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World File Search SystemACULAR
附录B-申请人排序的产品名称
ACULAR LS, KETOROLAC TROMETHAMINE ACULAR, KETOROLAC TROMETHAMINE ACUVAIL, KETOROLAC TROMETHAMINE ACZONE, DAPSONE ALPHAGAN P, BRIMONIDINE TARTRATE AVYCAZ, AVIBACTAM SODIUM CANASA, MESALAMINE CARAFATE, SUCRALFATE CELEXA, CITALOPRAM HYDROBROMIDE COMBIGAN, BRIMONIDINE TARTRATE CRINONE, PROGESTERONE CYCLOSPORINE, CYCLOSPORINE DALVANCE, DALBAVANCIN HYDROCHLORIDE DEPAKOTE ER, DIVALPROEX SODIUM DEPAKOTE, DIVALPROEX SODIUM DUOPA, CARBIDOPA DURYSTA, BIMATOPROST FETZIMA, LEVOMILNACIPRAN HYDROCHLORIDE FML FORTE, FLUOROMETHOLONE FML, FLUOROMETHOLONE GENGRAF, CYCLOSPORINE KALETRA, LOPINAVIR KYBELLA, DEOXYCHOLIC ACID LASTACAFT, ALCAFTADINE (OTC) LATISSE, BIMATOPROST LEXAPRO, ESCITALOPRAM OXALATE LINZESS, LINACLOTIDE LUMIGAN, BIMATOPROST MAVYRET, GLECAPREVIR NAMENDA, MEMANTINE HYDROCHLORIDE
ump（arrayrx）首选药物清单（PDL）2025
抗糖尿病层1- acarbose tab（previv）β阻滞剂1- acebutolol cap（Acebutolol Cap（e e e epiv）镇痛药 - 阿片类药物2 QL乙酰氨基酚/咖啡因/咖啡因/咖啡因/二氢可源性drocoseine tabs/for for 20或for for 20或for for 20或for for 20或for 20年龄; 90 days) ANALGESICS - OPIOID Tier 1 QL acetaminophen/codeine tab (TYLENOL/CODEINE equiv) (QL= 18 tabs/fill for members age 20 or younger; QL= 42 tabs/fill for members age 21 or older; Day supply limit of 42 days in 90 days) MIGRAINE PRODUCTS Tier 1 - acetaminophen/isometheptene/dichloral cap (MIDRIN equiv) MIGRAINE PRODUCTS Tier 2 - ACETAMINOPHEN/ISOMETHEPTENE/DICHLORAL CAP DIURETICS Tier 1 - acetazolamide ER cap (DIAMOX SEQUEL equiv) DIURETICS Tier 1 - acetazolamide tab OTIC AGENTS Tier 1 - acetic acid otic soln (VOSOL equiv) OTIC AGENTS Tier 1 - ACETIC ACID/ALUMINUM ACETATE OTIC SOLN COUGH/COLD/ALLERGY第1层 - 乙酰半胱氨酸溶液（Mucomyst Equiv）皮肤病学层2型抗凝集素帽（Soriatane Equiv）（阶梯疗法）需要对Adapalene，Adapalene/Adapalene/Adapalene/Benzoyl过氧化物或维美替诺蛋白）进行试验。Tier 2专业LD-PA ACTHAR HP凝胶ING（仅通过Accredo 800-803-2523或Walgreens 888-347-3416）内分泌和代谢剂 - Misc。Tier 2专业LD-PA Acthar Inj 80unit（仅通过认证800-803-2523或Walgreens 888-347-3416）咳嗽/冷/冷/过敏2 Ql actier 2 ql actier液体液体（Ql = 1200ml/30天） Acuvail Ophth Soln抗病毒药层1-阿塞克洛维尔帽（Zovirax equiv）皮肤病学系列2- acyclovir Cream（Zovirax equiv）