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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.

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NDC Brand Name Generic Name Form Strength PDL
Status		 Rebate Current Drug Use Criteria
00093113556 ACITRETIN acitretin CAPSULE 10 mg Y  
00115175008 ACITRETIN acitretin CAPSULE 10 mg Y  
00378702093 ACITRETIN acitretin CAPSULE 10 mg Y  
42794008008 ACITRETIN acitretin CAPSULE 10 mg Y  
62332074130 ACITRETIN acitretin CAPSULE 10 mg Y  
00093113856 ACITRETIN acitretin CAPSULE 17.5 mg Y  
00115175108 ACITRETIN acitretin CAPSULE 17.5 mg Y  
42794008108 ACITRETIN acitretin CAPSULE 17.5 mg Y  
62332074230 ACITRETIN acitretin CAPSULE 17.5 mg Y  
00115175208 ACITRETIN acitretin CAPSULE 22.5 mg Y  
00093113656 ACITRETIN acitretin CAPSULE 25 mg Y  
00115175308 ACITRETIN acitretin CAPSULE 25 mg Y  
00378702393 ACITRETIN acitretin CAPSULE 25 mg Y  
42794008308 ACITRETIN acitretin CAPSULE 25 mg Y  
62332074330 ACITRETIN acitretin CAPSULE 25 mg Y  
73372011601 SCENESSE afamelanotide acetate IMPLANT 16 mg Y  
00096070935 XERAC AC aluminum chloride SOLUTION 6.25 % Y  
00096070960 XERAC AC aluminum chloride SOLUTION 6.25 % Y  
00299392804 CETAPHIL avobenzone/octocrylene LOTION 3 %-10 % Y  
00884609704 TI-SCREEN benzophenone/octinox/Dihd-Acet CREAM(ML) 3-7.5% Y  
42546000330 BENZEPRO benzoyl peroxide micronized TOWELETTE 5.8 % Y N  
42546000360 BENZEPRO benzoyl peroxide micronized TOWELETTE 5.8 % Y N  
00781620675 BIMATOPROST bimatoprost DROP W/APP 0.03 % Y  
00781620693 BIMATOPROST bimatoprost DROP W/APP 0.03 % Y  
62332051103 BIMATOPROST bimatoprost DROP W/APP 0.03 % Y  
62332051105 BIMATOPROST bimatoprost DROP W/APP 0.03 % Y  
00023361605 LATISSE bimatoprost DROP W/APP 0.03 % Y  
00023361670 LATISSE bimatoprost DROP W/APP 0.03 % Y  
45802007830 BRIMONIDINE TARTRATE brimonidine tartrate GEL W/PUMP 0.33 % Y  
00299598035 MIRVASO brimonidine tartrate GEL W/PUMP 0.33 % Y  
51224016224 ASTRINGENT SOLUTION calcium acetate/aluminum sulf POWD PACK 952 mg-1,347 mg Y  
51224016299 ASTRINGENT SOLUTION calcium acetate/aluminum sulf POWD PACK 952 mg-1,347 mg Y  
45802016601 BLISTER-AID camph/la/mo/phe/petrolat/paraf OINT. (G) 1-0.4% Y  
49348014830 CAMPHOR camphor SPIRIT Y  
70000039601 CAMPHOR camphor SPIRIT Y  
70677120101 CAMPHOR camphor SPIRIT Y  
45802017851 ANTISEPTIC SKIN CLEANSER camphor/alcohol LIQUID Y  
45802017883 ANTISEPTIC SKIN CLEANSER camphor/alcohol LIQUID Y  
00024515006 CAMPHO-PHENIQUE camphor/phenol SOLUTION 10.8 %-4.7 % Y  
45802016662 MEDICATED LIP camphor/phenol/petrolatum OINT. (G) Y  
45861001405 MEDROX capsaicin/menthol ADH. PATCH 0.0375 %-5 % Y  
59088079405 DERMACINRX DIABECIN CS capsaicin/menthol CREAM (G) 0.05 %-2 % Y  
59088022008 CAPSAICIN-CAPSICUM OLEORESIN capsicum oleoresin CREAM (G) 0.025 % Y  
59088022308 CAPSAICIN-CAPSICUM OLEORESIN capsicum oleoresin CREAM (G) 0.05 % Y  
59088043305 DERMACINRX CIRCATA capsicum oleoresin CREAM (G) 0.05 % Y  
59088047905 DERMACINRX CIRCATRIX capsicum oleoresin CREAM (G) 0.05 % Y  
59088031008 DERMACINRX PENETRAL capsicum oleoresin CREAM(ML) 0.025 % Y  
59088031016 DERMACINRX PENETRAL capsicum oleoresin CREAM(ML) 0.025 % Y  
00132005024 SLOANS capsicum oleoresin/turp oil LINIMENT 0.025 %-47 % Y  
00132045024 SLOANS capsicum oleoresin/turp oil LINIMENT 0.025 %-47 % Y  
61570004415 MANTADIL chlorcyclizine HCl/hydrocort CREAM (G) 2-0.5% Y  
