VISN 2 FORMULARY LIST June-97 VISN-2 VA CLASSIFICATION: FORMULARY RESTRICTIONS* PRIMARY DRUG NAME: CLASS *(ITEMS MAY BE FURTHER RESTRICTED BY LOCAL P&T COMMITTEES) CLASS-I OPEN FORMULARY CLASS-II FORMULARY WITH RESTRICTIONS CLASS-III NON FORMULARY VA CLASSIFICATION: AD100 ALCOHOL DETERRENTS DISULFIRAM CLASS-I VA CLASSIFICATION: AD200 CYANIDE ANTIDOTES METHYLENE BLUE CLASS-I CYANIDE ANTIDOTE KIT CLASS-I VA CLASSIFICATION: AD300 HEAVY METAL ANTAGONISTS DEFEROXAMINE CLASS-I DIMERCAPROL CLASS-I EDETATE CALCIUM DISODIUM CLASS-I VA CLASSIFICATION: AD400- ANTIDOTES, DETERRENTS AND POISON CONTROL EXCHANGE RESINS SODIUM POLYSTYRENE SULFONATE CLASS-I VA CLASSIFICATION: AD900 ANTIDOTES/DETERRENTS, OTHER CHARCOAL ACTIVATED WITH SORBITOL CLASS-I CHARCOAL LIQUID CLASS-I DEXTRAN-I CLASS-I DIGOXIN IMMUNE FAB 40MG/VIAL CLASS-I FLUMAZENIL CLASS-I LOCAL INSECT STING KIT CLASS-I MESNA INJECTION CLASS-I NICOTINE POLACRILEX CLASS-I NICOTINE TRANSDERMAL SYSTEM CLASS-I PRALIDOXIME CLASS-I VA CLASSIFICATION: AH100 ANTIHISTAMINES, PHENOTHIAZINE PROMETHAZINE CLASS-I VA CLASSIFICATION: AH200 ANTIHISTAMINES, ETHANOLAMINE DIMENHYDRINATE CLASS-I DIPHENHYDRAMINE CLASS-III VA CLASSIFICATION: AH400 ANTIHISTAMINES,ALKYLAMINE CHLORPHENIRAMINE CLASS-I CHLORPHENIRAMINE SUSTAINED RELEASE CLASS-I VA CLASSIFICATION: AH500 ANTIHISTAMINES, PIPERAZINE HYDROXYZINE CLASS-I VA CLASSIFICATION: AH600 ANTIHISTAMINES, BUTROPHENONE TERFENADINE CLASS-I VA CLASSIFICATION: AH700 ANTIHISTAMINES, PIPERIDINE CYPROHEPTADINE CLASS-I VA CLASSIFICATION: AM051 PENCILLIN-G RELATED PENICILLINS PENICILLIN G BENZATHINE CLASS-I PENICILLIN G POTASSIUM CLASS-I PENICILLIN G PROCAINE CLASS-I PENICILLIN G SODIUM CLASS-I PENICILLIN V POTASSIUM CLASS-I VA CLASSIFICATION: AM052 PENICILLINS, AMINO DERIVATIVES AMOXICILLIN CLASS-I AMOXICILLIN/CLAVULANATE CLASS-I LOCAL AMPICILLIN INJECTION CLASS-I AMPICILLIN/SULBACTAM CLASS-I LOCAL APPLY VA CLASSIFICATION: AM053 PENICILLINASE-RESISTANT PENICILLINS DICLOXACILLIN CLASS-I NAFCILLIN CLASS-I VA CLASSIFICATION: AM054 EXTENDED SPECTRUM PENICILLINS MEZLOCILLIN CLASS-III PIPERACILLIN CLASS-I PIPERACILLIN/TAZOBACTAM CLASS-I LOCAL TICARCILLIN/CLAVULANATE CLASS-II LOCAL VA CLASSIFICATION: AM101 CEPHALOSORIN 1ST GENERATION CEFAZOLIN CLASS-I CEPHRADINE CLASS-III CEPHALEXIN CLASS-I VA CLASSIFICATION: AM102 CEPHALOSPORIN 2ND GENERATION CEFACLOR CLASS-II LOCAL CEFOTETAN CLASS-I LOCAL CEFPODOXIME CLASS-I CEFUROXIME CLASS-I LOCAL CEFOXITIN CLASS-II LOCAL VA CLASSIFICATION: AM103 CEPHALOSPORIN 3RD GENERATION CEFOTAXIME CLASS-I CEFTAZIDIME CLASS-I CEFTRIAXONE CLASS-I CEFIPIME CLASS-II LOCAL CEFIXIME CLASS-II LOCAL VA CLASSIFICATION: AM130 BETA-LACTAM ANTIMICROBIALS,OTHER AZTREONAM CLASS-I CILASTATIN/IMIPENEM CLASS-I LOCAL VA CLASSIFICATION: AM150 CHLORAMPHENICOL CHLORAMPHENICOL CLASS-I VA CLASSIFICATION: AM200 ERYTHROMYCINS/MACROLIDES AZITHROMYCIN CLASS-I LOCAL CLARITHROMYCIN CLASS-I LOCAL ERYTHROMYCIN BASE CLASS-I ERYTHROMYCIN ETHYLSUCCINATE CLASS-I ERYTHROMYCIN LACTOBIONATE CLASS-I VA CLASSIFICATION: AM250 TETRACYCLINES DOXYCYCLINE ORAL CLASS-I Oral is formulary Injectable-restr. DOXYCYCLINE INJ CLASS-II TETRACYCLINE CLASS-I DEMECLOCLYCLINE CLASS-I MINOCYCLINE CLASS-II ID Restriction VA CLASSIFICATION: AM300 AMINOGLYCOSIDES AMIKACIN CLASS-I LOCAL GENTAMICIN CLASS-I NEOMYCIN CLASS-I NEOMYCIN/POLYMYXIN B CLASS-I STREPTOMYCIN CLASS-I LOCAL TOBRAMYCIN CLASS-I LOCAL KANAMYCIN INJ CLASS-II VA CLASSIFICATION: AM350 LINCOMYCINS CLINDAMYCIN CLASS-I VA CLASSIFICATION: AM500 ANTITUBERCULARS ETHAMBUTOL CLASS-I ISONIAZID CLASS-I PYRAZINAMIDE CLASS-I RIFAMPIN CLASS-I CAPREOMYCIN CLASS-II CYCLOSERINE CLASS-II ETHIONAMIDE CLASS-II ISONIAZID/RIFAMPINE CLASS-II VA CLASSIFICATION: AM550 METHENAMINE SALTS ANTIMICROBIALS METHENAMINE CLASS-I VA CLASSIFICATION: AM600 NITROFURANS ANTIMICROBIALS NITROFURANTOIN CLASS-I VA CLASSIFICATION: AM650 SULFONAMIDE/RELATED ANTIMICROBIALS SULFAMETHOXAZOLE/TRIMETHOPRIM CLASS-I SULFADIAZINE ORAL CLASS-II VA CLASSIFICATION: AM700 ANTIFUNGALS AMPHOTERICIN-B CLASS-II ID RESTR LOCAL AMPHOTERICIN-B LYPOSOMAL CLASS-II ID RESTR FLUCONAZOLE CLASS-II LOCAL FLUCYTOSINE CLASS-II LOCAL GRISEOFULVIN CLASS-I ITRACONAZOLE CLASS-II LOCAL* KETOCONAZOLE CLASS-II LOCAL NYSTATIN CLASS-I TERBINIFINE CLASS-II LOCAL* *EXLUDES ONYCHOMYCOSIS TX VA CLASSIFICATION: AM800 ANTIVIRALS ACYCLOVIR ORAL CLASS-I LOCAL ACYCLOVIR INJ CLASS-II LOCAL ADENINE ARABINOSIDE INJ CLASS-III AMANTADINE CLASS-I OR CLASS III CLASS-III ANTIVIRAL... CLASS I ANTIPARKINSON ATOVAQUONE CLASS-I LOCAL CIDOFIVIR CLASS-II DIDANOSINE CLASS-I LOCAL FAMICICYLOVIR CLASS-II LOCAL FOSCARNET INJ CLASS II CMV FOSCARNET OCULAR IMPLANT CLASS II LOCAL GANCICLOVIR INJ CLASS-II CMV GANCICLOVIR ORAL CLASS-II SEVERE RESTRICTIONS APPLY GANCICLOVIR OCULAR IMPLANT CLASS-II INDINAVIR CLASS-I LOCAL LAMIVUDINE CLASS-II NELFINAVIR CLASS-II RIMANTIDINE CLASS-I LOCAL RITONAVIR CLASS-II SAQUINAVIR CLASS-I LOCAL STAVUDINE CLASS-I LOCAL VIDARABINE CLASS-I LOCAL VALCICLOVIR CLASS-III ZALCITABINE CLASS-I LOCAL ZIDOVUDINE CLASS-I LOCAL VA CLASSIFICATION: AM900 ANTI-INFECTIVES,OTHER BACITRACIN INJ. CLASS-I CIPROFLOXACIN INJECTION CLASS-I LOCAL CIPROFLOXACIN ORAL CLASS-II CLOFAZIMINE CLASS-II DAPSONE CLASS-I LOMEFLOXACIN CLASS-II METRONIDAZOLE CLASS-I NALIDIXIC ACID CLASS-III OFLOXACIN CLASS-I PENTAMIDINE CLASS-II POLYMYXIN B CLASS-I RIFABUTIN CLASS-I LOCAL VANCOMYCIN CLASS-I VA CLASSIFICATION: AN100 ANTINEOPLASTICS,ALKYLATING AGENTS BUSULFAN CLASS-I CARMUSTINE CLASS-I CHLORAMBUCIL CLASS-I CYCLOPHOSPHAMIDE CLASS-I IFOSFAMIDE . CLASS-I IFOSFAMIDE/MESNA INJ CLASS-II LOMUSTINE CLASS-I MECHLORETHAMINE CLASS-I MELPHALAN CLASS-I MESNA INJ. CLASS-I THIOTEPA CLASS-I URACIL MUSTARD CLASS-II VA CLASSIFICATION: AN200 ANTINEOPLASTIC ANTIBIOTICS BLEOMYCIN CLASS-I DACTINOMYCIN CLASS-I DAUNORUBICIN CLASS-I DOXORUBICIN CLASS-I IDARUBICIN CLASS-II MITHRAMYCIN CLASS-III MITOMYCIN CLASS-II PLICAMYCIN CLASS-I STREPTOZOCIN CLASS-II VA CLASSIFICATION: AN300 ANTINEOPLASTICS,ANTIMETABOLITES CLADRIBINE CLASS-II CYTARABINE CLASS-I FLOXURIDINE CLASS-I FLUDARABINE CLASS-I FLUOROURACIL CLASS-I HYDROXYUREA CLASS-I MERCAPTOPURINE CLASS-II METHOTREXATE CLASS-I THIOGUANINE CLASS-II VA CLASSIFICATION: AN400 ANTINEOPLASTIC ADJUVANTS LEVAMISOLE CLASS-II L-LEUCOVORIN CLASS-I VA CLASSIFICATION: AN500 ANTINEOPLASTIC HORMONES GOSERELIN ACETATE CLASS-II PROSTATE GDL LEUPROLIDE ACETATE CLASS-III TAMOXIFEN CLASS-I TESTOLACTONE CLASS-II VA CLASSIFICATION: AN700 PROTECTANTS DEXRAZOXANE CLASS-II VA CLASSIFICATION: AN900 ANTINEOPLASTIC,OTHER AZACYTIDINE CLASS-II ALL TRANS RETINOIC ACID CLASS-II AMIFOSTINE CLASS-II ASPARAGINASE INJECTION CLASS-I BCG, TICE CLASS-II BCNU CLASS-II CARBOPLATIN CLASS-I CISPLATIN CLASS-I DACARBAZINE CLASS-I DEOXYCORFOMYCIN CLASS-II ESTRAMUSTINE CLASS-II ETOPOSIDE CLASS-I FLUDARABINE CLASS-II FLUTAMIDE CLASS-II PROSTATE GDL GEMCITABINE CLASS-II HEXAMETHYLAMINE CLASS-III IDARUBICIN CLASS-II INTERLEULIN-2 CLASS-II IRINOTECAN CLASS-II L-ASPARAGINASE CLASS-II PACLITAXEL CLASS-II PENTOSTATIN/MANNITOL CLASS-II STREPTOZOTOCIN CLASS-II TAXOTERE CLASS-II TENIPOSIDE CLASS-II TOPOTECAN CLASS-II TRIMEXATE CLASS-II PROCARBAZINE CLASS-I VINBLASTINE CLASS-I VINCRISTINE CLASS-I VINORELBINE CLASS-I All Class-II drugs above are restricted to local Hematologists or Oncologists VA CLASSIFICATION: AP101 ANTIMALARIALS HYDROXYCHLOROQUINE CLASS-I QUININE CLASS-III PRIMAQUINE CLASS-I PYRAMETHAMIDE CLASS-I VA CLASSIFICATION: AP109 ANTIPROTOZOALS,OTHER ATOVAQUONE CLASS-II PENTAMIDINE ISETHIONATE CLASS-I LOCAL VA CLASSIFICATION: AP200 ANTIHELMINTHICS ALBENDAZOLE CLASS-I