Pulmonary Arterial Hypertension Oral and Inhaled Drugs
PDL Reference Documents
Drug Use Review Documents
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| NDC | Brand Name | Generic Name | Form | Strength | PDL Status |
Rebate | Carveout ‐ Bill FFS |
Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|---|
| 00378427193 | AMBRISENTAN | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 00591240630 | AMBRISENTAN | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 42794005208 | AMBRISENTAN | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 47335023783 | AMBRISENTAN | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 59651049530 | AMBRISENTAN | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 60505455303 | AMBRISENTAN | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 69097038702 | AMBRISENTAN | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 70710118003 | AMBRISENTAN | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 82009014230 | AMBRISENTAN | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 61958080201 | LETAIRIS | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 61958080205 | LETAIRIS | ambrisentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 00378427093 | AMBRISENTAN | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 00591240530 | AMBRISENTAN | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 42794005108 | AMBRISENTAN | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 47335023683 | AMBRISENTAN | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 59651049430 | AMBRISENTAN | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 60505455203 | AMBRISENTAN | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 69097038602 | AMBRISENTAN | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 70710117903 | AMBRISENTAN | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 82009014130 | AMBRISENTAN | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 61958080101 | LETAIRIS | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 61958080105 | LETAIRIS | ambrisentan | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 68180034011 | BOSENTAN | bosentan | TAB SUSP | 32 mg | N | Y | N | Pharmacy PA |
| 68180034013 | BOSENTAN | bosentan | TAB SUSP | 32 mg | N | Y | N | Pharmacy PA |
| 66215023214 | TRACLEER | bosentan | TAB SUSP | 32 mg | N | Y | N | Pharmacy PA |
| 66215023256 | TRACLEER | bosentan | TAB SUSP | 32 mg | N | Y | N | Pharmacy PA |
| 00591251260 | BOSENTAN | bosentan | TABLET | 125 mg | Y | Y | N | |
| 47335003986 | BOSENTAN | bosentan | TABLET | 125 mg | Y | Y | N | |
| 68382044714 | BOSENTAN | bosentan | TABLET | 125 mg | Y | Y | N | |
| 66215010203 | TRACLEER | bosentan | TABLET | 125 mg | Y | Y | N | |
| 66215010206 | TRACLEER | bosentan | TABLET | 125 mg | Y | Y | N | |
| 00591251160 | BOSENTAN | bosentan | TABLET | 62.5 mg | Y | Y | N | |
| 47335003886 | BOSENTAN | bosentan | TABLET | 62.5 mg | Y | Y | N | |
| 68382044614 | BOSENTAN | bosentan | TABLET | 62.5 mg | Y | Y | N | |
| 66215010103 | TRACLEER | bosentan | TABLET | 62.5 mg | Y | Y | N | |
| 66215010106 | TRACLEER | bosentan | TABLET | 62.5 mg | Y | Y | N | |
| 66215030200 | VENTAVIS | iloprost tromethamine | AMPUL-NEB | 10 mcg/mL | N | Y | N | Pharmacy PA |
| 66215030230 | VENTAVIS | iloprost tromethamine | AMPUL-NEB | 10 mcg/mL | N | Y | N | Pharmacy PA |
| 66215030300 | VENTAVIS | iloprost tromethamine | AMPUL-NEB | 20 mcg/mL | N | Y | N | Pharmacy PA |
| 66215030330 | VENTAVIS | iloprost tromethamine | AMPUL-NEB | 20 mcg/mL | N | Y | N | Pharmacy PA |
| 66215050115 | OPSUMIT | macitentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 66215050130 | OPSUMIT | macitentan | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 50419025001 | ADEMPAS | riociguat | TABLET | 0.5 mg | N | Y | N | Pharmacy PA |
| 50419025091 | ADEMPAS | riociguat | TABLET | 0.5 mg | N | Y | N | Pharmacy PA |
| 50419025101 | ADEMPAS | riociguat | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 50419025191 | ADEMPAS | riociguat | TABLET | 1 mg | N | Y | N | Pharmacy PA |
| 50419025201 | ADEMPAS | riociguat | TABLET | 1.5 mg | N | Y | N | Pharmacy PA |
| 50419025291 | ADEMPAS | riociguat | TABLET | 1.5 mg | N | Y | N | Pharmacy PA |
| 50419025301 | ADEMPAS | riociguat | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 50419025391 | ADEMPAS | riociguat | TABLET | 2 mg | N | Y | N | Pharmacy PA |
| 50419025401 | ADEMPAS | riociguat | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 50419025491 | ADEMPAS | riociguat | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 66215062820 | UPTRAVI | selexipag | TAB DS PK | 200 mcg (140)-800 mcg (60) | N | Y | N | Pharmacy PA |
| 66215061006 | UPTRAVI | selexipag | TABLET | 1,000 mcg | N | Y | N | Pharmacy PA |
| 66215061206 | UPTRAVI | selexipag | TABLET | 1,200 mcg | N | Y | N | Pharmacy PA |
| 66215061406 | UPTRAVI | selexipag | TABLET | 1,400 mcg | N | Y | N | Pharmacy PA |
| 66215061606 | UPTRAVI | selexipag | TABLET | 1,600 mcg | N | Y | N | Pharmacy PA |
| 66215060206 | UPTRAVI | selexipag | TABLET | 200 mcg | N | Y | N | Pharmacy PA |
| 66215060214 | UPTRAVI | selexipag | TABLET | 200 mcg | N | Y | N | Pharmacy PA |
| 66215060406 | UPTRAVI | selexipag | TABLET | 400 mcg | N | Y | N | Pharmacy PA |
| 66215060606 | UPTRAVI | selexipag | TABLET | 600 mcg | N | Y | N | Pharmacy PA |
| 66215060806 | UPTRAVI | selexipag | TABLET | 800 mcg | N | Y | N | Pharmacy PA |
| 00069033621 | REVATIO | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 00591405094 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 27241017529 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 31722013631 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 51672423108 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 59651042011 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 60219265101 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 69238157401 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 70710171604 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 70954016810 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 72205003576 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 72205005976 | SILDENAFIL CITRATE | sildenafil citrate | SUSP RECON | 10 mg/mL | N | Y | N | Pharmacy PA |