00178030105 MAXILUBE chlorhexidine/glycerin/he-cell JELLY (G) Y  
47335099436 WINLEVI clascoterone CREAM (G) 1 % N Y  
45802002503 DIPHENHYDRAMINE HCL diphenhydramine HCl CREAM (G) 2 % Y  
49348036734 ANTI-ITCH diphenhydramine HCl GEL (ML) 2 % Y  
24385003646 ANTI-ITCH diphenhydramine HCl SPRAY 2 % Y  
45802003646 DIPHENHYDRAMINE HCL diphenhydramine HCl SPRAY 2 % Y  
45802007282 CALDYPHEN diphenhydramine HCl/calamine LOTION Y  
11527006904 ANTI-ITCH diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
24385021003 ANTI-ITCH diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
46122080436 ANTI-ITCH diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
49348085472 ANTI-ITCH diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
70000038801 ANTI-ITCH diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
70677121301 ANTI-ITCH diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
70677128901 ANTI-ITCH diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
00904535431 BANOPHEN ANTI-ITCH diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
00113062264 ITCH RELIEF diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
45802035803 ITCH RELIEF diphenhydramine HCl/zinc acet CREAM (G) 2 %-0.1 % Y  
46122057246 ITCH RELIEF diphenhydramine HCl/zinc acet SPRAY 2 %-0.1 % Y  
70000002301 ITCH RELIEF diphenhydramine HCl/zinc acet SPRAY 2 %-0.1 % Y  
83324030227 ITCH RELIEF diphenhydramine HCl/zinc acet SPRAY 2 %-0.1 % Y  
00093960995 DOXEPIN HCL doxepin HCl CREAM (G) 5 % Y  
00378811745 DOXEPIN HCL doxepin HCl CREAM (G) 5 % Y  
69238173306 DOXEPIN HCL doxepin HCl CREAM (G) 5 % Y  
00378813045 PRUDOXIN doxepin HCl CREAM (G) 5 % Y  
00378812330 ZONALON doxepin HCl CREAM (G) 5 % Y  
00378812345 ZONALON doxepin HCl CREAM (G) 5 % Y  
00078052030 EYESCRUB edetate disodium/peg PAD Y  
46122069726 CHEST RUB eucalyptus oil/menthol/camphor OINT. (G) 1.2 %-2.6 %-4.8 % Y  
62011007501 CHEST RUB eucalyptus oil/menthol/camphor OINT. (G) 1.2 %-2.6 %-4.8 % Y  
70000048001 CHEST RUB eucalyptus oil/menthol/camphor OINT. (G) 1.2 %-2.6 %-4.8 % Y  
70677106101 CHEST RUB eucalyptus oil/menthol/camphor OINT. (G) 1.2 %-2.6 %-4.8 % Y  
00299595030 TRI-LUMA fluocinolone/tretinoin/h-quin CREAM (G) 0.01 %-0.05 %-4 % Y  
45802020033 ANTISEPTIC CLEANSING PADS glycerin/witch hazel leaf MED. PAD Y  
45802020096 ANTISEPTIC CLEANSING PADS glycerin/witch hazel leaf MED. PAD Y  
00132048140 FLEET MEDICATED WIPES glycerin/witch hazel leaf MED. PAD Y  
00116081001 PERIES 40 PADS glycerin/witch hazel leaf MED. PAD Y  
24385005028 GREEN SOAP green soap TINCTURE Y  
45802009705 HYDROPHILIC hydrophilic cream OINT. (G) Y  
99207029002 ESOTERICA FADE CREAM hydroquinone CREAM (G) 2 % Y  
00168036431 HYDROQUINONE hydroquinone CREAM (G) 4 % Y  
24689010101 HYDROQUINONE hydroquinone CREAM (G) 4 % Y  
42192015101 HYDROQUINONE hydroquinone CREAM (G) 4 % Y  
69367017401 HYDROQUINONE hydroquinone CREAM (G) 4 % Y  
75834013701 HYDROQUINONE hydroquinone CREAM (G) 4 % Y  
82429030928 HYDROQUINONE hydroquinone CREAM (G) 4 % Y  
99207029102 ESOTERICA FADE CREAM hydroquinone/oxybenzone/padima CREAM (G) 2 %-SPF 10 Y  
99207029202 ESOTERICA FADE CREAM hydroquinone/oxybenzone/padima CREAM (G) 2 %-SPF 10 Y  
45802008003 ICHTHAMMOL ichthammol OINT. (G) 10 % Y  
45802008005 ICHTHAMMOL ichthammol OINT. (G) 10 % Y  