MEBENDAZOLE CLASS-I THIABENDAZOLE CLASS-I Class II agents above are restricted to local infectious disease specialists or locally developed policies. VA CLASSIFICATION: AP300 PEDICULICIDES LINDANE CLASS-I VA CLASSIFICATION: AP900 ANTIPARASITICS,OTHER PERMETHRIN CLASS-I VA CLASSIFICATION: AS000 ANTISEPTICS/DISINFECTANTS AMPHYL CLASS-I BENZOYL PEROXIDE CLASS-I FORMALDEHYDE CLASS-I ISOPROPYL ALCOHOL CLASS-I POVIDONE IODINE CLASS-I SOD. HYPOCHLORITE CLASS-I VA CLASSIFICATION: AU100 SYMPATHOMIMETICS (ADRENERGICS) DOBUTAMINE CLASS-I DOPAMINE CLASS-I EPHEDRINE CLASS-I EPINEPHRINE CLASS-I ISOPROTERENOL CLASS-I METARAMINOL BITARTRATE CLASS-III METHOXAMINE HYDROCHLORIDE CLASS-I NOREPINEPHRINE CLASS-I PHENYLEPHRINE CLASS-I TERBUTALINE CLASS-I VA CLASSIFICATION: AU200 SYMPATHOLYTICS PHENOXYBENZAMINE CLASS-I PHENTOLAMINE CLASS-I VA CLASSIFICATION: AU300 PARASYMPATHOMIMETICS (CHOLINERGICS) BETHANECHOL CLASS-I EDROPHONIUM CLASS-I METOCLOPRAMIDE CLASS-I NEOSTIGMINE CLASS-I PHYSOSTIGMINE CLASS-I PILOCARPINE ORAL CLASS-I PYRIDOSTIGMINE CLASS-I PYRIDOSTIGMINE SUSTAINED RELEASE CLASS-I VA CLASSIFICATION: AU350 (PARASYMPATHOLYTICS) ATROPINE CLASS-I BENZTROPINE CLASS-I BIPERIDEN LACTATE CLASS-III DICYCLOMINE CLASS-I GLYCOPYRROLATE CLASS-III SCOPOLAMINE CLASS-I TRIHEXYPHENIDYL CLASS-I VA CLASSIFICATION: AU900 (AUTONOMIC AGENTS,OTHER) BROMOCRIPTINE CLASS-I VA CLASSIFICATION: BL100 (ANTICOAGULANTS) DELTAPARIN CLASS-II Restricted to ENOXAPARIN INJECTION CLASS-II Outpatient DVT Treatment and not Inpatient prophylaxis HEPARIN CLASS-I WARFARIN CLASS-I VA CLASSIFICATION: BL200 HEPARIN ANTAGONISTS PROTAMINE SULFATE CLASS-I VA CLASSIFICATION: BL300 ANTIHEMORRHAGICS AMINOCAPROIC ACID CLASS-I THROMBIN CLASS-I VA CLASSIFICATION: BL400 ANTIHEMORRHAGICS EPOETIN ALPHA,RECOMBINANT CLASS-I FERROUS SULFATE CLASS-I FERROUS GLUCONATE CLASS-I VA CLASSIFICATION: BL500-BLOOD DERIVATIVES ALBUMIN CLASS-I FACTOR IX COMPLEX (HUMAN) INJ. CLASS-II Indication Specific PLASMA PROTEIN FRACTION CLASS-I VA CLASSIFICATION: BL600 THROMBOLYTICS ALTEPLASE CLASS-II LOCAL STREPTOKINASE CLASS-II LOCAL UROKINASE CLASS-II LOCAL VA CLASSIFICATION: BL700 PLATELET AGGREGATION INHIBITORS ABCIXIMAB CLASS-II High risk PT* -PTCA s/p non q MI -2 type B lesions -1 type B lesion in woman> 65 -1 type B lesion in diabetic -1 type C lesion -degenerated bypass graft DIPYRIDAMOLE CLASS-I Patients ineligible for warfarin TICLOPIDINE CLASS-I Patients who have failed low-high dose ASA Tx VA CLASSIFICATION: BL800 -VOLUME EXPANDERS DEXTRAN 40/DEXTROSE CLASS-I DEXTRAN 40/SODIUM CHLORIDE CLASS-I DEXTRAN 75/DEXTROSE CLASS-I DEXTRAN 75/SODIUM CHLORIDE CLASS-I HETASTARCH CLASS-I VA CLASSIFICATION: CN101 -OPIOID ANALGESICS ALFENTANIL CLASS-II See Below^ ACETAMINOPHEN/CODEINE CLASS-I ACETAMINOPHEN/OXYCODONE CLASS-I ASPIRIN/OXYCODONE CLASS-III BELLADONNA/OPIUM CLASS-I BUPRENORPHINE HCL CLASS-I BUTORPHANOL CLASS-I CODEINE CLASS-I DROPERIDOL/FENTANYL CLASS-I FENTANYL CLASS-I FENTANYL TRANSDERMAL CLASS-I HYDROMORPHONE CLASS-I MEPERIDINE CLASS-I METHADONE CLASS-I MORPHINE CLASS-I MORPHINE CONTROLLED RELEASE CLASS-I NALBUPHINE CLASS-III OXYCODONE CLASS-II LOCAL PAIN GUIDELINES OXYCODONE/ACETAMINOPHEN CLASS-I OXYCODONE/ASA CLASS-II PENTAZOCINE NX CLASS-III PROPOXYPHENE HYDROCHLORIDE CLASS-III PROPOXYPHENE NAPSYLATE CLASS-I PROPOXYPHENE NAPSYLATE/APAP CLASS-III REMIFENTANYL CLASS-II See Below^ SUFENTANIL CLASS-II Local Pain Guidelines ^After trial of other CN101;CN102 formulary drugs VA CLASSIFICATION: CN102 LEVOMETHADYL CLASS-II See Above^ NALOXONE CLASS-I NALTREXONE CLASS-II VAWNYHS VA CLASSIFICATION: CN103 NON-OPIOID ANALGESICS ACETAMINOPHEN CLASS-I ACETAMINOPHEN/BUTALBITAL/CAFFEINE CLASS-I ASPIRIN CLASS-I ASPIRIN, ALUMINA & MAGNESIA CLASS-I ASPIRIN/BUTALBITAL/CAFFEINE CLASS-I ASPIRIN (BUFFERED) CLASS-I CHOLINE SALICYLATE/MAG. SALIC. CLASS-I KETOROLAC CLASS-II 5 days Tx CN104 NON-STEROIDAL ANTI-INFLAMMATORY DRUGS OXAPROZIN CLASS-III VA CLASSIFICATION: CN105 ANTIMIGRAINE AGENTS DIHYDROERGOTAMINE CLASS-I ERGOTAMINE CLASS-I ERGOTAMINE/CAFFEINE CLASS-I ISOMETHEPENE/DICHLORALPHEN/APAP CLASS-II DESI DRUG METHYSERGIDE CLASS-I SUMATRIPTAN CLASS-II LOCAL VA CLASSIFICATION: CN201 ANESTHETICS,INHALATION DESFLURANE CLASS-I ENFLURANE CLASS-I HALOTHANE CLASS-I ISOFLURANE CLASS-I PENTHRANE CLASS-I VA CLASSIFICATION: CN202 BARBITURIC ACID DERIVATIVE ANESTHETICS METHOHEXITAL CLASS-I THIOPENTAL CLASS-I VA CLASSIFICATION: CN203 GENERAL ANESTHETICS,OTHER ETOMIDATE CLASS-I KETAMINE CLASS-I PROPOFOL CLASS-I VA CLASSIFICATION: CN204 LOCAL ANESTHETICS,INJECTION BUPIVACAINE CLASS-I BUPIVACAINE/EPINEPHRINE CLASS-I EPINEPHRINE/ETIDOCAINE CLASS-I EPINEPHRINE/LIDOCAINE CLASS-I LIDOCAINE CLASS-I LIDOCAINE W/ EPINEPHRINE CLASS-I MEPIVACAINE CLASS-I MEPIVACAINE/LEVONORD CLASS-III PRILOCAINE W/EPI CLASS-III PROCAINE CLASS-I TETRACAINE CLASS-I VA CLASSIFICATION: CN205 ANESTHETIC ADJUNCTS ATROPINE/NEOSTIGMINE CLASS-I DROPERIDOL CLASS-I VA CLASSIFICATION: CN300 SEDATIVES/HYPONTICS VODKA CLASS-III WINE, SHERRY CLASS-III VA CLASSIFICATION: CN301 BARBITURIC ACID DERIVATIVE SEDATIVES/HYPNOTICS PHENOBARBITAL CLASS-I VA CLASSIFICATION: CN302 BENZODIAZEPINE DERIVATIVE SEDATIVES/HYPNOTICS ALPRAZOLAM CLASS-I DIAZEPAM CLASS-I CHLORDIAZEPOXIDE CLASS-II Patients not candidates for other benzos. LORAZEPAM CLASS-I MIDAZOLAM CLASS-I LOCAL TEMAZEPAM CLASS-I VA CLASSIFICATION: CN309 SEDATIVES/HYPNOTICS,OTHER BUSPIRONE CLASS-I CHLORAL HYDRATE CLASS-I ZOLPIDEM CLASS-II SHORT TERM TX, NO REFILLS VA CLASSIFICATION: CN400 ANTICONVULSANTS CARBAMAZEPINE CLASS-I CLONAZEPAM CLASS-I DIVALPROEX CLASS-I ETHOSUXIMIDE CLASS-III FELBAMATE CLASS-I FOSPHENYTOIN CLASS-II TO BE USED ONLY WHEN ALL SOURCES OF IV PHENYTOIN ARE UNAVAILABLE. GABAPENTIN CLASS-I LAMOTRIGINE CLASS-I MEPHENYTOIN CLASS-I PHENYTOIN CLASS-I PHENYTOIN CHEWABLE TABLETS CLASS-I PHENYTOIN EXTENDED CLASS-I PRIMIDONE CLASS-I TOPRIMATE CLASS-II Neurology VALPROIC ACID CLASS-I VA CLASSIFICATION: CN500 ANTIPARKINSON AGENTS CARBIDOPA/LEVODOPA CLASS-I CARBIDOPA/LEVODOPA CR CLASS-I LEVODOPA CLASS-I PERGOLIDE CLASS-I SELEGILINE CLASS-I VA CLASSIFICATION: CN550 ANTIVERTIGO AGENTS MECLIZINE CLASS-I VA CLASSIFICATION: CN601 TRICYCLIC ANTIDEPRESSANTS AMITRIPTYLINE CLASS-I CLOMIPRAMINE CLASS-I DESIPRAMINE CLASS-I DOXEPIN CLASS-I IMIPRAMINE HYDROCHLORIDE CLASS-I IMIPRAMINE PAMOATE CLASS-I NORTRIPTYLINE CLASS-I VA CLASSIFICATION: CN602 MONAMINE OXIDASE INHIBITOR ANTIDEPRESSANTS PHENELZINE SULFATE CLASS-I TRANYLCYPROMINE CLASS-I VA CLASSIFICATION: CN609 ANTIDEPRESSANTS, OTHER BUPROPION CLASS-I FLUOXETINE CLASS-I NEFAZODONE CLASS-I PAROXETINE CLASS-I SERTRALINE CLASS-I TRAZODONE CLASS-I VENLAFAXINE CLASS-I VA CLASSIFICATION: CN701 PHENOTHIAZINE/RELATED ANTIPSYCHOTICS CHLORPROMAZINE CLASS-I FLUPHENAZINE DECANOATE CLASS-I FLUPHENAZINE HYDROCHLORIDE CLASS-I PERPHENAZINE CLASS-I THIORIDAZINE CLASS-I THIOTHIXENE CLASS-I TRIFLUOPERAZINE CLASS-I VA CLASSIFICATION: CN709 ANTIPSYCHOTICS,OTHER CLOZAPINE CLASS-I HALOPERIDOL CLASS-I LOXAPINE CLASS-I ALT. THERAPY MOLINDONE CLASS-I ALT. THERAPY RISPERIDONE CLASS-II VISN GUIDELINES OLANZEPINE CLASS-II VISN GUIDELINES VA CLASSIFICATION: CN750 LITHIUM SALTS LITHIUM CLASS-I VA CLASSIFICATION: CN801 AMPHETAMINES DEXTROAMPHETAMINE CLASS-I VA CLASSIFICATION: CN802 AMPHETAMINE LIKE STIMULANTS METHYLPHENIDATE CLASS-I VA CLASSIFICATION: CN809 CNS STIMULANTS,OTHER CAFFEINE & SODIUM BENZOATE CLASS-I PEMOLINE CLASS-I VA CLASSIFICATION: CN900 CNS MEDICATIONS,OTHER AMITRIPTYLINE/PERPHENAZINE CLASS-I ERGOLOID MESYLATES CLASS-I TACRINE CLASS-II LOCAL Protocols DONEPEZIL CLASS-II Neurology