| 00093534301 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 00093534356 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 13668018801 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 13668018830 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 27241006903 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 27241006905 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 27241006910 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 31722071101 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 31722071105 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 31722071130 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 33342004307 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 33342004311 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 33342004344 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 59762003602 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 60219175303 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 65862069101 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 65862069105 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 65862069130 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 72241007105 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 72241007111 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 72241007122 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 72888001700 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 75834024100 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 75834024101 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 75834024130 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 76282064501 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 76282064530 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 82009009301 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 00069422030 | VIAGRA | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 00069422066 | VIAGRA | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 58151042893 | VIAGRA | sildenafil citrate | TABLET | 100 mg | N | Y | N | Pharmacy PA |
| 00069419068 | REVATIO | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 00093551798 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 00904667104 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 00904667106 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 13668018590 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 27241012403 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 27241012405 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 31722077605 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 31722077690 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 33342012110 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 33342053610 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 50268071711 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 50268071715 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 52817029590 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 59762003301 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 59762003303 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 60687078811 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 60687078821 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 62135037290 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 65162035109 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 65162035111 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 65862068890 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 65862068899 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 68001036305 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 68001059705 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 72888001800 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 72888001890 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 82009009490 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 00093534156 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 13668018630 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 27241006703 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 27241006705 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 31722070930 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 33342004107 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 33342004144 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 59762003401 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 60219175103 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 65862068930 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 65862068999 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 72241006911 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 72241006922 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 72888001505 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 75834027200 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 76282064330 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00069420030 | VIAGRA | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 58151042693 | VIAGRA | sildenafil citrate | TABLET | 25 mg | N | Y | N | Pharmacy PA |
| 00093534201 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 00093534256 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 13668018701 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 13668018730 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 27241006803 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 27241006805 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 31722071001 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 31722071030 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 33342004207 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 33342004211 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 33342004244 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 59762003501 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 59762003502 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 60219175203 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 65862069001 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 65862069030 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 65862069099 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 72241007005 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 72241007011 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 72241007022 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 72888001600 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 75834024000 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 75834024001 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 75834024030 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 76282064401 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 76282064430 | SILDENAFIL CITRATE | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 00069421030 | VIAGRA | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 00069421066 | VIAGRA | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 58151042701 | VIAGRA | sildenafil citrate | TABLET | 50 mg | N | Y | N | Pharmacy PA |