45802008103 ICHTHAMMOL ichthammol OINT. (G) 20 % Y  
45802008105 ICHTHAMMOL ichthammol OINT. (G) 20 % Y  
00574210745 IVERMECTIN ivermectin CREAM (G) 1 % N Y  
00591405289 IVERMECTIN ivermectin CREAM (G) 1 % N Y  
45802010284 IVERMECTIN ivermectin CREAM (G) 1 % N Y  
68308070145 IVERMECTIN ivermectin CREAM (G) 1 % N Y  
72578012008 IVERMECTIN ivermectin CREAM (G) 1 % N Y  
00299382345 SOOLANTRA ivermectin CREAM (G) 1 % N Y  
70211070408 COATS ALOE ANALGESIC m-salicy/aloe/menthol/eucalypt LINIMENT 10 % Y  
70211070433 COATS ALOE ANALGESIC m-salicy/aloe/menthol/eucalypt LINIMENT 10 % Y  
70000036701 COLD-HOT EXTRA STRENGTH menthol ADH. PATCH 5 % Y  
00536133215 MENTHOL COLD AND HOT menthol ADH. PATCH 5 % Y  
46122075145 PAIN RELIEF PATCH menthol ADH. PATCH 5 % Y  
00682555506 DOLOXYL menthol GEL (GRAM) Y  
37205070421 PAIN RELIEF menthol GEL (GRAM) Y  
45802027016 REFLEX PAIN RELIEF menthol GEL (GRAM) Y  
45802022505 THERAPEUTIC BLUE GEL menthol GEL (GRAM) Y  
45802022529 THERAPEUTIC BLUE GEL menthol GEL (GRAM) Y  
00884468808 WONDER ICE menthol GEL (GRAM) Y  
00536106139 BLUE GEL menthol GEL (GRAM) 2 % Y  
70000026001 ICE BLUE GEL menthol GEL (GRAM) 2 % Y  
83324000704 COLD THERAPY menthol GEL (ML) 4 % Y  
70000061701 COOLING PAIN RELIEF menthol GEL (ML) 4 % Y  
70000061801 COOLING PAIN RELIEF menthol GEL (ML) 4 % Y  
46122074327 COOL-HEAT menthol LIQUID 16 % Y  
59088025907 CAMPHOR-MENTHOL menthol/camphor GEL W/APPL 10 %-4 % Y  
59088028307 CAMPHOTREX menthol/camphor GEL W/APPL 10 %-4 % Y  
59088048807 CAMPHOTROL menthol/camphor GEL W/APPL 10 %-4 % Y  
00536126812 ANTI-ITCH menthol/camphor LOTION 0.5 %-0.5 % Y  
46122057310 ANTI-ITCH menthol/camphor LOTION 0.5 %-0.5 % Y  
70000054601 ANTI-ITCH menthol/camphor LOTION 0.5 %-0.5 % Y  
45802011426 MEDICATED SKIN CREAM menthol/camphor/phenol CREAM (G) Y  
45802059991 MEDICATED SKIN CREAM menthol/camphor/phenol CREAM (G) Y  
64380075216 METHOXSALEN methoxsalen CAP LQ RAP 10 mg N Y  
59088024306 METHYL SALICYLATE methyl salicylate CREAM (G) 10 % Y  
59088001306 METHYLTEN methyl salicylate CREAM (G) 10 % Y  
59088001406 METHYL SALICYLATE methyl salicylate CREAM (G) 25 % Y  
85477031110 METHYL SALICYLATE methyl salicylate CREAM (G) 25 % Y  
59088024506 METHYLTEN methyl salicylate CREAM (G) 25 % Y  
85477030110 METHYL SALICYLATE methyl salicylate CREAM(ML) 25 % Y  
46122064513 MEDICATED RELIEF methyl salicylate/menth/camph ADH. PATCH 10 %-6 %-3.1 % (large) Y  
70000036801 PAIN RELIEVING PATCH methyl salicylate/menth/camph ADH. PATCH 10 %-6 %-3.1 % (large) Y  
59088020207 MENTICAM methyl salicylate/menth/camph CREAM (G) 10 %-7.5 %-4 % Y  
70000020801 MUSCLE RUB ULTRA STRENGTH methyl salicylate/menth/camph CREAM (G) 30 %-10 %-4 % Y  
70000020802 MUSCLE RUB ULTRA STRENGTH methyl salicylate/menth/camph CREAM (G) 30 %-10 %-4 % Y  
59088020307 MENTICAM methyl salicylate/menth/camph GEL (GRAM) 30 %-10 %-4 % Y  
70512010460 NEURACIN methyl salicylate/menth/camph GEL (GRAM) 30 %-10 %-4 % Y  
00095012016 PANALGESIC methyl salicylate/menth/camph LOTION Y  
00904734201 ARTHRITIS PAIN RELIEF methyl salicylate/menthol ADH. PATCH 10 %-3 % Y  
00904734233 ARTHRITIS PAIN RELIEF methyl salicylate/menthol ADH. PATCH 10 %-3 % Y  
45802022653 ARTHRICREAM HEAT methyl salicylate/menthol CREAM (G) Y  
00095002105 PANALGESIC methyl salicylate/menthol CREAM (G) Y  
45802029153 ULTRA STRENGTH MUSCLE RUB methyl salicylate/menthol CREAM (G) Y  