or other locally approved providers PIMOZIDE CLASS-II Tourette's Synd. VA CLASSIFICATION: CV050 DIGITALIS GLYCOSIDES DIGOXIN CLASS-I VA CLASSIFICATION: CV100 BETA BLOCKERS/RELATED ACEBUTOLOL CLASS-III ATENOLOL CLASS-I BETAXOLOL CLASS-III ESMOLOL CLASS-I LABETOLOL TABLETS CLASS-III LABETALOL INJECTION CLASS-I METOPROLOL CLASS-I METOPROLOL 12.5&6.25MG CAPS CLASS-III METOPROLOL SR CAPS CLASS-III NADOLOL CLASS-I PENBUTOLOL CLASS-III PINDOLOL CLASS-III PROPRANOLOL CLASS-I PROPRANOLOL LA CAPS CLASS-III VA CLASSIFICATION: CV150 ALPHA BLOCKERS/RELATED DOXAZOSIN CLASS-III Therapeutic Intch->Teraz PRAZOSIN CLASS-I TERAZOSIN CLASS-I VA CLASSIFICATION: CV200 CALCIUM CHANNEL BLOCKERS AMLODIPINE CLASS-II CHF+LVEF <35% restrictions-> or ADRs/ FAILUES TO OTHER CCB DILTIAZEM CLASS-I DILTIAZEM CD CLASS-I FELODIPINE CLASS-I ISRADIPINE CLASS-III NICARDIPINE CLASS-III NIFEDIPINE EXTENDED RELEASE CLASS-I VERAPAMIL CLASS-I VERAPAMIL SUST REL CLASS-I VA CLASSIFICATION: CV250 ANTIANGINALS AMYL NITRATE CLASS-I CYANIDE ANTIDOTE ISOSORBIDE DINITRATE CLASS-I ISOSORBIDE DINITRATE SR CLASS-I ISOSORBIDE MONONITRATEE CLASS-III NITROGLYCERIN CLASS-I PENTAERYTHRITOL CLASS-III VA CLASSIFICATION: CV300 ANTIARRHYTHMICS ADENOSINE INJ CLASS-I AMIODARONE CLASS-I BRETYLIUM CLASS-I DISOPYRAMIDE CLASS-I LIDOCAINE CLASS-I MEXILETINE CLASS-I PROCAINAMIDE CLASS-I PROPAFENONE CLASS-III QUINIDINE GLUCONATE CLASS-I QUINIDINE SULFATE CLASS-I TOCAINIDE CLASS-III VA CLASSIFICATION: CV350 ANTILIPEMIC AGENTS ATORVASTATIN TABLETS CLASS-III CHOLESTYRAMINE CLASS-III GEMFIBROZIL CLASS-I FLUVASTATIN CLASS-III PRAVASTATIN CLASS-III LOVASTATIN CLASS-I SIMVASTATIN CLASS-I COLESTIPOL CLASS-I OMEGA 3 FATTY ACIDS CLASS-I VA CLASSIFICATION: CV490 ANTIHYPERTENSIVES,OTHER CLONIDINE CLASS-I CLONIDINE TD PATCH CLASS-II PTS WHO CANNOT USE ORAL CLON. GUANABENZ CLASS-III GUANFACINE CLASS-III HYDRALAZINE CLASS-I MECAMYALAMINE CLASS-III METHYLDOPATE CLASS-I SODIUM NITROPRUSSIDE CLASS-I RESERPINE CLASS-III VA CLASSIFICATION: CV500 PERIPHERAL VASODILATORS PAPAVERINE CLASS-III PAPAVERINE SUSTAINED RELEASE CLASS-III VA CLASSIFICATION: CV600 SCLEROSING AGENTS SODIUM TETRADECYL SULFATE CLASS-I VA CLASSIFICATION: CV701 THIAZIDES/RELATED DIURETICS CHLORTHALIDONE CLASS-I HYDROCHLOROTHIAZIDE CLASS-I INDAPAMIDE CLASS-II FAILURE TO OTHER CV750 DRUGS METOLAZONE CLASS-I VA CLASSIFICATION: CV702 LOOP DIURETICS BUMETANIDE CLASS-II FUROSEMIDE FAILURE ETHACRYNIC ACID CLASS-II FUROSEMIDE FAILURE FUROSEMIDE CLASS-I TORSEMIDE CLASS-III VA CLASSIFICATION: CV703 - CARBONIC ANHYDRASE INHIBITOR DIURETICS ACETAZOLAMIDE CLASS-I METHAZOLAMIDE CLASS-I VA CLASSIFICATION: CV704- POTASSIUM SPARING/COMBINATIONS DIURETICS AMILORIDE CLASS-III AMILORIDE/HCTZ CLASS-III SPIRONOLACTONE CLASS-I TRIAMTERENE CLASS-I TRIAMTERENE/HYDROCHLOROTHIAZIDE CLASS-I OTHER DIURETIC COMBINATIONS CLASS-III VA CLASSIFICATION: CV709 -DIURETICS,OTHER MANNITOL CLASS-I VA CLASSIFICATION: CV800 - ACE INHIBITORS CAPTOPRIL CLASS-I ENALAPRILAT CLASS-I FOSINOPRIL CLASS-I LISINOPRIL CLASS-I Second Line Treatment After Fosinopril And Captopril VA CLASSIFICATION: CV805 ANGIOTENSIN-II INHIBITORS LOSARTAN CLASS-II ACEI-ADRs OR ACEI-TX FAILURE VALSARTAN CLASS-III VA CLASSIFICATION: CV900 DERMATOLOGICAL AGENTS AMRINONE CLASS-I MILRINONE CLASS-I PENTOXYPHYLLINE CLASS-III VA CLASSIFICATION: DE100 ANTI-INFECTIVE,TOPICAL IODINE SOLUTION, STRONG CLASS-I PODOPHYLLIN CLASS-I SODIUM HYPOCHLORITE CLASS-I VA CLASSIFICATION: DE101 ANTIBACTERIAL,TOPICAL BACITRACIN OINT CLASS-I CHLORHEXIDINE TOP SOL CLASS-I GENTAMICIN CLASS-I HYDROGEN PEROXIDE CLASS-I IODOFORM GAUZE CLASS-I ISOPROPYL ALCOHOL CLASS-I MUPIROCIN CLASS-I POVIDONE IODINE CLASS-I SILVER SULFADIAZINE CLASS-I VA CLASSIFICATION: DE102 ANTIFUNGAL,TOPICAL AMPHOTERICIN B TOPICAL CLASS-I BENZOIC AND SALICYLIC ACID CLASS-I CASTELLANI'S PAINT BASIC FUCHIN/BORIC ACID/ RESORCINOL/ACETONE TOP CLASS-I CICLOPIROX OLAMINE CLASS-I CLIOQUINOL CLASS-I CLOTRIMAZOLE CLASS-I KETOCONAZOLE CLASS-I MICONAZOLE 2% TOP PWDR CLASS-I MICONAZOLE 2% TINCTURE CLASS-II Dermatology/Podiatry NAFTIFINE CLASS-I NYSTATIN CLASS-I OXICONAZOLE CLASS-I TERBINAFINE TOP CLASS-II Failure to clotrimazole TOLNAFTATE CLASS-I ZINC UNDECYLENATE CLASS-I VA CLASSIFICATION: DE103 ANTIVIRAL,TOPICAL ACYCLOVIR CLASS-I VA CLASSIFICATION: DE109 ANTI-INFECTIVE,TOPICAL,OTHER BACITRACIN-POLYMYXIN B CLASS-I GENTIAN VIOLET CLASS-I NEOMYCIN/POLYMYXIN B/BACITRACIN CLASS-I SODIUM HYPOCHLORITE TOP ADD VA CLASSIFICATION: DE200 ANTI-INFLAMMATORY,TOPICAL ALUMINUM ACETATE CLASS-I AMCINONIDE CLASS-I BETAMETHASONE CLASS-I LOCAL BUROWS SOLUTION CLASS-I CLOBETASOL CLASS-I LOCAL DESONIDE CLASS-I LOCAL DESOXIMETASONE CLASS-I LOCAL FLUOCINOLONE CLASS-I FLURANDRENOLIDE CLASS-I HALCINONIDE CLASS-I HYDROCORTISONE CLASS-I TRIAMCINOLONE CLASS-I VA CLASSIFICATION: DE300 SUN PROTECTANTS/SCREENS,TOPICAL SUNSCREENS CLASS-I VA CLASSIFICATION: DE350 EMOLLIENTS AMMONIUM LACTATE LOT CLASS-I AVEENO COLLOIDAL OATMEAL CLASS-I BATH OIL CLASS-I BODY LOTION CLASS-I CETAPHIL LOTION CLASS-I CONSTANT CARE CREAM CLASS-I EUCERIN CLASS-I HYDROPHILIC TOP OINT CLASS-I LACTIC ACID LOTION CLASS-I LANOLIN ANHYDROUS CLASS-I LANOLIN HYDROUS CLASS-I NIVEA SKIN OIL CLASS-I UREA CREAM CLASS-I VITAMIN A AND D OINT CLASS-I WHITE PETROLATUM CLASS-I VA CLASSIFICATION: DE400 SOAPS/SHAMPOOS AVEENOBAR SOAP CLASS-I CARA-KLENZ SKIN AND WOUND CLEANSER CLASS-I CASTILE SOAP CLASS-I HEXACHLOROPHENE CLASS-I NEUTRAGENA CLASS-I POVIDONE IODINE CLASS-I PYRITHIONE ZINC SHAMPOO CLASS-I SELENIUM SHAMPOO CLASS-I SOAP, SUPERFATTED CLASS-I VA CLASSIFICATION: DE450 DEODORANTS/ANTIPERSPIRANTS,TOPICAL ALUMINUM CHLORIDE SOL CLASS-I VA CLASSIFICATION: DE500 KERATOLYTICS/CAUSTICS,TOPICAL COAL TAR,SAL.AC./SULFUR TOP SHAMPO CLASS-I FLEXIBLE COLLOIDIUM CLASS-I PODOPHYLLUM RESIN CLASS-I SALICYLIC ACID CMPDS CLASS-I SALICYLIC ACID,SULFUR PREPS CLASS-I SILVER NITRATE CLASS-I TRICHLOROACETIC ACID CLASS-I VA CLASSIFICATION: DE600 ANTINEOPLASTIC,TOPICAL FLUOROURACIL 2% TOP SOL CLASS-II Dermatology/Podiatry FLUOROURACIL 5% CREAM CLASS-II " " FLUOROURACIL 5% TOP SOL CLASS-II " " VA CLASSIFICATION: DE650 ANALGESICS,TOPICAL ANALGESIC OINTMENT CLASS-I CAPSAICIN CREAM CLASS-I MENTHOL 10%/ME SAL 15% TOP CLASS-I VA CLASSIFICATION: DE700 LOCAL ANESTHETICS,TOPICAL ANESTHETIC THROAT SPRAY CLASS-I DIBUCAINE CLASS-I DYCLONINE 0.5% TOPICAL SOL CLASS-I ETHYL CHLORIDE CLASS-I FLUORI-METHANE TOP SPRAY CLASS-I LIDOCAINE CLASS-I PRAMOXINE CLASS-I TETRACAINE CLASS-I VA CLASSIFICATION: DE751 ANTI-ACNE AGENTS,SYSTEMIC ISOTRETINOIN CLASS-II Dermatology VA CLASSIFICATION: DE752 ANTIACNE AGENTS,TOPICAL BENZOYL PEROXIDE CLASS-I CLINDAMYCIN CLASS-I ERYTHROMYCIN CLASS-I METRONIDAZOLE CLASS-II DERMATOLOGY Dermatology SALICYLIC ACID 20% CLASS-II " " TETRACYCLINE TOP SOL CLASS-I TRETINOIN TOP CLASS-I VA CLASSIFICATION: DE800 ANTIPSORIATIC LCD COMPOUNDS CLASS-I VA CLASSIFICATION: DE 801 ANTIPSORIATIC, SYSTEMIC ETRETINATE ORAL CLASS-II Dermatology METHOXSALEN ORAL CLASS-II Dermatology VA CLASSIFICATION: DE802 ANTIPSORIATICS,TOPICAL ANTHRALIN CLASS-I CALCIPOTRIENE CLASS-I COAL TAR CLASS-I VA CLASSIFICATION DE890 ANTIPSORIATICS, SYSTEMIC TRIOXSALEN CLASS-II VA CLASSIFICATION: DE900 DERMATOLOGICALS,TOPICAL OTHER ALUMINUM ACETATE CLASS-I ALUMINUM SULF./CA. ACET. CLASS-I DOMEBORO TABS) AQUAPHOR OINT. CLASS-I BABY POWDER CLASS-I BENZOIN COMPOUND TINCTURE CLASS-I CADEXOMER CLASS-I CALAMINE LOTION CLASS-I CASTOR OIL/PERUVIAN BALSAM/TRYPSIN CLASS-I COCOA BUTTER CLASS-I COLLAGENASE CLASS-I CORNSTARCH CLASS-I DESOXYRIBONUCLEASE/FIBRINOLYSIN CLASS-I DEXTRANOMER CLASS-I FERRIC SUBSULFATE