| 46287004515 | TADLIQ | tadalafil | ORAL SUSP | 20 mg/5 mL (4 mg/mL) | N | Y | N | Pharmacy PA |
| 00480231056 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 13668056730 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 16714007601 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 16729037110 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 16729037116 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 24979072906 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 24979072969 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 27241011303 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 27241011305 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 29300028805 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 29300028813 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 31722064530 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 33342026707 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 35573046230 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 43547003203 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 43547005003 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 43547005050 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 43598057430 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 47335001183 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 62332017930 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 62332017991 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 65862085230 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 68180092106 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 68382089806 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 68382089810 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 69238134803 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 75834024901 | TADALAFIL | tadalafil | TABLET | 10 mg | N | Y | N | Pharmacy PA |
| 00480230830 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 00480230865 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 13668056530 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 16714007401 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 16714007402 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 16729036910 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 24979072702 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 24979072706 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 27241011103 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 27241011105 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 29300028605 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 29300028613 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 31722064330 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 33342026507 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 35573046038 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 35573046056 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 43547003003 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 43547004703 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 43547004750 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 43598057630 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 47335000964 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 47335000972 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 62332017715 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 62332017730 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 62332017791 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 68180091906 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 68382089606 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 68382089610 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 69238134603 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 75834024701 | TADALAFIL | tadalafil | TABLET | 2.5 mg | N | Y | N | Pharmacy PA |
| 66302046760 | ADCIRCA | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 00480927706 | ALYQ | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 00480231156 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 13668056830 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 13668058130 | TADALAFIL | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 16714007701 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 16729037210 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 16729037216 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 24979073006 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 24979073044 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 27241011403 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 27241011405 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 27241012302 | TADALAFIL | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 29300028905 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 29300028913 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 31722064630 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 31722064730 | TADALAFIL | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 33342026807 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 33342027809 | TADALAFIL | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 35573046330 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 43547003303 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 43547005103 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 43547005150 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 43547099006 | TADALAFIL | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 43598057330 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 43598057331 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 43598057379 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 43598057860 | TADALAFIL | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 47335001283 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 50268073911 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 50268073913 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 62332018030 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 62332018091 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 65862085330 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 65862088060 | TADALAFIL | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 68180092206 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 68382089906 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 68382089910 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 69097052603 | TADALAFIL | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 69238134903 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 75834025001 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 82009007905 | TADALAFIL | tadalafil | TABLET | 20 mg | N | Y | N | Pharmacy PA |
