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 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$75.00 $187.50 None\nACULAR PF 0.5% EYE DROPS 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nACYCLOVIR 200MG CAPSULE (1000 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nACYCLOVIR 200MG/5ML SUSP 1 Tier 1 Preferred Generic $9.00 $13.50 None\nACYCLOVIR 400MG TABLET (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nACYCLOVIR SOD 50MG/ML VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nACYCLOVIR SODIUM 1GM VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nACYCLOVIR SODIUM 500MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nACYCLOVIR TABLET USP 800MG (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nADACEL VIAL 2UNT/5UNT 2 Tier 2 Preferred Brand $35.00 $87.50 None\nADAGEN 250U/ML VIAL 5 Tier 5. 33% N/A None\nADALAT CC 30MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nADALAT CC 60MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nADALAT CC 90MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 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$87.50 Q:60\nADVAIR HFA 115/21MCG INHALER 2 Tier 2 Preferred Brand $35.00 $87.50 Q:12\nADVAIR HFA 230/21MCG INHALER 2 Tier 2 Preferred Brand $35.00 $87.50 Q:12\nADVAIR HFA 45/21MCG INHALER 2 Tier 2 Preferred Brand $35.00 $87.50 Q:12\nADVICOR 1000-20MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nADVICOR 1000MG/40MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nADVICOR 500-20MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nADVICOR ER 20-750MG TABLET (90 CT) 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAEROBID AEROSOL W/ADAPTER 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:21\nAEROBID-M AEROSOL W/ADAPTER 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:21\nAFEDITAB CR 30MG TABLET SA 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAFEDITAB CR 60MG TABLET SA 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAGGRENOX 25-200MG CAPSULE 2 Tier 2 Preferred Brand $35.00 $87.50 None\nAGRYLIN 0.5MG CAPSULE 5 Tier 5. 33% N/A None\nAK-CON 0.1% EYE DROPS 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAK-POLY-BAC EYE OINTMENT 500UNT/1000UNT 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAK-SPORE EYE OINTMENT 3.5 MG 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAKNE-MYCIN 2% OINTMENT 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAKTOB 0.3% EYE DROPS 1 Tier 1 Preferred Generic $9.00 $13.50 Q:10\nALA-CORT 1% CREAM 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALA-CORT 1% LOTION 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALA-SCALP HP 2% LOTION 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALAMAST 0.1% DROPS 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:20\nALBALON LIQUIFILM 0.1% DROP 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALBENZA 200MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALBUTEROL SULFATE 0.63MG/3ML VIAL NEBULIZER 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALBUTEROL SULFATE 2.5MG/3ML VIAL NEBULIZER 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALBUTEROL SULFATE 4MG TABLET SR 12HR 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALBUTEROL SULFATE 8MG TABLET SR 12HR 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALBUTEROL SULFATE TABLET 2MG (500 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALBUTEROL TABLET 4MG (500 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALCAINE 0.5% EYE DROPS 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALCLOMETASONE DIPROPIONATE 0.05% CREAM 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALCLOMETASONE DIPROPIONATE 0.05% OINTMENT 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALCOHOL 5%/DEXTROSE 5% 4 Tier 4 Non-Specialty Injectable 33% 33% None\nALCOHOL ANTISEPTIC PADS 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALDACTAZIDE 25/25 TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALDACTAZIDE 50/50 TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALDACTONE 100MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALDACTONE 25MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALDACTONE 50MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALDARA 5% CREAM 2 Tier 2 Preferred Brand $35.00 $87.50 None\nALDURAZYME 2.9MG/5ML VIAL 5 Tier 5. 33% N/A None\nALENDRONATE SODIUM 10MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:30\nALENDRONATE SODIUM 40MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:30\nALENDRONATE SODIUM 5MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:30\nALENDRONATE SODIUM 70MG TABLET 4 BLPK 1 Tier 1 Preferred Generic $9.00 $13.50 Q:4\nALENDRONATE SODIUM TABLET 35MG 20 CRTN 1 Tier 1 Preferred Generic $9.00 $13.50 Q:4\nALFERON N INJ 5MU/ML 5 Tier 5. 33% N/A None\nALIMTA 500MG VIAL 5 Tier 5. 33% N/A None\nALIMTA INJECTION 5 Tier 5. 