CLASS-I FUNGOID HC CLASS-I FUNGOID TINCTURE CLASS-I GRANULDERM CLASS-I HYDROQUINONE CREAM CLASS-I LANOLIN 5% CREAM CLASS-I LUBRICATING JELLY CLASS-I MAGNESIUM SULFATE CRYSTAL CLASS-I MEDICATED BODY LOTION CLASS-I METHOXSALEN TOP LIQ CLASS-II METHYLSALICYLATE OINTMENT 10% CLASS-I SORBSAN CLASS-I PERINEAL WASH CLASS-I SULITAINS OINT CLASS-I SPECTRA CLASS-I TALC CLASS-I THYMOL 4% CLASS-I TRIETHANOLAMINE SALICYLATE CREAM CLASS-I UREA CLASS-I WITCH HAZEL CLASS-I ZINC OXIDE CLASS-I VA CLASSIFICATION: DX000 DIAGNOSTIC AGENTS GLUCOSE ORAL SOL CLASS-I VA CLASSIFICATION: DX101 NON-IONIC CONTRAST MEDIA BARIUM CLASS-I INDOCYANINE GREENE INJ CLASS-I IODINE CLASS-I IOHEXOL CLASS-I IOPAMIDOL INJ CLASS-I IPODATE SODIUM CLASS-I METRIZAMIDE CLASS-I SINCALIDE CLASS-I VA CLASSIFICATION: DX102 IONIC CONTRAST MEDIA DIATRIZOATE MEGLUMINE CLASS-I DIATRIZOATE MEGLUMINE/ DIATRIZOATE SODIUM CLASS-I DIATRIZOATE SODIUM CLASS-I DIATRIZOATE/IODIPAMIDE CLASS-I IODIPAMIDE MEGLUMINE CLASS-I IOPANOIC ACID CLASS-I IOPHENDYLATE CLASS-I IOTHALAMATE CLASS-I VA CLASSIFICATION: DX300 DIAGNOSTIC ANTIGENS BENZYLPENICILLOYL POLYLYSINE CLASS-I CANDIDA (OIDIOMYCIN)1:100 SKIN TST CLASS-I COCCIDIOIDIN CLASS-I MUMPS SKIN TEST ANTIGEN CLASS-I HISTOPLASMIN CLASS-I TRICHOPHYTON 1:30 SKIN TEST ANTIGN CLASS-I TUBERCULIN PPD CLASS-I VA CLASSIFICATION: DX900 DIAGNOSTICS,OTHER BLOOD GLUCOSE MONITORING STRIP CLASS-I BENTIROMIDE CLASS-I BETAZOLE CLASS-I CHEMSTRIP 10 WITH SG(MULTI)TEST STRIP CLASS-I COSYNTROPIN CLASS-I DIASTIX (GLUCOSE) TEST STRIP CLASS-I GLUCOSE BLOOD TEST STRIPS CLASS-I GLUCOSE TOLERANCE TEST CLASS-I GONADORELIN CLASS-I HISTAMINE CLASS-I HYDRION CLASS-I CHEMSTRIP UGK (GLUCOSE,KETONE) TEST STRIP CLASS-I CLASS-II LOCAL INDIGOINDISULFONATE SODIUM . CLASS-I LACTOSE CLASS-I METYRAPONE CLASS-I MULTISTIX 10 SG MULTIPLE TEST STRIP CLASS-I PENTAGASTRIN CLASS-I PROTIRELIN CLASS-I SCHIRMER TEAR TEST CLASS-I SECRETIN CLASS-I THYROTROPIN CLASS-I URINE TEST STRIPS, GLUCOSE CLASS-III LOCAL XYLOSE CLASS-I pH TEST CLASS-I VA CLASSIFICATION GA 101 ALUMINUM CONTAINING ANTACIDS ALUMINUM HYDROXIDE GEL VA CLASSIFICATION GA 103 ALUMIINUM/MAGNESIUM ANTACIDS ALGINIC AC/ALOH/CA STEAR/MG TRI CHEW ORAL CLASS-I VA CLASSIFICATION: GA108 MAGNESIUM CONTAINING ANTACIDS MILK OF MAGNESIA CLASS-I VA CLASSIFICATION: GA110 SODIUM BICARBONATE CONTAINING ANTACIDS SODIUM BICARBONATE CLASS-I VA CLASSIFICATION: GA199 ANTACIDS,OTHER ALOH/MG CARB/ NA ALGINATE ORAL CLASS-I ALOH/MGOH/SIMETH ORAL CLASS-I VA CLASSIFICATION: GA201 BULK-FORMING LAXATIVES BRAN CLASS-I HYDROCIL CLASS-I PSYLLIUM CLASS-I VA CLASSIFICATION: GA202 HYPEROSMOTIC LAXATIVES CITRATE OF MAGNESIA SOLUTION CLASS-I PEG-3350/ELECTROLYTES POWDER COLON PREP CLASS-I LACTULOSE CLASS-I MAGNESIUM SULFATE CLASS-I SODIUM PHOSPHATE/BIPHOSPHATE CLASS-I VA CLASSIFICATION: GA203 LUBRICANT LAXATIVES MINERAL OIL USP CLASS-I VA CLASSIFICATION: GA204 STIMULANT LAXATIVES AROMATIC CASCARA FLUIDEXTRACT CLASS-I BISACODYL CLASS-I CASTOR OIL CLASS-I SENNA CLASS-I VA CLASSIFICATION: GA205 STOOL SOFTENER DOCUSATE SODIUM CLASS-I VA CLASSIFICATION: GA209 LAXATIVES,OTHER DOCUSATE/CASANTHRANOL CLASS-I MILK OF MAGNESIA/CASCARA CLASS-I SODIUM PHOSPHATE/BISACODYL PREP KT CLASS-I VA CLASSIFICATION: GA301 HISTAMINE ANTAGONISTS CIMETIDINE CLASS-I FAMOTIDINE CLASS-I RANITIDINE CLASS-III TAC APPROVAL NIZATIDINE CLASS-III TAC APPROVAL VA CLASSIFICATION: GA302 PROTECTANTS,ULCER SUCRALFATE CLASS-I VA CLASSIFICATION: GA309 ANTIULCER AGENTS,OTHER MISOPROSTOL CLASS-II Local Policies VA CLASSIFICATION: GA400 ANTIDIARRHEAL AGENTS ATTAPULGITE (FOR KAOPECTATE) CLASS-I BISMUTH SUBSALICYLATE CLASS-I DIPHENOXYLATE/ATROPINE CLASS-I LACTOBACILLUS CHEW CLASS-I LOPERAMIDE CLASS-I PAREGORIC CLASS-I OCTREOTIDE CLASS-II Case by case review Indication specific OPIUM 10% TINCTURE CLASS-II VA CLASSIFICATION: GA500 DIGESTANTS LACTASE CLASS-I PANCREATIC ENZYME CLASS-I VA CLASSIFICATION GA600 EMETICS IPECAC CLASS-I VA CLASSIFICATION: GA700 ANTIEMETICS GRANISETRON. CLASS-III MITODRINE ORAL CLASS-I Unavailable ONDANSETRON CLASS-I PROCHLORPERAZINE CLASS-I TRIETHYLPERAZINE CLASS-I TRIMETHOBENZAMIDE CLASS-I VA CLASSIFICATION: GA751 CENTRALLY-ACTING APPETITE SUPPRESSANTS FENFLURAMINE CLASS-III TAC APPROVAL DEXFENFLURAMINE CLASS-III TAC APPROVAL VA CLASSIFICATION: GA900 GASTRIC MEDICATIONS,OTHER LANSOPRAZOLE CLASS-I CISAPRIDE CLASS-I MESALAMINE CLASS-I OLSALAZINE CLASS-I SIMETHICONE CLASS-I SULFASALAZINE CLASS-I URSODIOL ORAL CLASS-II Indication specific VA CLASSIFICATION: GU100 ANALGESICS,URINARY PHENAZOPYRIDINE CLASS-I VA CLASSIFICATION: GU201 ANTISPASMODICS,URINARY OXYBUTYNIN CHLORIDE CLASS-I VA CLASSIFICATION: GU300 ANTI-INFECTIVES,VAGINAL CLINDAMYCIN VAG CREAM CLASS-I CLOTRIMAZOLE VAG CLASS-I METRONIDAZOLE VAG CLASS-I MICONAZOLE VAG CLASS-I NYSTATIN VAG CLASS-I POVIDONE VAG CLASS-I TRIPLE SULFA VAG CLASS-I VA CLASSIFICATION: GU500 ESTROGENS,VAGINAL ESTROGENS, CONJUGATED CRM CLASS-I VA CLASSIFICATION: GU600 OXYTOCICS ERGONOVINE MALEATE CLASS-I OXYTOCIN CLASS-I VA CLASSIFICATION: GU900 GENITO-URINARY AGENTS, OTHER DIMETHYLSULFOXIDE URH SOL CLASS-I PARAGARD T(Cu380A) CLASS-I Restricted to Women's wellness Program. VA CLASSIFICATION: HS051 GLUCOCORTICOIDS BETAMETHASONE ORAL CLASS-I CORTISONE ORAL CLASS-I DEXAMETHASONE ORAL/INJ CLASS-I HYDROCORTISONE ORAL/INJ CLASS-I METHYLPREDNISOLONE ORAL/INJ CLASS-I PREDNISONE ORAL CLASS-I TRIAMCINOLONE ORAL/INJ CLASS-I VA CLASSIFICATION: HS052 MINERALOCORTICOIDS FLUDROCORTISONE ACETATE CLASS-I VA CLASSIFICATION: HS100 ANDROGENS/ANABOLICS DANAZOLE ORAL CLASS-I FLUOXYMESTERONE CLASS-I METHANDROSTENOLONE CLASS-I METHYLTESTOSTERONE CLASS-I NANDROLONE DECAN CLASS-I TESTOSTERONE INJ(IN OIL) CLASS-II TESTOSTERONE PATCH CLASS-II VA CLASSIFICATION: HS200 CONTRACEPTIVES, SYSTEMIC DESOGESTREL 0.15/ETHINYL ESTRADIOL 30 TAB CLASS-I ETHINYL ESTRADIOL 30/NORGESTREL 0.3 TAB CLASS-I ETHINYL ESTRADIOL 35/NORETHINDRONE 1 TAB CLASS-I MESTRANOL 50/NORETHINDRONE 1 TAB CLASS-I NORGESTREL 0.075 TAB CLASS-I ORTHO-NOVUM 7/7/7 TAB CLASS-I VA CLASSIFICATION: HS300 ESTROGENS DIETHYLSTILBESTROL CLASS-III no longer available ESTRADIOL PATCHES CLASS-I ESTRADIOL INJ CLASS-I ESTRADIOL ORAL CLASS-I ESTROGENS,CONG TABS CLASS-I ESTROGEN SEMI-SYNTHETIC CLASS-III VA CLASSIFICATION: HS400 GONADOTROPINS CLOMIPHENE CLASS-I GONADOTROPIN,CHORIONIC CLASSI VA CLASSIFICATION: HS501 INSULIN INSULIN,REGULAR HUMAN CLASS I INSULIN,SEMI-LENTE CLASS III INSULIN, NPH HUMAN CLASS I INSULIN,LENTE INSULIN CLASS III INSULIN,ULTRALENTE INSULIN CLASS I INSULIN, NPH/REG 50/50 CLASS I Patient must fail ALL other formulary insulins. INSULIN,NPH-REGULAR 70/30 CLASS I INSULIN, BUFFERED HUMAN REGULAR CLASS II DIABETIC SPECIALIST INSULIN,LISPRO CLASS-II DIABETIC SPECIALIST VA CLASSIFICATION: HS502 ORAL HYPOGLYCEMIC AGENTS,ORAL ACARBOSE CLASS II DIAB ALG ACETOHEXAMIDE CLASS-III CHLORPROPAMIDE CLASS-III GLIPIZIDE CLASS-III GLYBURIDE CLASS-I METFORMIN CLASS-II DIAB ALG TOLAZAMIDE CLASS-III TOLBUTAMIDE CLASS-III TROGLITAZONE CLASS-III VA CLASSIFICATION: HS503 ANTIHYPOGLYCEMICS DEXTROSE 50% CLASS-I GLUCAGON CLASS-I DEXTROSE SQUEEZE TUBE CLASS-I GLUCOSE CHEW TAB CLASS-I VA CLASSIFICATION: HS701 ANTERIOR PITUITARY CORTICOTROPIN CLASS-I VA CLASSIFICATION: HS702 POSTERIOR PITUITARY VASOPRESSIN CLASS-I DESMOPRESSIN ACETATE CLASS-I LYPRESSIN CLASS-I VA CLASSIFICATION: HS800 PROGESTINS MEDROXYPROGESTERONE CLASS-I MEGESTROL ACETATE CLASS-I VA CLASSIFICATION: HS851 THYROID SUPPLEMENTS LEVOTHYROXINE SODIUM CLASS-I LIOTHYRONINE SODIUM CLASS-I THYROID CLASS-I VA CLASSIFICATION: HS852 ANTITHYROID AGENTS METHIMAZOLE CLASS-I