73352057504 TRICYLATE methyl salicylate/menthol CREAM (G) 10 %-2 % Y  
00536110145 PAIN RELIEVING CREAM methyl salicylate/menthol CREAM (G) 15 %-1 % Y  
00178032003 THERA-GESIC methyl salicylate/menthol CREAM (G) 15 %-1 % Y  
71269000503 THERA-GESIC methyl salicylate/menthol CREAM (G) 15 %-1 % Y  
71269000505 THERA-GESIC methyl salicylate/menthol CREAM (G) 15 %-1 % Y  
45802017495 EXTRA STRENGTH MUSCLE RUB methyl salicylate/menthol CREAM (G) 15 %-10 % Y  
00536134957 MUSCLE RUB methyl salicylate/menthol CREAM (G) 15 %-10 % Y  
11527005740 MUSCLE RUB methyl salicylate/menthol CREAM (G) 15 %-10 % Y  
71269001003 THERA-GESIC PLUS methyl salicylate/menthol CREAM (G) 25 %-4 % Y  
59088043405 CAPASIL methyl salicylate/menthol CREAM(ML) 10 %-2 % Y  
59088021505 MENCYLATE methyl salicylate/menthol CREAM(ML) 10 %-2 % Y  
45802007503 ANALGESIC BALM methyl salicylate/menthol OINT. (G) Y  
45802007505 ANALGESIC BALM methyl salicylate/menthol OINT. (G) Y  
45802011305 BACK RUB methyl salicylate/menthol OINT. (G) Y  
45802014953 MUSCLE RUB methyl salicylate/menthol OINT. (G) Y  
45861000301 MENTHODERM methyl salicylate/menthol OINT. (G) 15 %-10 % Y  
45861000360 MENTHODERM methyl salicylate/menthol OINT. (G) 15 %-10 % Y  
00299383645 METROCREAM metronidazole CREAM (G) 0.75 % Y  
00168032346 METRONIDAZOLE metronidazole CREAM (G) 0.75 % Y  
66993096045 METRONIDAZOLE metronidazole CREAM (G) 0.75 % Y  
68308071145 METRONIDAZOLE metronidazole CREAM (G) 0.75 % Y  
72578012908 METRONIDAZOLE metronidazole CREAM (G) 0.75 % Y  
43538018045 ROSADAN metronidazole CREAM (G) 0.75 % Y  
00187520260 NORITATE metronidazole CREAM (G) 1 % Y  
21922007006 METRONIDAZOLE metronidazole GEL (GRAM) 0.75 % Y  
51672411606 METRONIDAZOLE metronidazole GEL (GRAM) 0.75 % Y  
43538018245 ROSADAN metronidazole GEL (GRAM) 0.75 % Y  
00299382060 METROGEL metronidazole GEL (GRAM) 1 % Y  
00713057460 METRONIDAZOLE metronidazole GEL (GRAM) 1 % Y  
51672416403 METRONIDAZOLE metronidazole GEL (GRAM) 1 % Y  
51672421503 METRONIDAZOLE metronidazole GEL (GRAM) 1 % Y  
59651081360 METRONIDAZOLE metronidazole GEL (GRAM) 1 % Y  
62332063060 METRONIDAZOLE metronidazole GEL (GRAM) 1 % Y  
66993093661 METRONIDAZOLE metronidazole GEL (GRAM) 1 % Y  
68308066360 METRONIDAZOLE metronidazole GEL (GRAM) 1 % Y  
51672416409 METRONIDAZOLE metronidazole GEL W/PUMP 1 % N Y  
51672421509 METRONIDAZOLE metronidazole GEL W/PUMP 1 % N Y  
62332063055 METRONIDAZOLE metronidazole GEL W/PUMP 1 % N Y  
68308066355 METRONIDAZOLE metronidazole GEL W/PUMP 1 % N Y  
00168038360 METRONIDAZOLE metronidazole LOTION 0.75 % Y  
66993096159 METRONIDAZOLE metronidazole LOTION 0.75 % Y  
68308071259 METRONIDAZOLE metronidazole LOTION 0.75 % Y  
43538018145 ROSADAN metronidazole/skin cleanser 23 KIT CL-CRM 0.75 % Y  
43538018345 ROSADAN metronidazole/skin cleanser 23 KIT CL-GEL 0.75 % Y  
51672212804 MINOXIDIL FOR MEN minoxidil FOAM 5 % Y  
51672212904 MINOXIDIL FOR WOMEN minoxidil FOAM 5 % Y  
49348013430 HAIR REGROWTH TREATMENT minoxidil SOLUTION 2 % Y  
57782032598 MINOXIDIL minoxidil SOLUTION 2 % Y  
82429026110 GAINEXTRA HAIR REGROWTH minoxidil SOLUTION 5 % Y  
00113079830 HAIR REGROWTH TREATMENT minoxidil SOLUTION 5 % Y  
37205038016 MINOXIDIL minoxidil SOLUTION 5 % Y  
37205038026 MINOXIDIL minoxidil SOLUTION 5 % Y  
61269009473 MINOXIDIL minoxidil SOLUTION 5 % Y  