33% N/A None\nALINIA 100MG/5ML SUSPENSION 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALINIA 500MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALKERAN 50MG VIAL 5 Tier 5. 33% N/A None\nALLOPURINOL SODIUM 500MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nALLOPURINOL TABLET 300MG (1000 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALLOPURINOL TABLET USP 100MG (1000 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nALOCRIL 2% EYE DROPS 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:10\nALOMIDE 0.1% EYE DROPS 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:20\nALOPRIM 500MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nALORA 0.025MG PATCH 2 Tier 2 Preferred Brand $35.00 $87.50 Q:8\nALORA 0.05MG PATCH 2 Tier 2 Preferred Brand $35.00 $87.50 Q:8\nALORA 0.075MG PATCH 2 Tier 2 Preferred Brand $35.00 $87.50 Q:8\nALORA 0.1MG PATCH 2 Tier 2 Preferred Brand $35.00 $87.50 Q:8\nALOXI 0.25MG/5ML VIAL 5 Tier 5. 33% N/A None\nALPHAGAN P 0.1% DROPS 2 Tier 2 Preferred Brand $35.00 $87.50 None\nALPHAGAN P 0.15% EYE DROPS 2 Tier 2 Preferred Brand $35.00 $87.50 None\nALREX 0.2% EYE DROPS 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nALTABAX 1% OINTMENT 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:30\nALTOPREV 20MG TABLET SR 24HR 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:30\nALTOPREV 40MG TABLET SR 24HR 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:30\nALTOPREV 60MG TABLET SR 24HR 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:30\nALUPENT 650MCG INHALER COMP 2 Tier 2 Preferred Brand $35.00 $87.50 Q:42\nAMANTADINE 100MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMANTADINE 100MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMARYL 1MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAMARYL 2MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAMARYL 4MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAMBIEN 10MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P Q:30\nAMBIEN 5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P Q:30\nAMBIEN CR 12.5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P Q:30\nAMBIEN CR 6.25MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P Q:30\nAMBISOME 50MG VIAL 5 Tier 5. 33% N/A None\nAMCINONIDE 0.1% CREAM 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMCINONIDE 0.1% LOTION 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMCINONIDE 0.1% OINTMENT 60GM TUBE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMERGE 1MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:9\nAMERGE 2.5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:9\nAMEVIVE ADMISTRATION PACK FOR INTRAMUSCULAR ADMINISTRATION KIT 15MG 1 X 4 PKGCOM 5 Tier 5. 33% N/A P\nAMIFOSTINE FOR INJECTION 500MG/VIAL 5 Tier 5. 33% N/A None\nAMIKACIN 250MG/ML VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMIKACIN 50MG/ML VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMIKIN 250MG/ML VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMIKIN POWDER FOR INJECTION 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMILORIDE HCL 5MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMILORIDE HCL W/HCTZ 5MG-50MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMINESS 5.2% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOPHYLLINE 100MG TABLET (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMINOPHYLLINE 200MG TABLET (1000 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMINOPHYLLINE INJECTION 250MG 10ML X 25 VIALSD 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMINOSYN 10% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN 3.5% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN 5% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN 7% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN 7%-ELECTROLYTE SOL 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN 8.5% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 10% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 15% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 3.5% IN D25W IV 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 3.5% IN D5W IV 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 3.5% M/D5W IV 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 3.5% W/ELEC DEX 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 4.25% IN D10W 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 4.25% IN D20W 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 4.25% M/D10W IV 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 4.25% W/ELEC DW 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 4.25%-D25W IV 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 5% IN D25W IV 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 7% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 8.5% ELECTROLYT 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN II 8.5% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN M 3.5% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN PF INJECTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5% 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN-HBC 7% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN-HF 8% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMINOSYN-PF 7% IV SOLUTION 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAMIODARONE HCL 200MG TABLET (60 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMIODARONE HCL 400MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMIODARONE HCL INJECTION 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMITRIP/CDP 25-10 TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIP/PERPHEN 10-2 TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIP/PERPHEN 10-4 TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIP/PERPHEN 25-2 TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIP/PERPHEN 25-4 TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIP/PERPHEN 50-4 TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIPTYLINE HCL 100MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIPTYLINE HCL 10MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIPTYLINE HCL 150MG TABLET (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIPTYLINE HCL 25MG TABLET USP (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIPTYLINE HCL 50MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMITRIPTYLINE HCL 75MG TABLET USP (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMLODIPINE BESYLATE 10MG TABLET (90 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 Q:30\nAMLODIPINE BESYLATE 2.5MG TABLET (90 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 Q:30\nAMLODIPINE BESYLATE 5MG TABLET (90 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 Q:45\nAMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMMONIUM CHLORIDE 5 MEQ/ML 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMMONIUM LACTATE 12% CREAM 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMMONIUM LACTATE 12% LOTION 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMNESTEEM 10MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMNESTEEM 20MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMNESTEEM 40MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOCLAN 200-28.5/5 SUSPENSION RECONSTITUTED ORAL 1 Tier 1 Preferred Generic $9.00 $13.50 Q:450\nAMOCLAN 400-57MG/5 SUSPENSION RECONSTITUTED ORAL 1 Tier 1 Preferred Generic $9.00 $13.50 Q:450\nAMOX TR-K CLV 200-28.5 CHEW 1 Tier 1 Preferred Generic $9.00 $13.50 Q:160\nAMOX TR-K CLV 200-28.5/5 SU 1 Tier 1 Preferred Generic $9.00 $13.50 Q:450\nAMOX TR-K CLV 400-57 CHW TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:80\nAMOX TR-K CLV 400-57/5 SUSP 1 Tier 1 Preferred Generic $9.00 $13.50 Q:450\nAMOX TR-K CLV 500-125MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:60\nAMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL 1 Tier 1 Preferred Generic $9.00 $13.50 Q:450\nAMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE 1 Tier 1 Preferred Generic $9.00 $13.50 Q:160\nAMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:60\nAMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE 1 Tier 1 Preferred Generic $9.00 $13.50 Q:80\nAMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL 1 Tier 1 Preferred Generic $9.00 $13.50 Q:450\nAMOX TR-POTASSIUM CLAVULANATE 500-125MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:60\nAMOXAPINE 100MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXAPINE 150MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXAPINE 25MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXAPINE 50MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXICIILIN CLAVULNATE POTASSIUM FOR ORAL SUSPENSION 1 Tier 1 Preferred Generic $9.00 $13.50 Q:450\nAMOXICILLIN 125MG TABLET CHEW 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXICILLIN 200MG TABLET CHEW 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXICILLIN 250MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXICILLIN 400MG TABLET CHEW 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXICILLIN 500MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXICILLIN 500MG TABLET (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXICILLIN 875MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT 1 Tier 1 Preferred Generic $9.00 $13.50 Q:450\nAMOXICILLIN CLAVULANATE POTASSIUM TABLET 875-125MG 1 BLPK 1 Tier 1 Preferred Generic $9.00 $13.50 Q:40\nAMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT 1 Tier 1 Preferred Generic $9.00 $13.50 Q:600\nAMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL 1 Tier 1 Preferred Generic $9.00 $13.50 Q:600\nAMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT 1 Tier 1 Preferred Generic $9.00 $13.50 Q:600\nAMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL 1 Tier 1 Preferred Generic $9.00 $13.50 Q:600\nAMOXICILLIN TABLET USP CHEWABLE 250MG (250 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXIL 250MG/5ML SUSPENSION 1 Tier 1 Preferred Generic $9.00 $13.50 Q:600\nAMOXIL 400MG/5ML SUSPENSION 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:600\nAMOXIL 500MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMOXIL 50MG/ML PED DROPS 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:600\nAMPHET ASP/ AMPHET/ D-AMPHET 10MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPHET ASP/ AMPHET/ D-AMPHET 5MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPHETAMINE SALT COMBO 12.5MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPHETAMINE SALT COMBO 15MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPHETAMINE SALT COMBO 30MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPHETAMINE SALT COMBO 7.5MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPHETAMINE SALTS 20MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPHETAMINE SALTS 30MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPHOTEC 100MG VIAL 5 Tier 5. 33% N/A None\nAMPHOTEC INJ 50MG 5 Tier 5. 33% N/A None\nAMPHOTERICIN B FOR INJECTION 50 MG 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN AND SULBACTAM FOR INJECTION 1-0.5 10 VIAL VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN AND SULBACTAM FOR INJECTION 10-5 1 VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN FOR INJECTION 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN FOR INJECTION 1GM VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN FOR INJECTION 2GM/ML 10 VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN FOR INJECTION 500MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN FOR INJECTION POWDER 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN FOR INJECTION USP 125MG/ML 1 VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPICILLIN POWDER FOR INJECTION 1 GM/ML 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN SODIUM STERILE 2 GM/VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAMPICILLIN TR 250MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nAMPICILLIN TR 500MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nANADROL-50 50MG TABLET (100 CT) 5 Tier 5. 33% N/A P\nANAFRANIL 25MG CAPSULE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANAFRANIL 50MG CAPSULE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANAFRANIL 75MG CAPSULE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANAGRELIDE HCL 0.5MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nANAGRELIDE HCL 1MG CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nANAPROX 275MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANAPROX DS 550MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANCOBON 250MG CAPSULE 2 Tier 2 Preferred Brand $35.00 $87.50 None\nANCOBON 500MG CAPSULE 5 Tier 5. 33% N/A None\nANDRODERM 2.5MG/24HR PATCH 2 Tier 2 Preferred Brand $35.00 $87.50 P Q:60\nANDRODERM 5MG/24HR PATCH 2 Tier 2 Preferred Brand $35.00 $87.50 P Q:30\nANDROGEL 1%(25MG) GEL PACKET 2 Tier 2 Preferred Brand $35.00 $87.50 P Q:300\nANDROGEL 1.25G (1%) GEL IN METERED-DOSE PUMP 2 Tier 2 Preferred Brand $35.00 $87.50 P Q:300\nANDROGEL 1%(50MG) GEL PACKET 2 Tier 2 Preferred Brand $35.00 $87.50 P Q:300\nANDROID 10MG CAPSULE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P\nANTABUSE 250MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 None\nANTABUSE 500MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 None\nANTARA 130MG CAPSULE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANTARA 43MG CAPSULE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANTIVERT 12.5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANTIVERT 25MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANTIVERT 50MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANTIZOL INJECTION 1GM 4 X 1.5ML VIAL CRTN 5 Tier 5. 33% N/A None\nANUSOL-HC 2.5% CREAM 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nANZEMET 100MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P Q:5\nANZEMET 20MG/ML VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nANZEMET 50MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P Q:5\nAPHTHASOL 5% PASTE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAPIDRA 100UNITS/ML VIAL 2 Tier 2 Preferred Brand $35.00 $87.50 None\nAPOKYN FOR INJECTION 30MG 5 CTG 5 Tier 5. 33% N/A None\nAPRI 0.15-0.03 TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:28\nAPTIVUS 250MG CAPSULE 5 Tier 5. 33% N/A None\nARALAST 1000MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nARALAST 500MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nARALEN PHOSPHATE 500MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nARANELLE 7-9-5 TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:28\nARANESP 100MCG/ML VIAL 5 Tier 5. 33% N/A P\nARANESP 200MCG/0.4ML SYRINGE 5 Tier 5. 33% N/A P\nARANESP 200MCG/ML VIAL 5 Tier 5. 33% N/A P\nARANESP 25MCG/ML VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% P\nARANESP 300MCG/ML VIAL 5 Tier 5. 