PROPYLTHIOURACIL CLASS-I SODIUM IODIDE CLASS-I VA CLASSIFICATION:HS875 PROSTAGLANDINS ALPROSTADIL CLASS-II Subject to Case by case Approval by Local P&T Committees VA CLASSIFICATION: HS900 HORMONES/SYNTHETICS/MODIFIERS, OTHER ALENDRONATE CLASS-II *VISN-2 Osteoporosis Treatment algorithm AMINOGLUTETHIMIDE CLASS-I CALCITONIN-SALMON INJ CLASS-III CALCITONIN NASAL SPRAY CLASS-II VISN-2 ALG ETIDRONATE CLASS-I FINASTERIDE CLASS-III NONOXYL 100MG VAG SUPP CLASS-I VA CLASSIFICATION: IM100 VACCINES HEPATITS A VACCINE CLASS-I Routine Stocking HEPATITIS B VACCINE CLASS-I of below vaccines BACILLUS CALMETTE-GUERIN VACCINE CLASS-I is not required. INFLUENZA VACCINE CLASS-I With excpetion of PNEUMOCOCCAL VACCINE CLASS-I Pneumococcal and THYPHOID VACCINE CLASS-I Flu Vaccine, RABIES VACCINE CLASS-I Prophylactic shots MEASLES, MUMPS, RUBELLA VACCINE CLASS-I Are limited to MENINGOCOCCAL POLYSACCARIDE VACCINE CLASS-I Title 5/38 emp. MUMPS VIRUS VACCINE, LIVE CLASS-I Travel Vaccinations POLIOVIRUS VACCINE CLASS-I Are Prohibited! RUBELLA VIRUS VACCINE CLASS-I TYPHOID VACCINE CLASS-I VA CLASSIFICATION: IM200 TOXOIDS DIPHTHERIA AND TETANUS TOXOID CLASS-I See above restriction TETANUS TOXOID CLASS-I VA CLASSIFICATION: IM300 ANTIVENINS/ANTITOXINS ANTIVENIN, CROTALIDAE POLYVALENT CLASS-I Regular Stocking is not required** BOTULISM ANTITOXIN INJ CLASS-II Neurology/Ophthalmology TETANUS ANTITOXIN INJ CLASS-I " "** VA CLASSIFICATION: IM400 IMMUNE SERUMS ANTIRABIES SERUM CLASS-I Regular Stocking is Not Required VA CLASSIFICATION: IM500 IMMUNOGLOBULINS CYTOMETALOVIRUS IMMUNE GLOBULIN CLASS-I Regular Stocking GLOBULIN, IMMUNE CLASS-I is Not Required HEPATITIS B IMMUNE GLOBULIN (IM> CLASS-I RABIES IMMUNE GLOBULINE, HUMAN CLASS-I TETANUS IMMUNE GLOBULIN CLASS-I VARICELLA ZOSTER IMMUNE GLOBULIN (HUMAN> CLASS-I VA CLASSIFICATION IM600 IMMUNE SUPPRESSANTS AZATHIOPRINE CLASS-I CYCLOSPORIN CLASS-I MYCOPHENOLATE ORAL CLASS-II Restricted to specific Indication TACROLIUMUS INJ CLASS-II " " TACROLIUMUS ORAL CLASS-II " " VA CLASSIFICATION: IM700 IMMUNE STIMULANTS ALDESLEUKIN CLASS-II Visn-2 Asthma Gdl. INTERFERON ALFA-2A CLASS-II INTERFERON ALFA-2B CLASS-II SPECIFIC INDICATION INTERFERON ALFA-3N CLASS-II INTERFERON BETA-1A INJ CLASS-II INTERFERON GAMMA-1B INJ CLASS-II VA CLASSIFICATION: IM900 IMMUNOLOGICAL AGENTS, OTHER ALLERGY EXTRACT CLASS-I ANTI-THYMOCYTIE GLOBULIN INJ CLASS-II CROMOLYN ORAL CLASS-II Unavailable GLATIRMAMER INJ CLASS-II INTERFERON BETA-1B CLASS-II VA CLASSIFICATION: IR100 IRRIGATION SOLUTIONS ACETIC ACID CLASS-I CITRIC ACID/GLUCODELTA/LACTONE/MAG. CARB. CLASS-I CITRIC ACID/MAGNESIUM OXIDE/SOD CARB. CLASS-I GLYCINE CLASS-I LACTATED RINGERS IRR SOL CLASS-I NEO/POLYMIX IRR SOL CLASS-I RINGERS IRR SOL CLASS-I SODIUM CHLORIDE FOR IRRIGATION CLASS-I UROLOGIC G SOLUTION CLASS-I UROLOGIC IRRIGATING SOLUTION CLASS-I WATER FOR IRRIGATION CLASS-I VA CLASSIFICATION: IR200 PERITONEAL DIALYSIS SOLUTIONS PERITONEAL DIALYSIS SOLUTION CLASS-I VA CLASSIFICATION: MS101 SALICYLATES,ANTIRHEUMATIC SALSALATE CLASS-I VA CLASSIFICATION: MS102 NONSALICYLATE NSAIs,ANTIRHEUMATIC IBUPROFEN CLASS-I INDOMETHACIN CLASS-I NABUMETONE CLASS-III NAPROXEN CLASS-I PIROXICAM CLASS-I VA CLASSIFICATION: MS104 PENICILLAMINE PENICILLAMINE CLASS-I VA CLASSIFICATION: MS106 GOLD COMPOUNDS,ANTIRHEUMATIC AURANOFIN CLASS-I AUROTHIOGLUCOSE CLASS-I GOLD SODIUM THIOMALATE CLASS-I VA CLASSIFICATION: MS200 KELETAL MUSCLE RELAXANTS BACLOFEN CLASS-I CYCLOBENZAPRINE CLASS-I DANTROLENE CLASS-I METHOCARBAMOL CLASS-I ORPHENADRINE CITRATE CLASS-I VA CLASSIFICATION: MS300 NEUROMUSCULAR BLOCKING AGENTS ATRACURIUM BESYLATE CLASS-I CIS-ATRACURIUM CLASS-II LOCAL GALLAMINE TRIETHIODIDE CLASS-I PANCURONIUM BROMIDE CLASS-I SUCCINYLCHOLINE CLASS-I TUBOCURARINE CLASS-I VECURONIUM CLASS-I VA CLASSIFICATION: MS400 ANTIGOUT AGENTS ALLOPURINOL CLASS-I COLCHICINE CLASS-I PROBENECID CLASS-I SULFINPYRAZONE CLASS-IIII VA CLASSIFICATION: NT100 DECONGESTANTS,NASAL OXYMETAZOLINE CLASS-I PHENYLEPHRINE CLASS-I VA CLASSIFICATION: NT200 ANTI-INFLAMMATORIES,NASAL BECLOMETHASONE CLASS-I SODIUM CHLORIDE NASAL SPRAY CLASS-I VA CLASSIFICATION: NT300 ANESTHETICS,MUCOSAL BENZOCAINE DENTAL GEL CLASS-I BENZOCAINE/CETYLPYRIDINIUM LOZ CLASS-I COCAINE TOP SOL CLASS-II LIDOCAINE 10% ORAL AEROSOL CLASS-I LIDOCAINE 5% DENTAL OINT CLASS-I LIDOCAINE 5% DENTAL SOL CLASS-I LIDOCAINE 2% ORAL SOL CLASS-I LIDOCAINE HCL 2% VISCOUS LIQ CLASS-I PHENOL ORAL TOP LIQ CLASS-I VA CLASSIFICATION: NT900 NASAL AND THROAT,TOPICAL,OTHER AMPHOTERICIN B ORAL SUSP CLASS-I CLOTRIMAZOLE ORAL CLASS-I CPC LOZENGE CLASS-I CROMOLYN NASAL INHALAR CLASS-I CASE BY CASE P&T REVIEW NYSTATIN ORAL CLASS-I SODIUM CHLORIDE NASAL CLASS-I CPC THROAT LOZENGES CLASS-I CPC THROAT SPRAY CLASS-III VA CLASSIFICATION OP101- BETA BLOCKERS BETAXOLOL 0.5% OPH SOL - CLASS II OPHTHAMOLOGY BETAXOLOL 0.25% OPH SOL CLASS III CARTEOLOL OPH SOL CLASS III LEVOBUNOLOL 0.5% OPH SOL CLASS II OPHTH METIPRANOLOL 0.3% OPH SOL CLASS III TIMOLOL 0.5% OPH SOL CLASS II OPHTH TIMOLOL 0.25% OPH SOL CLASS II OPHTH TIMOLOL 0.5% XE OPH GEL CLASS III VA CLASSIFICATION OP102 TOPICAL MIOTICS ACETYLCHOLINE INTRAOCULAR CLASS II CARBACHOL 0.3% OPH SOL CLASS II CARBACHOL 0.15% OPH SOL CLASS III ECHOTHIOPHATE 0.06% OPH SOL CLASS III ECHOTHIOPHATE 0.125% OPH SOL CLASS III ECHOTHIOPHATE 0.25% OPH SOL CLASS III PILOCARPINE 0.25% OPH SOL CLASS III PILOCARPINE 0.5% OPH SOL CLASS III PILOCARPINE 1% OPH SOL CLASS II OPHTH PILOCARPINE 2% OPH SOL CLASS II OPHTH PILOCARPINE 3% OPH SOL CLASS II OPHTH PILOCARPINE 4% OPH SOL CLASS II OPHTH PILOCARPINE 6% OPH SOL CLASS III PILOCARPINE 8% OPH SOL CLASS III PILOCARPINE 4% OPH GEL CLASS II OPHTH PILOCARPINE OCULAR DISC 20 CLASS III PILOCARPINE OCULAR DISC 40 CLASS III VA CLASSIFICATION: OP103 ADRENERGICS DIPIVEFRIN 0.1% OPH SOL CLASS II OPHTH EPINEPHRINE OPH SOL CLASS II VA CLASSIFICATION: OP105 GLAUCOMA COMBINATIONS E-PILO 1% OPH SOL CLASS III E-PILO 2% OPH SOL CLASS III E-PILO 3% OPH SOL CLASS III E-PILO 4% OPH SOL CLASS III VA CLASSIFICATION: OP106 OSMOTIC AGENTS, SYSTEMIC OPHTHALMIC ISOSORBIDE ORAL SOLUTION CLASS II VA CLASSIFICATION OP109: CARBONIC ANHYDRASE INHIBITORS DORZOLAMIDE OPH SOL CLASS II OPHTH LATANOPROST 0.005% OPH SOL CLASS II OPHTH VA CLASSIFICATION OP201: ANTIBACTERIALS VISN-2 POLICY: RESTRICT ANTIBACTERIAL OPHTHALMIC PRODUCTS TO ONE FILL WITH ONE REFILL. BACITRACIN-POLYMYXIN B OPH OINT CLASS I CEFAZOLIN FORTIFIED OPH SOL CLASS II OPHTH CHLORAMPHENICOL 0.5% OPH SOL CLASS III CHLORAMPHENICOL OPH OINT CLASS I CIPROFLOXACIN 0.3% OPH SOL CLASS III ERYTHROMYCIN OPH OINT CLASS I GENTAMICIN OPH OINT CLASS I GENTAMICIN OPH SOL CLASS I GENTAMICIN OPH SOL (FORTIFIED) CLASS II OPHTH NEOMYCIN-POLYMYXIN-GRAMICIDIN CLASS III OFLOXACIN 0.3% OPH SOL CLASS II OPHTH POLYMYXIN-TRIMETHOPRIM OPH SOL CLASS I SILVER PROTEIN MILD 20% OPH SOL CLASS III SILVER PROTEIN MILD 10% OPH SOL CLASS III SODIUM SULFACETAMIDE 10% OPH SOL CLASS I SODIUM SULFACETAMIDE 10% OINT CLASS III SULFISOXAZOLE 4% OPH SOL CLASS III TETRACYCLINE 10MG/ML OPH SOL CLASS III TETRACYCLINE 1% OPH OINT CLASS III TOBRAMYCIN 0.3% OPH SOL CLASS III TOBRAMYCIN OPH OINT CLASS III TOBRAMYCIN OPH SOL (FORTIFIED) CLASS II OPHTH VA CLASSIFICATION: OP202 ANTIFUNGALS NATAMYCIN 5% OPH SOL CLASS III VA CLASSIFICATION OP203 ANTIVIRALS GANCICLOVIR OPH IMPLANT CLASS-II TRIFLURIDINE 1% OPH SOL CLASS II VIDARABINE 3% OPH OINT CLASS II VA CLASSIFICATION OP209 ANTI,INFECTIVE,TOPICAL,OPHTHALMIC, OTHER BACITRACIN/NEOMYCIN, POLYMIXIN, OPH OINT CLASS I REVIEW BY BACITRACIN/POLYMIXIN OPHTHALMIC OINT CLASS I OPHTHALOMOLGIST