61269009475 MINOXIDIL minoxidil SOLUTION 5 % Y  
00096068275 SOLBAR PF oxybenzone/cinoxate CREAM (G) Y  
00096068404 SOLBAR PF oxybenzone/cinoxate LIQUID Y  
00096068504 SOLBAR PF oxybenzone/cinoxate LIQUID Y  
00884309604 TI-SCREEN oxybenzone/cinoxate LOTION Y  
00884209604 TI-SCREEN oxybenzone/octinox/sunscreen GEL (GRAM) Y  
00884159604 TI-SCREEN oxybenzone/octinoxate LOTION Y  
00113023426 SUNBLOCK oxybenzone/padimate O LOTION Y  
45802019489 LIP TREATMENT W/SUNBLOCK 15 oxybenzone/pdo/petrolatum OINT. (G) Y  
51862076530 RHOFADE oxymetazoline HCl CREAM (G) 1 % Y  
71403000330 RHOFADE oxymetazoline HCl CREAM (G) 1 % Y  
00884209301 CASTELLANI PAINT MODIFIED phenol liquid LIQUID Y  
00884629730 PHENOL EZ phenol liquid MED. SWAB 89 % Y  
00023611803 CONDYLOX podofilox GEL (GRAM) 0.5 % Y  
00574062105 PODOFILOX podofilox GEL (GRAM) 0.5 % Y  
00574061105 PODOFILOX podofilox SOLUTION 0.5 % Y  
00574060115 PODOCON-25 podophyllum resin LIQUID 25 % Y  
00245002168 AMLACTIN pramoxine HCl/ammonium lactate KIT 1 %-12 % Y  
83324005306 CALAMINE MEDICATED pramoxine HCl/calamine LOTION 1 %-8 % Y  
70000040001 CALAMINE PLUS pramoxine HCl/calamine LOTION 1 %-8 % Y  
24385007282 CALDYPHEN pramoxine HCl/calamine LOTION 1 %-8 % Y  
70677119801 CALDYPHEN pramoxine HCl/calamine LOTION 1 %-8 % Y  
46122074531 CALAMINE PLUS pramoxine HCl/calamine SPRAY 1 %-8 % Y  
83324024241 CALAMINE PLUS pramoxine HCl/calamine SPRAY 1 %-8 % Y  
45802028182 CALDYPHEN CLEAR pramoxine HCl/camph/zinc acet LOTION Y  
49348061036 CALDYPHEN CLEAR pramoxine HCl/camph/zinc acet LOTION Y  
24385007682 CLEAR MEDICATED LOTION pramoxine HCl/camph/zinc acet LOTION Y  
70000039701 CALAMINE CLEAR pramoxine HCl/zinc acetate LOTION 1 %-0.1 % Y  
00536126958 CALDYPHEN CLEAR pramoxine HCl/zinc acetate LOTION 1 %-0.1 % Y  
24385043930 CALDYPHEN CLEAR pramoxine HCl/zinc acetate LOTION 1 %-0.1 % Y  
70677119901 CALDYPHEN CLEAR pramoxine HCl/zinc acetate LOTION 1 %-0.1 % Y  
83324024506 CLEAR ANTI-ITCH pramoxine HCl/zinc acetate LOTION 1 %-0.1 % Y  
54859020204 DERMAGESIC pramoxine/zinc oxide/calamine CREAM (G) 1 %-0.4 %-0.4 % Y  
54859012004 DERMAGESIC pramoxine/zinc oxide/calamine LOTION 1 %-0.4 %-0.4 % Y  
00113015364 DANDRUFF SHAMPOO pyrithione zinc SHAMPOO 1 % Y  
00113017764 DANDRUFF SHAMPOO pyrithione zinc SHAMPOO 1 % Y  
00113028164 DANDRUFF SHAMPOO pyrithione zinc SHAMPOO 1 % Y  
70000053301 DANDRUFF SHAMPOO pyrithione zinc SHAMPOO 1 % Y  
00113087864 SHAMPOO PLUS pyrithione zinc SHAMPOO 1 % Y  
00096073508 DHS ZINC pyrithione zinc SHAMPOO 2 % Y  
00096073516 DHS ZINC pyrithione zinc SHAMPOO 2 % Y  
00024153001 PHISOAC BP resorcinol/sulfur CREAM (G) Y  
46122052413 CALLUS REMOVERS salicylic acid ADH. PATCH 40 % Y  
70000033301 CALLUS REMOVERS salicylic acid ADH. PATCH 40 % Y  
46122052623 CORN REMOVER salicylic acid ADH. PATCH 40 % Y  
70000033001 CORN REMOVER salicylic acid ADH. PATCH 40 % Y  
70677123701 CORN REMOVER salicylic acid ADH. PATCH 40 % Y  
59088044508 DERMACINRX ATRIX salicylic acid CLEANSER 2 % Y  
82098000995 RAYASAL salicylic acid CREAM (G) 5.9 % Y  
59088022705 SALYCIM salicylic acid CREAM (G) 6 % Y  
59088044605 DERMACINRX ATRIX salicylic acid CREAM(ML) 2 % Y  
42192011270 SALICYLIC ACID salicylic acid FOAM 6 % Y  
42192013002 SALICYLIC ACID salicylic acid FOAM 6 % Y  
73159000560 CLEARACYLIC salicylic acid GEL (GRAM) 5.7 % Y  