| 82009008060 | TADALAFIL | tadalafil | TABLET | 20 mg | Y | Y | N | Pharmacy PA |
| 00480230930 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 00480230956 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 00480230965 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 13668056630 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 16714007501 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 16729037010 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 16729037016 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 24979072802 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 24979072806 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 27241011203 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 27241011205 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 29300028705 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 29300028713 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 29300028751 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 31722064430 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 33342026607 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 35573046130 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 43547003103 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 43547004903 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 43547004950 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 43598057530 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 43598057531 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 43598057579 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 47335001083 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 50268073811 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 50268073813 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 62332017815 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 62332017830 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 62332017891 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 65862085130 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 68180092006 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 68382089706 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 68382089710 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 69238134703 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 75834024801 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 82009007705 | TADALAFIL | tadalafil | TABLET | 5 mg | N | Y | N | Pharmacy PA |
| 66302020603 | TYVASO | treprostinil | AMPUL-NEB | 1.74 mg/2.9 mL (0.6 mg/mL) | N | Y | N | Pharmacy PA |
| 66302061601 | TYVASO DPI | treprostinil | CART INHAL | 16 mcg | N | Y | N | Pharmacy PA |
| 66302061603 | TYVASO DPI | treprostinil | CART INHAL | 16 mcg | N | Y | N | Pharmacy PA |
| 66302071604 | TYVASO DPI | treprostinil | CART INHAL | 16 mcg | N | Y | N | Pharmacy PA |
| 66302061002 | TYVASO DPI | treprostinil | CART INHAL | 16 mcg(112)-32 mcg(112)-48 mcg(28) | N | Y | N | Pharmacy PA |
| 66302063201 | TYVASO DPI | treprostinil | CART INHAL | 32 mcg | N | Y | N | Pharmacy PA |
| 66302063203 | TYVASO DPI | treprostinil | CART INHAL | 32 mcg | N | Y | N | Pharmacy PA |
| 66302073204 | TYVASO DPI | treprostinil | CART INHAL | 32 mcg | N | Y | N | Pharmacy PA |
| 66302062003 | TYVASO DPI | treprostinil | CART INHAL | 32 mcg-48 mcg | N | Y | N | Pharmacy PA |
| 66302064801 | TYVASO DPI | treprostinil | CART INHAL | 48 mcg | N | Y | N | Pharmacy PA |
| 66302064803 | TYVASO DPI | treprostinil | CART INHAL | 48 mcg | N | Y | N | Pharmacy PA |
| 66302074804 | TYVASO DPI | treprostinil | CART INHAL | 48 mcg | N | Y | N | Pharmacy PA |
| 66302066401 | TYVASO DPI | treprostinil | CART INHAL | 64 mcg | N | Y | N | Pharmacy PA |
| 66302066403 | TYVASO DPI | treprostinil | CART INHAL | 64 mcg | N | Y | N | Pharmacy PA |
| 66302076404 | TYVASO DPI | treprostinil | CART INHAL | 64 mcg | N | Y | N | Pharmacy PA |
| 66302030001 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 0.125 mg | N | Y | N | Pharmacy PA |
| 66302030002 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 0.125 mg | N | Y | N | Pharmacy PA |
| 66302030201 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 0.25 mg | N | Y | N | Pharmacy PA |
| 66302030202 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 0.25 mg | N | Y | N | Pharmacy PA |
| 66302031001 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 1 mg | N | Y | N | Pharmacy PA |
| 66302031002 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 1 mg | N | Y | N | Pharmacy PA |
| 66302032501 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 2.5 mg | N | Y | N | Pharmacy PA |
| 66302032502 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 2.5 mg | N | Y | N | Pharmacy PA |
| 66302035001 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 5 mg | N | Y | N | Pharmacy PA |
| 66302035002 | ORENITRAM ER | treprostinil diolamine | TABLET ER | 5 mg | N | Y | N | Pharmacy PA |
| 66302036256 | ORENITRAM MONTH 2 TITRATION KT | treprostinil diolamine | TB ER DSPK | 0.125 mg (126)-0.25 mg (210) | N | Y | N | Pharmacy PA |
| 66302036128 | ORENITRAM MONTH 1 TITRATION KT | treprostinil diolamine | TB ER DSPK | 0.125 mg (126)-0.25 mg (42) | N | Y | N | Pharmacy PA |
| 66302036384 | ORENITRAM MONTH 3 TITRATION KT | treprostinil diolamine | TB ER DSPK | 0.125 mg (126)-0.25 mg (42)-1 mg (84) | N | Y | N | Pharmacy PA |
| 72964001401 | YUTREPIA | treprostinil sodium | CAP W/DEV | 106 mcg | N | Y | N | Pharmacy PA |
| 72964001101 | YUTREPIA | treprostinil sodium | CAP W/DEV | 26.5 mcg | N | Y | N | Pharmacy PA |
| 72964001201 | YUTREPIA | treprostinil sodium | CAP W/DEV | 53 mcg | N | Y | N | Pharmacy PA |
| 72964001301 | YUTREPIA | treprostinil sodium | CAP W/DEV | 79.5 mcg | N | Y | N | Pharmacy PA |
| 66302020602 | TYVASO REFILL KIT | treprostinil/neb accessories | AMPUL-NEB | 1.74 mg/2.9 mL (0.6 mg/mL) | N | Y | N | Pharmacy PA |
| 66302020604 | TYVASO INSTITUTIONAL START KIT | treprostinil/nebulizer/accesor | AMPUL-NEB | 1.74 mg/2.9 mL (0.6 mg/mL) | N | Y | N | Pharmacy PA |
| 66302020601 | TYVASO STARTER KIT | treprostinil/nebulizer/accesor | AMPUL-NEB | 1.74 mg/2.9 mL (0.6 mg/mL) | N | Y | N | Pharmacy PA |