GRAMICIDIN/NEOMYCIN/POLYMIXIN OPH SOL CLASS I REQUIRED FOR ALL POLYMIXIN/TRIMETHOPRIM OPH SOL CLASS II ANTIBIOTIC COMBOS. VA CLASSIFICATION: OP300 ANTI-INFLAMMATORY DEXAMETHASONE 0.1% OPH SOL CLASS III DICLOFENAC 0.1% OPH SOL CLASS III FLURBIPROFEN 0.03% OPH SOL CLASS II OPHTH FLUROMETHOLONE 0.1% OPH SOL CLASS II OPHTH FLUROMETHOLONE 0.1% OPH OINT CLASS II OPHTH FLUROMETHOLONE 0.25% OPH SOL CLASS III KETOROLAC 0.5% OPH SOL CLASS III PREDNISOLONE ACET. 0.12% OPH SUSP CLASS III PREDNISOLONE ACETATE 1% OPH SUSP CLASS II OPHTH RIMEXOLONE OPH SUSP CLASS II VA CLASSIFICATION: OP350 ANTI-INFECTIVE ANTI-INFLAMMATORY COMBINATIONS BLEPHAMIDE OPH SUSP CLASS III (SULFACETAMIDE/PREDNISOLONE) BACITRACIN/HC/NEO/POLYMYX OPH OINT CLASS-I ALL ANTIBIOTIC DEXAMETHASONE/NEOMY/OPH SOL CLASS-I STEROID COMBOS DEXAMETHASONE/TOBRAMYCIN OPH SUSP CLASS-I REQUIRE GENTAMICIN/PREDNISOLONE OPH SUSP CLASS-I OPHTHAMOLOGIST DEXACIDIN OPH OINT CLASS I REVIEW (NEOMYCIN/POLYMIXIN/DEXAMETHASONE) MAXITROL OPH SOL CLASS I MAXITROL OPH OINT CLASS III (NEOMYCIN/POLYMIXIN/DEXAMETHASONE) NEOMYCIN-POLYMYXIN- DEXAMETHASONE OPH OINT CLASS I DEXAMETHASONE/TOBRAMYCIN OINT CLASS I OPHTH (TOBRADEX) VA CLASSIFICATION: OP400 CONTACT LENS SOLUTIONS CLERZ-II OPH SOL CLASS II OPHTH PRESERVED SALINE - CONTACT LENSES CLASS I VA CLASSIFICATION: OP500 EYE WASHES ARTIFICIAL TEARS CLASS I (VANC) METHYLCELLULOSE OR POLYVINYL ALCOHOL BALANCED SALT OPH SOL CLASS I BALANCED SALT IRRIGATION CLASS I BALANCED SALT PLUS OPH SOL CLASS III CARBOXYMETHYLCELLULOSE OPH SOL CLASS II FAILURE TO OTHER ARTIFICIAL TEARS DACRIOSE EYE RINSE OPH SOL CLASS I DACRIOSE OPH OINT CLASS I DURATEARS OPH OINT CLASS III EMOLLIENT OPH OINT CLASS I (VANC) HYDROXYPROPYLMETHYLCELLULOSE SOL CLASS II OPHTH (GONIOSOL 2.5%) HYDROXYMETHYCELLULOSE 0.5% CLASS I HYPOTEARS OPH SOL CLASS III HYPOTEARS PF OPH SOL CLASS III LACRISERT 5 MG INSERTS CLASS III LUBRICATING (PF> OPH OINT CLASS-I POVIDINE IODINE 5% OPH SOL CLASS III REFRESH PM OPH OINT CLASS III TEARS NATURAL II OPH SOL CLASS III VA CLASSIFICATION: OP600 MYDIATICS ATROPINE SULFATE 1% OPH SOL CLASS I ALL MYDRIATICS ATROPINE SULFATE 1% OPH OINT CLASS I REQUIRE CYCLOPENTOLATE 1% OPH SOL CLASS I OPHTHAMOLOGIST HOMATROPINE 5% OPH SOL CLASS I REVIEW ISOPTO-HYOSCINE 0.25% OPH SOL CLASS I " " PHENYLEPHERINE 2.5% OPH SOL CLASS I " " PHENYLEPHERINE 10% OPH SOL CLASS I " " TROPICAMIDE 1% OPH SOL CLASS I " " VA CLASSIFICATION: OP700 ANESTHETICS PROPARACAINE 0.5% OPH SOL CLASS II OPHTH TETRACAINE 0.5% OPH SOL CLASS I OPHTH. REVIEW TETRACAINE CAN BE USED IN THE ER, BUT NOT FOR OUTPATIENT REQUIRED DISPENSING EXCEPT PER OPHTHAMOLOGY. VA CLASSIFICATION: OP800 DECONGESTANTS NAPHAZOLINE 0.012% OPH SOL CLASS I VA CLASSIFICATION; OP900 OPTHALMAGIC AGENTS, OTHER APRACLONIDINE 0.5% OPH SOL CLASS II APRACLONIDINE 1% OPH SOL CLASS II OPHTH BRIMONIDINE 0.2% OPH SOL CLASS II OPHTH CROMOLYN 4% OPH SOL CLASS II CHYMOTRYPSYN OPH SOL CLASS I OPHTH REVIEW FLUORESCEIN 0.25% - BENOXINATE 0.4% OPH SOL CLASS II OPHTH FLUORESCEIN 10% INJECTION CLASS I FLUORESCEIN 25% INJECTION CLASS I OPHTH FLUORESCEIN OPH STRIPS CLASS I FLUOROSCEIN/PROPARACAINE OPH SOL CLASS-I OPHTH GLYCERIN OPH SOL CLASS I OPHTH GELATIN, ABSORBABLE CLASS-I LEVOCABASTINE OPH SOL CLASS I OPHTH REVIEW LODOXAMIDE 0.1% OPH SOL CLASS I OPHTH REVIEW NAPHAZOLINE-ANTAZOLINE OPH SOL CLASS I SODIUM CHLORIDE 5% OPH SOL CLASS I OPHTH SODIUM CHLORIDE 5% OPH OINT CLASS II OPHTH SODIUM HYALURONATE 0.4MG SYRINGE CLASS I OPHTH ROSE BENGAL OPH SOL CLASS I TYLOXAPOL 0.25% OPH SOL CLASS I VA CLASSIFICATION OR100: CARIOSTATICS STANNOUS FLUORIDE GEL CLASS II DENTAL REVIEW VA CLASSIFICATION OR200 DENTAL PROTECTANTS ORABASE PLAIN CLASS II DENTAL REVIEW VA CLASSIFICATION: OR500 MOUTHWASHES ARTIFICIAL SALIVA Class I DENTAL REVIEW CETYLPYRIDINIUM CL MOUTHWASH CLASS I DENTAL REVIEW CHLORHEXIDINE GLUCONATE ORAL RINSE CLASS II DENTAL REVIEW VA CLASSIFICATION: OR900 DENTAL AND ORAL AGENTS,TOPICAL,OTHER TRIAMCINOLONE IN ORABASE Class I ARTIFICIAL SALIVA Class I VA CLASSIFICATION: OT109 ANTI-INFECTIVES,TOPICAL OTIC OTHER ACETIC ACID OTIC Class I ALUMINUM ACETATE/ACETIC ACID OTIC Class I VA CLASSIFICATION: OT250 ANTI-INFECTIVE/ANTI-INFLAMMATORY COMBINATIONS,TOPICAL OTIC ACETIC ACID/HYDROCORTISONE Class I HYDROCORTISONE/NEOMYCIN/POLYMYXIN Class I VA CLASSIFICATION: OT300 CERUMINOLYTICS CARBAMIDE PEROXIDE Class I TRIETHANOLAMINE Class I VA CLASSIFICATION: OT400 CERUMINOLYTICS ANTIPYRINE/BENZOCAINE Class I VA CLASSIFICATION: PH000 PHARMACEUTICAL AIDS/REAGENTS COMPOUNDING STOCK *** ACETIC ACID,GLACIAL LIQUID CLASS I DEXTROSE 25% INJ CLASS I GLYCOLIC ACID CLASS I HYDROCHLORIC ACID LIQUID CLASS I LACTOSE POWDER CLASS I PHENOL LIQUID CLASS I PODOPHYLLIN POWDER CLASS I POTASSIUM PERMANGANATE GRANULES CLASS I PROPYLINE GLYCOL LIQUID CLASS I SODIUM THIOSULFATE CRYSTALS CLASS I SORBITOL 70% SOLUTION CLASS I WATER FOR INJECTION CLASS I VA CLASSIFICATION: RE101 ANTI-INFLAMMATORIES, INHALATION BECLOMETHASONE DIPROPIONATE Class I NEDOCROMIL Class I TRIAMCINOLONE Class I VA CLASSIFICATION:RE102 BRONCHODILATORS,SYMPATHOMIMETIC,INHALATION ALBUTEROL INH Class I EPINEPHRINE INH Class I ISOETHARINE Class I ISOPROTERENOL Class I METAPROTERENOL Class I PIRBUTEROL Class I SALMETEROL Class I TERBUTALINE Class I VA CLASSIFICATION: RE103 BRONCHODILATORS,SYMPATHOMIMETIC,ORAL EPHEDRINE Class I TERBUTALINE Class I VA CLASSIFICATION: RE104 BRONCHODILATORS,XANTHINE-DERIVATIVE AMINOPHYLLINE Class I THEOPHYLLINE Class I THEOPHYLLINE SUSTAINED RELEASE Class I VA CLASSIFICATION: RE105 BRONCHODILATORS,ANTICHOLINERGIC IPRATROPIUM Class I VA CLASSIFICATION: RE109 ANTIASTHMA,OTHER CROMOLYN SODIUM Class I VA CLASSIFICATION: RE200 DECONGESTANTS,SYSTEMIC PSEUDOEPHEDRINE Class I VA CLASSIFICATION: RE301 ANTITUSSIVES GUAIFENESIN/CODEINE Class I HYDROCODONE BITARTRATE Class III VA CLASSIFICATION: RE302 NON-OPIOD-CONTAINING ANTITUSSIVES/EXPECTORANTS BENZONATATE Class I DEXTROMETHORPHAN/GUAIFENESIN Class I GUAIFENESIN Class I GUAIFENESIN SR Class I LOCAL P&T REVIEW POTASSIUM IODIDE SATURATED SOL Class I VA CLASSIFICATION: RE400 MUCOLYTICS ACETYLCYSTEINE Class I VA CLASSIFICATION: RE501 ANTIHISTAMINE/DECONGESTANT CHLORPHENIRAMINE/PSEUDOEPHEDRINE Class I DEXBROMPHENIRAMINE/PSEUDOEPHED SR Class I TRIPROLIDINE/PSEUDOEPHEDRINE Class I VA CLASSIFICATION: RE516 DECONGESTANT/EXPECTORANT PHENYLPROPANOLAMINE/GUAIFENESIN LA Class I VA CLASSIFICATION: RE900 RESPIRATORY AGENTS,OTHER ALPHA-1-PROTEINASE INHIBITOR Class II AMMONIA Class I DOXAPRAM Class I SODIUM CHLORIDE Class I WATER FOR INHALATION Class I VA CLASSIFICATION: RS100 ANTI-INFLAMMATORIES,RECTAL HYDROCORTISONE RECTAL FOAM Class I HYDROCORTISONE RECTAL ENEMA Class I MESALAMINE ENENA Class I MESALAMINE RECTAL SUPPOSITORIES Class I VA CLASSIFICATION: RS201 HEMORRHOIDAL PREPARATIONS WITHOUT STEROID HEMORRHOIDAL OINTMENT Class I HEMORRHOIDAL SUPPOSITORIES Class I VA CLASSIFICATION: RS202 HEMORRHOIDAL PREPARATIOS WITH STEROID HEMORRHOIDAL/HC RECTAL OINTMENT Class I HYDROCORTISONE/ PRAMOXINE RECTAL CREAM Class I Restricted to HYDROCORTISONE/ PRAMOXINE RECTAL FOAM Class I use ONLY after HYDROCORTISONE/ PRAMOXINE RECTAL OINTMENT Class I failure of Hem/HC ointment VA CLASSIFICATION: RS300 LAXATIVES,RECTAL BISACODYL Class I CE0-TWO RECTAL SUPP Class III ENEMA, MINERAL OIL Class I GLYCERIN SUPPOSITORY Class I SODIUM BIPHOSPHATE/SODIUM PHOS. Class I VA CLASSIFICATION: TN100 IV SOLUTIONS ALCOHOL, ETHYL DEHYDRATED Class I DEXTROSE Class I DEXTROSE/LACTATED RINGERS Class I DEXTROSE/SODIUM CHLORIDE/ELECTROL Class I DISTILLED WATER Class I VA CLASSIFICATION: TN101 