42192013440 SALICYLIC ACID salicylic acid GEL (GRAM) 6 % Y  
71085007360 SALICYLIC ACID salicylic acid GEL (GRAM) 6 % Y  
73159000760 CLEARACYLIC PRO salicylic acid GEL (GRAM) 6.3 % Y  
42192013510 SALICYLIC ACID salicylic acid LIQ-FILM 27.5 % Y  
45802015861 CORN REMOVER salicylic acid LIQUID 10 % Y  
59088021403 SALICATE salicylic acid LIQUID 10 % Y  
45802019163 WART LIQUID salicylic acid LIQUID 15 % Y  
70000033201 LIQUID CORN-CALLUS REMOVER salicylic acid LIQUID 17 % Y  
46122036229 WART REMOVER salicylic acid LIQUID 17 % Y  
70000032901 WART REMOVER salicylic acid LIQUID 17 % Y  
73352010730 SALICYLIC ACID salicylic acid OINT. (G) 3 % Y  
00096073804 DHS SAL salicylic acid SHAMPOO 3 % Y  
70000055001 THERAPEUTIC DANDRUFF SHAMPOO salicylic acid SHAMPOO 3 % Y  
00575100408 X-SEB T PEARL salicylic acid/coal tar SHAMPOO Y  
45802010106 SEBEX-T salicylic acid/coal tar/sulfur SHAMPOO Y  
45802090107 SEBEX-T salicylic acid/coal tar/sulfur SHAMPOO Y  
45802090108 SEBEX-T salicylic acid/coal tar/sulfur SHAMPOO Y  
45802010006 SEBEX salicylic acid/sulfur SHAMPOO Y  
45802090007 SEBEX salicylic acid/sulfur SHAMPOO Y  
45802090008 SEBEX salicylic acid/sulfur SHAMPOO Y  
00536196297 SEBEX salicylic acid/sulfur SHAMPOO 2 %-2 % Y  
45802004064 SELENIUM SULFIDE selenium sulfide LOTION 2.5 % Y  
00536199553 ANTI-DANDRUFF selenium sulfide SHAMPOO 1 % Y  
70000053101 MEDICATED DANDRUFF SHAMPOO selenium sulfide SHAMPOO 1 % Y  
00074662001 SELSUN BLUE selenium sulfide SHAMPOO 1 % Y  
00074662030 SELSUN BLUE selenium sulfide SHAMPOO 1 % Y  
00074662035 SELSUN BLUE selenium sulfide SHAMPOO 1 % Y  
00074616501 SELSUN GOLD FOR WOMEN selenium sulfide SHAMPOO 1 % Y  
00074616520 SELSUN GOLD FOR WOMEN selenium sulfide SHAMPOO 1 % Y  
00074616540 SELSUN GOLD FOR WOMEN selenium sulfide SHAMPOO 1 % Y  
42192015206 SELENIUM SULFIDE selenium sulfide SHAMPOO 2.25 % Y  
58657047806 SELENIUM SULFIDE selenium sulfide SHAMPOO 2.25 % Y  
69367022918 SELENIUM SULFIDE selenium sulfide SHAMPOO 2.25 % Y  
00074660301 SELSUN BLUE selenium sulfide/aloe vera SHAMPOO 1 % Y  
00074660302 SELSUN BLUE selenium sulfide/aloe vera SHAMPOO 1 % Y  
00074660303 SELSUN BLUE selenium sulfide/aloe vera SHAMPOO 1 % Y  
00074660601 SELSUN BLUE selenium sulfide/menthol SHAMPOO 1 %-0.5 % Y  
00074660610 SELSUN BLUE selenium sulfide/menthol SHAMPOO 1 %-0.5 % Y  
00074660620 SELSUN BLUE selenium sulfide/menthol SHAMPOO 1 %-0.5 % Y  
68599630207 SILVER NITRATE APPLICATOR silver nitrate applicator STICK (EA) 75 %-25 % Y  
68599630208 SILVER NITRATE APPLICATOR silver nitrate applicator STICK (EA) 75 %-25 % Y  
68599630308 SILVER NITRATE APPLICATOR silver nitrate applicator STICK (EA) 75 %-25 % Y  
00259601908 AQUA GLYCOLIC skin cleanser CLEANSER Y  
00281019037 CATRIX CORRECTION skin cleanser CLEANSER Y  
00299392702 CETAPHIL skin cleanser CLEANSER Y  
00299392708 CETAPHIL skin cleanser CLEANSER Y  
00003401887 SEPTI-SOFT skin cleanser CLEANSER Y  
00003401888 SEPTI-SOFT skin cleanser CLEANSER Y  
00003401889 SEPTI-SOFT skin cleanser CLEANSER Y  
43538040016 ACUWASH skin cleanser comb no.19 CLEANSER Y  
43538042116 REHYLA HAIR-BODY skin cleanser comb no.40 CLEANSER Y  
00299011022 CETAPHIL GENTLE SKIN CLEANSER skin cleanser comb no.42 CLEANSER Y  
00299011024 CETAPHIL GENTLE SKIN CLEANSER skin cleanser comb no.42 CLEANSER Y  
00299011026 CETAPHIL GENTLE SKIN CLEANSER skin cleanser comb no.42 CLEANSER Y  