33% N/A P\nARANESP 500MCG/1ML SYRINGE 5 Tier 5. 33% N/A P\nARANESP 60MCG/ML VIAL 5 Tier 5. 33% N/A P\nARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR 5 Tier 5. 33% N/A P\nARANESP PREFILLED SYRINGE SINGLE USE 25MCG/0.42ML SYR 4 Tier 4 Non-Specialty Injectable 33% 33% P\nARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR 5 Tier 5. 33% N/A P\nARANESP SINGLE USE PREFILLED AUTOINJECTOR SOLUTION 100MCG/.5ML 5 Tier 5. 33% N/A P\nARANESP SINGLE USE PREFILLED SURECLICK AUTOINJECTOR SOLUTION 500MCG/ML 5 Tier 5. 33% N/A P\nARANESP SINGLE USE PREFILLED SURECLIK AUTOINJECTOR 60MCG/.3ML 5 Tier 5. 33% N/A P\nARANESP SINGLE USE VIAL 150MCG 4 X 150MCG/ 0.75ML VIALSD 5 Tier 5. 33% N/A P\nARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD 5 Tier 5. 33% N/A P\nARAVA 10MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nARAVA 20MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nARCALYST INJECTION 220MG/VIAL 5 Tier 5. 33% N/A None\nAREDIA 30MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAREDIA 90MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nARICEPT 10MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nARICEPT 5MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nARICEPT ODT 10MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nARICEPT ODT 5MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nARIMIDEX 1MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 None\nARIXTRA 10MG SYRINGE 5 Tier 5. 33% N/A None\nARIXTRA 2.5MG SYRINGE 5 Tier 5. 33% N/A None\nARIXTRA 5MG SYRINGE 5 Tier 5. 33% N/A None\nARIXTRA 7.5MG SYRINGE 5 Tier 5. 33% N/A None\nAROMASIN 25MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 None\nARRANON 250MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nARTHROTEC 50 50MG TABLET -200MCG (60 CT) 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P\nARTHROTEC 75 TABLET EC 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P\nASACOL 400MG TABLET EC 2 Tier 2 Preferred Brand $35.00 $87.50 None\nASCOMP W/CODEINE 30-50-325 CAPSULE 1 Tier 1 Preferred Generic $9.00 $13.50 None\nASMANEX 220MCG(14) AEROSOL POWDER BREATH ACTIVATED 2 Tier 2 Preferred Brand $35.00 $87.50 None\nASMANEX TWISTHALER 220MCG #120 2 Tier 2 Preferred Brand $35.00 $87.50 None\nASMANEX TWISTHALER 220MCG #30 2 Tier 2 Preferred Brand $35.00 $87.50 None\nASMANEX TWISTHALER 220MCG #60 2 Tier 2 Preferred Brand $35.00 $87.50 None\nASTELIN 137MCG AEROSOL SPRAY W/PUMP 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nASTEPRO NASAL SPRAY 137 MCG/SPRY 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nASTRAMORPH-PF 0.5MG/ML VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nASTRAMORPH-PF 1MG/ML VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nATACAND 16MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nATACAND 32MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nATACAND 4MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nATACAND 8MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nATACAND HCT 16/12.5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nATACAND HCT 32/12.5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nATACAND HCT TABLETS 32;25MG;MG 90 TABLETS BOT 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nATAMET 1 Tier 1 Preferred Generic $9.00 $13.50 None\nATENOLOL 25MG TABLET (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nATENOLOL TABLET 100MG (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nATENOLOL TABLET USP 50MG (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 None\nATRIPLA TABLET 600MG/200MG 5 Tier 5. 33% N/A None\nATROPINE 0.05MG/ML SYRINGE 4 Tier 4 Non-Specialty Injectable 33% 33% None\nATROPINE 0.1MG/ML SYRINGE 4 Tier 4 Non-Specialty Injectable 33% 33% None\nATROVENT HFA AER 17MCG 2 Tier 2 Preferred Brand $35.00 $87.50 Q:39\nATROVENT NASAL SPRAY 0.03% 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:30\nATROVENT NASAL SPRAY 0.06% 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:15\nATTENUVAX VACCINE W/DILUENT 1 DOSE/0.5ML 2 Tier 2 Preferred Brand $35.00 $87.50 None\nAUGMENTIN 125 SUSPENSION 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:450\nAUGMENTIN 200MG/5ML SUSP 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:450\nAUGMENTIN 250 SUSPENSION 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:450\nAUGMENTIN 250 TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:60\nAUGMENTIN 250 TABLET CHEW 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:120\nAUGMENTIN 400MG/5ML SUSP 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:450\nAUGMENTIN 500MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:60\nAUGMENTIN 875MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:40\nAUGMENTIN ES-600 SUSPENSION 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:450\nAUGMENTIN XR 1000-62.5 TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:40\nAVALIDE 150-12.5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAVALIDE 300-12.5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAVALIDE 300-25MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAVANDAMET 2MG/1000MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:60\nAVANDAMET 2MG/500MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:120\nAVANDAMET 4MG/500MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:60\nAVANDAMET TABLET 4-1000MG 2 Tier 2 Preferred Brand $35.00 $87.50 Q:60\nAVANDARYL 4MG/1MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:60\nAVANDARYL 4MG/2MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:60\nAVANDARYL 4MG/4MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nAVANDARYL 8MG-2MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nAVANDARYL 8MG-4MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nAVANDIA 2MG TABLET 2 Tier 2 Preferred Brand $35.00 $87.50 Q:60\nAVANDIA 4MG TABLET (90 CT) 2 Tier 2 Preferred Brand $35.00 $87.50 Q:60\nAVANDIA 8MG TABLET (90 CT) 2 Tier 2 Preferred Brand $35.00 $87.50 Q:30\nAVAPRO 150MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAVAPRO 300MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAVAPRO 75MG TABLET (30 CT) 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAVASTIN 100MG/4ML VIAL 5 Tier 5. 33% N/A None\nAVASTIN 400MG/16ML VIAL 5 Tier 5. 33% N/A None\nAVELOX 400MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:21\nAVELOX ABC PACK 400MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:5\nAVELOX IV 400MG/250ML 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAVIANE 0.1-0.02 TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:28\nAVINZA 120MG CAPSULE MULTIPHASIC RELEASE 24 HR 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:60\nAVINZA 30MG CAPSULE MULTIPHASIC RELEASE 24 HR 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:60\nAVINZA 60MG CAPSULE MULTIPHASIC RELEASE 24 HR 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:60\nAVINZA 90MG CAPSULE MULTIPHASIC RELEASE 24 HR 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:60\nAVINZA CAPSULES EXTENDED RELEASE 45MG 100 BOTPL 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:60\nAVINZA CAPSULES EXTENDED RELEASE 75MG 100 BOTPL 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:60\nAVITA 0.025% CREAM 1 Tier 1 Preferred Generic $9.00 $13.50 Q:90\nAVODART 0.5MG SOFTGEL 2 Tier 2 Preferred Brand $35.00 $87.50 None\nAVONEX ADMIN PACK 30MCG SYR 5 Tier 5. 33% N/A P\nAVONEX ADMIN PACK 30MCG VL 5 Tier 5. 33% N/A P\nAXERT 12.5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:9\nAXERT 6.25MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:9\nAXID 150MG PULVULE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAXID 15MG/ML ORAL SOLUTION 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAXID NIZATIDINE CAPSULES 300MG (30 CT) 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAYGESTIN 5MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAZACTAM 1GM VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAZACTAM 2GM VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAZACTAM INJECTION 1GM 50ML BAG 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAZACTAM/ISO-OSMOT 2GM/50ML 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAZASAN 100MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P\nAZASAN 75MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 P\nAZATHIOPRINE 50MG TABLET 1 Tier 1 Preferred Generic $9.00 $13.50 P\nAZATHIOPRINE SOD 100MG VIAL 4 Tier 4 Non-Specialty Injectable 33% 33% P\nAZELEX 20% CREAM 30GM TUBE 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL 1 Tier 1 Preferred Generic $9.00 $13.50 Q:15\nAZITHROMYCIN 1G PACKET 1 Tier 1 Preferred Generic $9.00 $13.50 Q:2\nAZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL 1 Tier 1 Preferred Generic $9.00 $13.50 Q:46\nAZITHROMYCIN 250MG TABLET (30 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 Q:6\nAZITHROMYCIN 500MG TABLET (30 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 Q:3\nAZITHROMYCIN FOR INJECTION 500MG 10 VIALSD 4 Tier 4 Non-Specialty Injectable 33% 33% None\nAZITHROMYCIN TABLET 600MG (30 CT) 1 Tier 1 Preferred Generic $9.00 $13.50 Q:8\nAZMACORT AER 75MCG 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 Q:40\nAZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAZOR 10MG-20MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAZOR 10MG-40MG TABLET (30 CT) 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAZOR 5MG-20MG TABLET (30 CT) 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAZOR 5MG-40MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAZULFIDINE 500MG TABLET 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nAZULFIDINE EN TABLET S 500MG TABLET 6 X (300 CT)PL 3 Tier 3 Non-Preferred Brand or Generic $75.00 $187.50 None\nBelow are a few notes to help you understand the above 2009 Medicare Part D Blue MedicareRx Premier Plan Formulary.


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