IV SOLUTIONS WITHOUT ELECTROLYTES ALCOHOL 5%/DEXTROSE 5% Class I DEXTROSE 10% Class I DEXTROSE 10% 17ML Class I DEXTROSE 30% Class I DEXTROSE 50% INJECTION Class I DEXTROSE 70% Class I VA CLASSIFICATION: TN102 IV SOLUTIONS WITH ELECTROLYTES BICARBONATE HEMODIALYSIS CONC Class I DEXTROSE 10%/0.9% NACL IV Class I DEXTROSE 2.5%/0.45% NACL IV Class I DEXTROSE 5% IN 1/2NS W/20MEQ KCL Class I DEXTROSE 5% IN 1/2NS W/40MEQ KCL Class I DEXTROSE 5% IN LACT.RINGERS Class I DEXTROSE 5%/SODIUM CHLORIDE 0.2% Class I DEXTROSE 5%/SODIUM CHLORIDE 0.45% Class I DEXTROSE 5%/SODIUM CHLORIDE 0.9% Class I DEXTROSE IN 1/4NS WITH KCL Class I DEXTROSE/ELECTROLYTES Class I DEXTROSE/LACTATED RINGER'S Class I LACTATED RINGER'S Class I POTASSIUM CHLORIDE Class I RINGERS INJECTION Class I SODIUM LACTATE Class I SODIUM CHLORIDE 0.45% Class I SODIUM CHLORIDE 0.9% Class I SODIUM CHLORIDE 3% Class I SODIUM CHLORIDE 5% Class I VA CLASSIFICATION: TN200 ENTERAL NUTRITION DIETARY SUPPLEMENT ENSURE POWDER Class I DIETARY SUPPLEMENT OSMOLYTE HN Class I VA CLASSIFICATION: TN300 LIPID SUPPLEMENTS FAT EMULSION Class I VA CLASSIFICATION: TN401 IRON FERROUS GLUCONATE Class I FERROUS SULFATE Class I IRON DEXTRAN Class I VA CLASSIFICATION: TN402 CALCIUM CALCIUM CARBONATE Class I CALCIUM ACETATE CLASS I CALCIUM GLUCONATE TABS CLASS III CALCIUM GLUCONATE INJ CLASS I CALCIUM CITRATE CLASS III CALCIUM CHLORIDE INJ CLASS I VA CLASSIFICATION: TN403 POTASSIUM POTASSIUM CHLORIDE INJECTION Class I POTASSIUM CHLORIDE ORAL Class I VA CLASSIFICATION: TN404 SODIUM SODIUM ACETATE INJ Class I SODIUM CHLORIDE INJ Class I VA CLASSIFICATION: TN405 ZINC ZINC CHLORIDE INJ Class I VA CLASSIFICATION: TN406 MAGNESIUM MAGNESIUM ODIDE TAB Class I MAGNESIUM SULFATE INJ VA CLASSIFICATION: TN407 FLUORIDE FLUORIDE Class I VA CLASSIFICATION: TN408 PHOSPHORUS K PHOSHPATE/NA BIPHOSPHATE/ NA PHOSPHATE ORAL CLASS I PHOSPHORUS/K/NA ORAL CLASS I PHOSPHORUS/POTASSIUM INJ CLASS I PHOSPHORUS/POTASSIUM PWDR CLASS I PHOSPHORUS/SODIUM INJ CLASS I VA CLASSIFICATION: TN409 BICARBONATES SODIUM BICARBONATE INJ Class I VA CLASSIFICATION: TN410 CITRATES CITRIC ACID/K CITRATE/NA CITRATE SYRUP Class I CITRIC ACID/NA CITRATE ORAL SOLN. VA CLASSIFICATION: TN490 ELECTROLYTES/MINERALS, COMBINATIONS TRACE ELEMENTS Class I TRACE ELEMENTS INJ. VA CLASSIFICATION: TN499 ELECTROLYTES/MINERALS, OTHER AMMONIUM CHLORIDE Class I CUPRIC CHLORIDE Class I CUPRIC SULFATE Class I HYDROCHLORIC ACID INJ Class I HYDROCHLORIC ACID LIQ Class I SELENIUM INJ Class I SODIUM LACTATE Class I VA CLASSIFICATION: TN501 AMINO ACIDS/PROTEINS,PARENTERAL,WITHOUT ADDED ELECTROLYTES AMINO ACIDS INJ Class II AMINO ACIDS /DEXTROSE INJ Class II VA CLASSIFICATION: TN502 AMINO ACIDS/PROTEINS,PARENTERAL,WITH ADDED ELECTROLYTES AMINO ACIDS WITH ELECTROLYTES Class I VA CLASSIFICATION: VT050 VITAMIN A VITAMIN A Class I Local Policies Indication Specific VA CLASSIFICATION: VT101 CYANOCOBALALMIN CYANOCOBALAMIN Class I VA CLASSIFICATION: VT102 FOLIC ACID/LEUCOVORIN FOLIC ACID Class I LEUCOVORIN CALCIUM Class I VA CLASSIFICATION: VT103 NICOTINIC ACID NIACIN Class I NIACIN SR Class I NIACINAMIDE Class II Dermatology VA CLASSIFICATION: VT104 PYRIDOXINE PYRIDOXINE Class I VA CLASSIFICATION: VT105 THIAMINE THIAMINE INJ Class I THIAMINE TAB Class I Local Policies Indication Specific VA CLASSIFICATION: VT109 VITAMIN B, OTHER VITAMIN B COMPLEX WITH C Class I Local Policies Indication Specific VA CLASSIFICATION: VT400 VITAMIN C ASCORBIC ACID inj Class I ASCORBIC ACID ORAL Class I Local Policies Indication Specific VA CLASIFICATION: VT501 CALCIFEDIOL CALCIFEDIOL CLASS II OSTEO GDL VA CLASSIFICATION: VT502 VITAMIN D CALCITRIOL ORAL Class I CALCITRIOL INJ CLASS II OSTEO GDL VA CLASSIFICATION: VT503 DIHYDROTACHYSTEROL DIHYDROTACHYSTEROL CLASS II OSTEO GDL VA CLASSIFICATION: VT504 ERGOGOCALCIFEROL ERGOCALCIFEROL INJ Class I ERGOCALCIFEROL ORAL CLASS III VITAMIN D ORAL CLASS I VA CLASSIFICATION: VT600 VITAMIN E VITAMIN E Class I VA CLASSIFICATION: VT702 PHYTONADIONE PHYTONADIONE Class I VA CLASSIFICATION: VT801 MULTIVITAMINS MULTIVITAMIN INJ Class I VA CLASSIFICATION: VT802 MUTIVITAMINS &MINERALS MULTIVITAMINS-MINERALS Class II CALCIUM/VITAMIN D Class I VA CLASSIFICATION: XA101 PADS,GAUZE,STERILE BURN DRESSING (OTC) CLASS I EYE PAD STERILE (OTC) CLASS I GAUZE PAD STERILE (OTC) CLASS I VA CLASSIFICATION XA102 PADS,GAUZE,NON-STERILE GAUZE PAD NONSTERILE(OTC) CLASS I PAD,ABDOMINAL NONSTERILE CLASS I PAD,ABDOMINAL STERILE CLASS I VA CLASSIFICATION XA103 PADS,NON-ADHERING DRESSING,ALLEVYN (OTC) CLASS I GAUZE ADAPTIC (OTC) CLASS I GAUZE,PETROLATUM (OTC) CLASS I PAD, NON-ADHERANT, DRY CLASS I TELFA PAD NON-ADHESIVE 3IN X 4IN (OTC) CLASS I VA CLASSIFICATION XA104 PADS,GAUZE WITH ADHESIVE BAND-AID (OTC) CLASS I PAD,FOAM (OTC) CLASS I TELFA ADHESIVE PAD (OTC) CLASS I VA CLASSIFICATION XA105 PADS,GAUZE WITH MEDICATION ADDED PAD BISMUTH ANTISEPTIC (OTC) CLASS I POVIDONE IODINE 10% PAD (OTC) CLASS I CLASS I VA CLASSIFICATION XA106 GAUZE,FINE MESH CLASS I GAUZE,FINE MESH STERILE (OTC) CLASS I VA CLASSIFICATION XA107 BANDAGE,FILM TRANSPARENT DRESSING (OTC) CLASS I VA CLASSIFICATOIN XA108 BANDAGE,ELASTIC BANDAGE,ELASTIC (OTC) CLASS I ELASTOPLAST (OTC) CLASS I VA CLASSIFICATION XA 109 BANDAGE,STRETCH BANDAGE TUBULAR ELASTIC (OTC) CLASS I LOCAL GAUZE,ELASTIC (OTC) CLASS I PRESCIBING KERLIX (OTC) CLASS I GUIDELINES KERLIX 4.5IN NONSTERILE (OTC) CLASS I PREVAIL KLING (OTC) CLASS I VA CLASSIFICATION XA110 FOAM WITH ADHESIVE PAD,FOAM SELF-ADHERE (OTC) CLASS I VA CLASSIFICATION XA111 PACKING,GAUZE,PLAIN GAUZE,PACKING (OTC) CLASS I VA CLASSIFICATION XA112 PACKING,GAUZE,MEDICATED GUAZE PACKING, MEDICATED (OTC) CLASS I VA CLASSIFICATION: XA199 BANDAGES/DRESSINGS,OTHER UNNA BOOT CLASS I UNNA BOOT STERILE CLASS I DRESSING,CLEARSITE (OTC) CLASS I DRESSING,DUODERM (OTC) CLASS I DRESSING,RESTORE (OTC) CLASS I DRESSING,SORBSAN (OTC) CLASS I KALTOSTAT CA/NA ALGINATE WOUND PACKING (OTC) CLASS I KALTOSTAT DRESSING (OTC) CLASS I KALTOSTAT FORTEX CA/NA ALGINATE DRESSING (OTC) CLASS I TRACHEOSTOMY PAD (OTC) CLASS I VA CLASSIFICATION XA 201 TAPE, PAPER CLASS I VA CLASSIFICATION XA202 TAPE,CLOTH TAPE,MICROPORE (OTC) CLASS I TAPE,WATER REPELLENT (OTC) CLASS I VA CLASSIFICATION XA 203 TAPE,PLASTIC TAPE,PLASTIC (OTC) CLASS I TAPE,PLASTIC TRANSPORE (OTC) CLASS I TAPE,SURGICAL PLASTIC STRETCH (OTC) CLASS I VA CLASSIFICATION XA 204: TAPE, FOAM TAPE,FOAM MICROPORE (OTC) CLASS I VA CLASSIFICATION XA 205, STRAPS, MONTGOMERY NO LISTINGS VA CLASSIFICATION XA 209: TAPE OTHER NO LIISTINGS VA CLASSIFICATION XA 301:PADS,BED DISPOSABLE UNDERPAD (OTC RESTRICTED) ** VA CLASSIFICATION XA 305: DIAPERS DIAPERS, ADULT INCONTINENT LINER (BLUE) CLASS I BRIEFS, INCONTINENT CLASS II LOCAL ADD?? (MAXICARE/DEPENDS) VA CLASSIFICATION XA 401: BAGS, DRAINABLE WITH ADHESIVE, COLOSTOMY, ILEOSTOMY POUCH,DRAINABLE,FIRSTCHOICE H#3618 (OTC) CLASS I POUCH,DRAINABLE,FIRSTCHOICE H#3619 (OTC) CLASS I POUCH,DRAINABLE,FIRSTCHOICE H#3631 (OTC) CLASS I POUCH,DRAINABLE,FIRSTCHOICE H#3675 (OTC) CLASS I POUCH,DRAINABLE,KARAYA SEAL H#3223 (OTC) CLASS I POUCH,DRAINABLE,KARAYA SEAL H#3224 (OTC) CLASS I POUCH,DRAINABLE,KARAYA SEAL H#3225 (OTC) CLASS I POUCH,DRAINABLE,KARAYA SEAL H#3228 (OTC) CLASS I POUCH,DRAINABLE,KARAYA SEAL H#3229 (OTC) CLASS I POUCH,DRAINABLE,PREMIUM H#3663 (OTC) CLASS I POUCH,DRAINABLE,PREMIUM H#3664 (OTC) CLASS I POUCH,DRAINABLE,PREMIUM H#3668 (OTC) CLASS I POUCH,DRAINABLE,PREMIUM H#3669 (OTC) CLASS I VA CLASSIFICATION XA 402: BAG, DRAINABLE WITHOUT ADHESIVE, COLOSTOMY /ILEOSTOMY POUCH,DRAINABLE,CENTER POINT LOCK H#3812 (OTC) CLASS I POUCH,DRAINABLE,CENTER POINT LOCK H#3813 (OTC) CLASS I POUCH,DRAINABLE,CENTER POINT LOCK H#3817 (OTC) CLASS I POUCH,DRAINABLE,FIRSTCHOICE H#3614 (OTC) CLASS I POUCH,DRAINABLE,FIRSTCHOICE H#3616 (OTC) CLASS I POUCH,DRAINABLE,SUR-FIT C#0256-30 (OTC) CLASS I POUCH,DRAINABLE,SUR-FIT C#0256-31 (OTC) CLASS I POUCH,DRAINABLE,SUR-FIT C#0256-32 (OTC) CLASS I POUCH,DRAINABLE,SUR-FIT C#0256-33 (OTC) CLASS I POUCH,DRAINABLE,SUR-FIT C#0256-40 (OTC) CLASS I POUCH,DRAINABLE,SUR-FIT C#0256-41 (OTC) CLASS I POUCH,DRAINABLE,SUR-FIT C#0256-42 (OTC) CLASS I POUCH,DRAINABLE,SUR-FIT C#0256-43 (OTC) CLASS I POUCH,OSTOMY H#3802 (OTC) CLASS I POUCH,OSTOMY H#3803 (OTC) CLASS I POUCH,OSTOMY H#3804 (OTC) CLASS I POUCH,OSTOMY H#3806 (OTC) CLASS I POUCH,OSTOMY H#3807 (OTC) CLASS I POUCH,OSTOMY H#3814 (OTC) CLASS I POUCH,OSTOMY,ACTIVE LIFE C#0227-71 (OTC) CLASS I POUCH,OSTOMY,ACTIVE LIFE C#1757-78 (OTC) CLASS I POUCH,OSTOMY,ACTIVE LIFE C#1757-79 (OTC) CLASS I POUCH,OSTOMY,ACTIVE LIFE C#1757-80 (OTC) CLASS I POUCH,MINI,CLOSED,FILTER H#3144 (OTC) CLASS I POUCH,MINI,CLOSED,SUR-FIT C#0257-77 (OTC) CLASS I VA CLASSIFICATION XA501, BAG, BEDSIDE URINARY COLLECTION DEVICE BEDSIDE DRAINAGE COLLECTION SYSTEM--- URINARY DRAINAGE BAG CLASS I VA CLASSIFICATION XA 502: BOTTLES/OTHER URINARY COLECTION DEVICES URINAL,FEMALE PLASTIC REUSABLE (OTC) CLASS I VA CLASSIFICATION XA 504: BAG, DRAINABLE WITH ADHESIVE,UROSTOMY POUCH,UROSTOMY,ACTIVE LIFE C#1757-92 (OTC) CLASS I POUCH,UROSTOMY,ACTIVE LIFE C#1757-93 (OTC) CLASS I POUCH,UROSTOMY,ACTIVE LIFE C#1757-94 (OTC) CLASS I POUCH,UROSTOMY,ACTIVE LIFE C#1757-96 (OTC) CLASS I POUCH,UROSTOMY,ACTIVE LIFE C#1757-98 (OTC) CLASS I POUCH,UROSTOMY,FIRSTCHOICE H#1482 (OTC) CLASS I POUCH,UROSTOMY,FIRSTCHOICE H#1483 (OTC) CLASS I POUCH,UROSTOMY,FIRSTCHOICE H#1484 (OTC) CLASS I POUCH,UROSTOMY,FIRSTCHOICE H#1486 (OTC) CLASS I POUCH,UROSTOMY,FIRSTCHOICE H#1488 (OTC) CLASS I VA CLASSIFICATION XA 505: BAG, DRAINABLE WITHOUT ADHESIVE,UROSTOMY POUCH,UROSTOMY H#3902 (OTC) CLASS I POUCH,UROSTOMY H#3903 (OTC) CLASS I POUCH,UROSTOMY W/ACCUSEAL C#0219-26 (OTC) CLASS I POUCH,UROSTOMY W/ACCUSEAL C#0219-27 (OTC) CLASS I POUCH,UROSTOMY W/ACCUSEAL C#0219-28 (OTC) CLASS I POUCH,UROSTOMY W/ACCUSEAL C#0219-29 (OTC) CLASS I POUCH,UROSTOMY W/ACCUSEAL C#0219-36 (OTC) CLASS I POUCH,UROSTOMY W/ACCUSEAL C#0219-37 (OTC) CLASS I POUCH,UROSTOMY W/ACCUSEAL C#0219-38 (OTC) CLASS I POUCH,UROSTOMY W/ACCUSEAL C#0219-39 (OTC) CLASS I VA CLASSIFICATION XA 508: BAG, LEG URINARY DRAINAGE COLLECTION DEVICE BAG,LEG (OTC) VA CLASSIFICATION XA 509 CATHETER FOLEY CATHETER CLASS III VA CLASSIFICATION XA 510: CATHETER, COUDE-TIP CATHETER, COUDE TIP CLASS III VA CLASSIFCATION XA 511: CATHETER, BALOON CATHETER, BALOON CLASS III VA CLASSIFICATION XA 512: CATHETER, RED RUBBER CATHETER, RED RUBBER CLASS III VA CLASSIFICATION XA 513: CATHETER, EXTERNAL URINARY CATHETER, EXTERNAL URINARY CLASS III VA CLASSIFICATION XA 514: PLUG,CATHETER CATHER PLUG CLASS III VA CLASSIFICAITON XA 515: KIT, CATHETER CARE CATHETER INSERTION TRAY CLASS III VA CLASSIFICATION XA 516 : SET, IRRIGATION CATHETER IRRIGATION TRAY CLASS I VA CLASSIFICATION XA 599: UROSTOMY/URINARY COLLECTION DEVICES, OTHER CLAMP,CUNNINGHAM (OTC) CLASS I DRIP COLLECTOR CONVEEN #5410 (OTC) CLASS I LEG BAG STRAP CLASS I VA CLASSIFICATION XA 601: RINGS, OSTOMY MOUNTING RING,NEOPRINE CLASS III VA CLASSIFICATION XA602: DISCS, OSOTOMY BARRIER,OSTOMY H#3702 (OTC) CLASS I BARRIER,OSTOMY H#3703 (OTC) CLASS I BARRIER,OSTOMY H#3704 (OTC) CLASS I BARRIER,OSTOMY H#3706 (OTC) CLASS I BARRIER,OSTOMY H#3707 (OTC) CLASS I COLLAR,TAN,SUR-FIT FLEX C#0225-21 (OTC) CLASS I COLLAR,TAN,SUR-FIT FLEX C#0225-22 (OTC) CLASS I COLLAR,TAN,SUR-FIT FLEX C#0225-23 (OTC) CLASS I CONVEX INSERT,SUR-FIT C#1850-12 (OTC) CLASS I CONVEX INSERT,SUR-FIT C#1850-15 (OTC) CLASS I CONVEX INSERT,SUR-FIT C#1850-16 (OTC) CLASS I CONVEX INSERT,SUR-FIT C#1850-17 (OTC) CLASS I CONVEX INSERT,SUR-FIT C#1850-20 (OTC) CLASS I VA CLASSIFICATION XA 603: ADHESIVES, OSTOMY MEDICAL ADHESIVE H#7730 (OTC) CLASS I CEMENT, SKIN BOND CLASS I VA CLASSIFICATION XA 604: PROTECTANTS, SKIN,OSTOMY BARRIER,HOLLIHESIVE H#7701 (OTC) CLASS I COMPOUND BENZOIN TINCTURE,TOP (OTC) CLASS I DUODERM HYDROGEL (OTC) CLASS I KARAYA POWDER (OTC) CLASS I KERODEX TOP CREAM (OTC) CLASS I MOISTURE BARRIER SKIN OINT H (OTC) CLASS I PASTE,STOMAHESIVE (OTC) CLASS I POWDER,STOMAHESIVE (OTC) CLASS I WAFER,DURAHESIVE W/FLANGE C#0225-66 (OTC) CLASS I WAFER,DURAHESIVE W/FLANGE C#0225-67 (OTC) CLASS I WAFER,DURAHESIVE W/FLANGE C#0225-68 (OTC) CLASS I WAFER,DURAHESIVE W/FLANGE C#0225-69 (OTC) CLASS I WAFER,STOMAHESIVE 4IN X 4IN C#0217-12 (OTC) CLASS I VA CLASSIFICATION XA605: BELTS,OSTOMY BELT,OSTOMY (OTC) CLASS I VA CLASSIFICATION XA 606: ODOR CONTROL PRODUCTS, OSTOMY APPLIANCE DEODORANT CLASS I CHLOROPHYLL CLASS I VA CLASSIFICATION XA 607: IRRIGATORS/SETS, OSTOMY IRRIGATION SLEEVE,SUR-FIT C#0242-52 (OTC) CLASS I IRRIGATION SLEEVE,SUR-FIT C#0242-53 (OTC) CLASS I IRRIGATION SLEEVE,SUR-FIT C#0242-54 (OTC) CLASS I IRRIGATOR DRAIN (OTC) CLASS I IRRIGATOR,VISI-FLOW (OTC) CLASS I VA CLASSIFICATION XA 608: CAPS, OSTOMY STOMA CAP (OTC) CLASS I VA CLASSIFICATION XA 699;OSTOMY SUPPLIES OTHER CLAMP,BAG (OTC) CLASS I VA CLASSIFICATION XA 701: BAGS FEEDING BAG,TUBE FEEDING (OTC) CLASS I BAG,TUBE FEEDING GRAVITY (OTC) CLASS I VA CLASSICATION XA 703: TUBES, FEEDING FEEDING TUBE (OTC) CLASS I VA CLASSIFICATION XA 802: SET MAXI-DRIP,INTAVENOUS IV SET PRIMARY (OTC) CLASS I VA CLASSIFICATION XA 809 INTRAVENOUS SETS, OTHER IV SET SECONDARY (OTC) CLASS I VA CLASSIFICATION XA854 SYRINGES,INSULIN,INJECTION INSULIN SYRINGES CLASS-I INSULIN SYRINGES LO-DOSE CLASS-I INSULIN SYRINGES 0.3CC CLASS-III VA CLASSIFICATION XA845 NEEDLES,INJECTION SYRINGE NEEDLES (OTC) CLASS I local VA CLASSIFICATION XA859 SYRINGES, NEEDLES, OTHER FILTER NEEDLE (OTC) CLASS I SYRINGE (OTC) CLASS I local TUBEX SYRINGE HOLDER (OTC) CLASS I VA CLASSIFICATION XA 900: SUPPLIES OTHER ADHESIVE REMOVER PAD (OTC) CLASS I ADHESIVE REMOVER SPRAY (OTC) CLASS I BEDPAN,DISPOSABLE (OTC) CLASS I CONDOM LATEX LUBRICATED (OTC) CLASS I CONDOM LATEX PLAIN (OTC) CLASS I COTTON BALL (OTC) CLASS I COTTON-TIP APPLICATOR NONSTERILE (OTC) CLASS I COTTON-TIP APPLICATOR STERILE (OTC) CLASS I DIAPHRAGM KIT (OTC) CLASS I DRESSING TRAY FOR CENTRAL LINE (OTC) CLASS I EMPTY FLEXIBLE CONTAINER (OTC) CLASS I ENEMA BAG (OTC) CLASS I EVACUATED CONTAINER (OTC) CLASS I FECAL INCONTINENCE COLLECTOR (OTC) CLASS I FINGER COT (OTC) CLASS I GLOVE LATEX NONSTERILE (OTC) CLASS I GLOVE VINYL NONSTERILE (OTC) CLASS I GLOVE, LATEX, STERILE (OTC) CLASS I HOSE ANTI-EMBOLISM (OTC) CLASS I INCONTINENT SHEATH HOLDER (OTC) CLASS I IRRIGATING SYRINGE CATHETER TIP (OTC) CLASS I LAMBS WOOL (OTC) CLASS I LANCET (OTC) CLASS I LANCET HOLDER (OTC) CLASS I MASK,SURGICAL CUP SHAPE(OTC) CLASS I MULTIDEX HYDROPHILIC WOUND DRESSING PWDR (OTC) CLASS I NASAL OXYGEN TUBE (OTC) CLASS I NEEDLE DISPOSAL CONTAINER (OTC) CLASS I PERI-WASH II CLEANSER (OTC) CLASS I SKIN CLEANSER (OTC) CLASS I SPACER-INHALER (OTC) CLASS I SPIKE,ASPIRATING,STERILE (OTC) CLASS I SUSPENSORY SUPPORTER (OTC) CLASS I SUTURE REMOVAL KIT (OTC) CLASS I SYRINGE MAGNIFIER (OTC) CLASS I TONGUE DEPRESSOR (OTC) CLASS I TRACH SUCTION KIT (OTC) CLASS I TRACHEOSTOMY CARE KIT (OTC) CLASS I TUBING,LATEX (OTC) CLASS I VA CLASSIFICATION: XX000 MISCELLANEOUS AGENTS AMMONIA, AROMATIC SPIRITS CLASS I BEER CLASS I BRANDY CLASS I EMERGENCY INSECT KIT CLASS I HYALURONIDASE CLASS I PLACEBO CLASS I WHISKEY CLASS I ================================================