00299392734 CETAPHIL DAILY FACIAL CLEANSER skin cleanser comb no.44 CLEANSER Y  
43538042016 REHYLA skin cleanser comb.no.23 CLEANSER Y  
00299392304 CETAPHIL soap BAR Y  
00003325416 SENSI-CARE soap LIQ. SOAP Y  
00003159700 SAF-CLENS sodium chloride SPRAY 0.9 % Y  
00003159707 SAF-CLENS sodium chloride SPRAY 0.9 % Y  
60793021809 SODIUM CHLORIDE sodium chloride VIAL 0.9 % Y  
60793022109 SODIUM CHLORIDE sodium chloride VIAL 0.9 % Y  
00409666001 SODIUM CHLORIDE sodium chloride VIAL 2.5 mEq/mL Y  
00409666075 SODIUM CHLORIDE sodium chloride VIAL 2.5 mEq/mL Y  
63323009002 SODIUM CHLORIDE sodium chloride VIAL 2.5 mEq/mL Y  
63323009004 SODIUM CHLORIDE sodium chloride VIAL 2.5 mEq/mL Y  
63323009020 SODIUM CHLORIDE sodium chloride VIAL 2.5 mEq/mL Y  
63323009040 SODIUM CHLORIDE sodium chloride VIAL 2.5 mEq/mL Y  
00409114102 SODIUM CHLORIDE sodium chloride VIAL 4 mEq/mL Y  
00409114112 SODIUM CHLORIDE sodium chloride VIAL 4 mEq/mL Y  
63323008863 SODIUM CHLORIDE sodium chloride VIAL 4 mEq/mL Y  
63323009301 SODIUM CHLORIDE sodium chloride VIAL 4 mEq/mL Y  
63323009330 SODIUM CHLORIDE sodium chloride VIAL 4 mEq/mL Y  
63323009502 SODIUM CHLORIDE sodium chloride VIAL 4 mEq/mL Y  
63323009561 SODIUM CHLORIDE sodium chloride VIAL 4 mEq/mL Y  
63323009903 SODIUM CHLORIDE sodium chloride VIAL 4 mEq/mL Y  
63323009963 SODIUM CHLORIDE sodium chloride VIAL 4 mEq/mL Y  
00178049906 OVACE sulfacetamide sodium CLEANSER 10 % Y  
00178049912 OVACE sulfacetamide sodium CLEANSER 10 % Y  
00178063016 OVACE PLUS sulfacetamide sodium CLEANSER 10 % Y  
42192012916 SODIUM SULFACETAMIDE sulfacetamide sodium CLEANSER 10 % Y  
44523060612 SODIUM SULFACETAMIDE sulfacetamide sodium CLEANSER 10 % Y  
44523060616 SODIUM SULFACETAMIDE sulfacetamide sodium CLEANSER 10 % Y  
44523061306 SODIUM SULFACETAMIDE sulfacetamide sodium CLEANSER 10 % Y  
58657047706 SODIUM SULFACETAMIDE sulfacetamide sodium CLEANSER 10 % Y  
58657047712 SODIUM SULFACETAMIDE sulfacetamide sodium CLEANSER 10 % Y  
58657047716 SODIUM SULFACETAMIDE sulfacetamide sodium CLEANSER 10 % Y  
82429012708 SODIUM SULFACETAMIDE sulfacetamide sodium CLEANSER 10 % Y  
82429012716 SODIUM SULFACETAMIDE sulfacetamide sodium CLEANSER 10 % Y  
00178049012 OVACE PLUS WASH sulfacetamide sodium CLNSR GEL 10 % Y  
42192014612 SODIUM SULFACETAMIDE sulfacetamide sodium CLNSR GEL 10 % Y  
44523056812 SODIUM SULFACETAMIDE sulfacetamide sodium CLNSR GEL 10 % Y  
00178049502 OVACE PLUS sulfacetamide sodium CREAM (G) 10 % Y  
00178062002 OVACE PLUS sulfacetamide sodium LOTION 9.8 % Y  
00178048508 OVACE PLUS sulfacetamide sodium SHAMPOO 10 % Y  
44523051008 SODIUM SULFACETAMIDE sulfacetamide sodium SHAMPOO 10 % Y  
10337002361 SULPHO-LAC sulfur MED. SOAP 5 % Y  
00281020502 SURGILUBE surgical lubricant JELLY (G) Y  
00281020512 SURGILUBE surgical lubricant JELLY (G) Y  
00281020536 SURGILUBE surgical lubricant JELLY (G) Y  
00281020537 SURGILUBE surgical lubricant JELLY (G) Y  
00281020543 SURGILUBE surgical lubricant JELLY (G) Y  
00281020545 SURGILUBE surgical lubricant JELLY (G) Y  
00281020555 SURGILUBE surgical lubricant JELLY (G) Y  
00338421002 TISSEEL VHSD thrombin/fibrinog/aprotin/calc KIT 500 unit/mL-67 to 106 mg/mL-3,000 unit/mL-40 mcmol/mL (2 mL) Y  
00338430102 TISSEEL VHSD thrombin/fibrinog/aprotin/calc KIT 500 unit/mL-67 to 106 mg/mL-3,000 unit/mL-40 mcmol/mL (2 mL) Y  
00338421104 TISSEEL VHSD thrombin/fibrinog/aprotin/calc KIT 500 unit/mL-67 to 106 mg/mL-3,000 unit/mL-40 mcmol/mL (4 mL) Y  
00338430204 TISSEEL VHSD thrombin/fibrinog/aprotin/calc KIT 500 unit/mL-67 to 106 mg/mL-3,000 unit/mL-40 mcmol/mL (4 mL) Y  
00338421210 TISSEEL VHSD thrombin/fibrinog/aprotin/calc KIT 500 unit/mL-67 to 106 mg/mL-3,000 unit/mL-40 mcmol/mL(10 mL) Y  
00338430310 TISSEEL VHSD thrombin/fibrinog/aprotin/calc KIT 500 unit/mL-67 to 106 mg/mL-3,000 unit/mL-40 mcmol/mL(10 mL) Y  
00338964101 ARTISS thrombin/fibrinog/aprotin/calc SYRINGE 2.5 to 6.5 unit-67 to 106 mg/mL (10 mL) Y  
00338963701 ARTISS thrombin/fibrinog/aprotin/calc SYRINGE 2.5 to 6.5 unit-67 to 106 mg/mL (2 mL) Y  
00338963901 ARTISS thrombin/fibrinog/aprotin/calc SYRINGE 2.5 to 6.5 unit-67 to 106 mg/mL (4 mL) Y  
00338956001 TISSEEL VHSD thrombin/fibrinog/aprotin/calc SYRINGE 500 unit/mL-67 to 106 mg/mL-3,000 unit/mL-40 mcmol/mL (2 mL) Y  
00338956401 TISSEEL VHSD thrombin/fibrinog/aprotin/calc SYRINGE 500 unit/mL-67 to 106 mg/mL-3,000 unit/mL-40 mcmol/mL (4 mL) Y  
00338956801 TISSEEL VHSD thrombin/fibrinog/aprotin/calc SYRINGE 500 unit/mL-67 to 106 mg/mL-3,000 unit/mL-40 mcmol/mL(10 mL) Y  
00187515020 RENOVA tretinoin/emollient base CREAM (G) 0.02 % Y  
00187515040 RENOVA tretinoin/emollient base CREAM (G) 0.02 % Y  
00187515060 RENOVA tretinoin/emollient base CREAM (G) 0.02 % Y  
00187515044 RENOVA PUMP tretinoin/emollient base CREAM (G) 0.02 % Y  
45802035603 ANALGESIC BALM trolamine salicylate CREAM (G) 10 % Y  
45802016553 ARTHRICREAM trolamine salicylate CREAM (G) 10 % Y  
46122071321 ARTHRITIS trolamine salicylate CREAM (G) 10 % Y  
70000016901 PAIN RELIEVING trolamine salicylate CREAM (G) 10 % Y  
45802022882 ARTHRI-LOTION trolamine salicylate LOTION 10 % Y  
00536110945 UREA urea CREAM (G) 20 % Y  
44523061803 UREA urea CREAM (G) 20 % Y  
44523080108 UREA urea CREAM (G) 39 % Y  
59088069816 UREA urea CREAM (G) 39.5 % Y  
00904716723 UREA urea CREAM (G) 40 % Y  
00904716783 UREA urea CREAM (G) 40 % Y  
00904716799 UREA urea CREAM (G) 40 % Y  
44523061701 UREA urea CREAM (G) 40 % Y  
44523061703 UREA urea CREAM (G) 40 % Y  
44523061707 UREA urea CREAM (G) 40 % Y  
50268087219 UREA urea CREAM (G) 40 % Y  
50268087228 UREA urea CREAM (G) 40 % Y  
50268087285 UREA urea CREAM (G) 40 % Y  
58657048707 UREA urea CREAM (G) 40 % Y  
58657048901 UREA urea CREAM (G) 40 % Y  
58657048903 UREA urea CREAM (G) 40 % Y  
68134080101 UREA urea CREAM (G) 40 % Y  
68134080103 UREA urea CREAM (G) 40 % Y  
68134080107 UREA urea CREAM (G) 40 % Y  
82429030815 UREA urea CREAM (G) 40 % Y  
82429030824 UREA urea CREAM (G) 40 % Y  
82429030825 UREA urea CREAM (G) 40 % Y  
59088048916 UREA urea CREAM (G) 41 % Y  
85477090530 UREA urea CREAM (G) 41 % Y  
43538022010 URAMAXIN urea FOAM 20 % Y  
42192011515 UREA urea FOAM 35 % Y  
43538041028 TOETAL FRESH urea/camphor/menthol/eucalyptl SOLUTION Y  
46122033543 WITCH HAZEL witch hazel SOLUTION 86 % Y  
49348018138 WITCH HAZEL witch hazel SOLUTION 86 % Y  
62011026801 WITCH HAZEL witch hazel SOLUTION 86 % Y  
70000061501 WITCH HAZEL witch hazel SOLUTION 86 % Y  
70677125201 WITCH HAZEL witch hazel SOLUTION 86 % Y  
00132058550 WITCH DOCTOR witch hazel leaf PAD Y  
00113082234 WITCH HAZEL witch hazel leaf SOLUTION Y  
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