Drug Benefit List

84:00 SKIN AND MUCOUS MEMBRANE AGENTS (SMMA)

84:04.04 SMMA - ANTIBIOTICS

BACITRACIN

500IU Ointment

00584908     BACITIN     PMS

02060833     BACITRACIN     SHI

BACITRACIN ZINC, POLYMYXIN B SULFATE

500IU & 10,000IU Ointment

02237227     POLYSPORIN ANTIBIOTIC     PFI

CLINDAMYCIN PHOSPHATE

1% Solution

00582301     DALACIN T     PFI

02266938     TARO-CLINDAMYCIN     TAR

2% Vaginal Cream

02060604     DALACIN     PMJ

ERYTHROMYCIN, ETHYL ALCOHOL

2% & 44% Solution

01902628     SANS-ACNE     GAC

ERYTHROMYCIN, TRETINOIN

4% & 0.01% Gel

02015994     STIEVAMYCIN MILD     STI

4% & 0.025% Gel

01905112     STIEVAMYCIN     STI

4% & 0.05% Gel

01945262     STIEVAMYCIN FORTE     STI

FUSIDATE SODIUM

2% Ointment

00586676     FUCIDIN     LEO

FUSIDIC ACID

2% Cream

00586668     FUCIDIN     LEO

GRAMICIDIN, POLYMYXIN B SULFATE

0.25MG & 10,000IU Cream

02230844     POLYSPORIN ANTIBIOTIC     PFI

MUPIROCIN

2% Cream

02239757     BACTROBAN     GSK

2% Ointment

01916947     BACTROBAN     GSK

POLYMYXIN B SULFATE, BACITRACIN

10,000IU & 500IU Ointment

00792217     ANTIBIOTIC     PDD

00876488     BACIMYXIN     PMS

00621366     BIODERM     ODN

01942921     POLYTOPIC     SDZ

84:04.06 SMMA - ANTIVIRALS

ACYCLOVIR

5% Cream

02039524     ZOVIRAX     GSK

5% Ointment

00569771     ZOVIRAX     GSK

IDOXURIDINE

0.1% Topical Solution

00001317     HERPLEX-D LIQUIFILM     ALL

02237187     SANDOZ-IDOXURIDINE     SDZ

84:04.08 SMMA - ANTIFUNGALS

CLOTRIMAZOLE

1% Cream

02150867     CANESTEN     BCD

00812382     CLOTRIMADERM     TAR

00874043     NEO-ZOL     NEO

1% & 200MG Cream & Vaginal Suppository

02150921     CANESTEN 3 COMBI PAK     BCD

1% & 500MG Cream & Vaginal Suppository

02150948     CANESTEN 1 COMBI PAK     BCD

1% Vaginal Cream

02150891     CANESTEN     BCD

00812366     CLOTRIMADERM     TAR

00874051     NEO-ZOL     NEO

2% Vaginal Cream

02150905     CANESTEN     BCD

00812374     CLOTRIMADERM     TAR

ECONAZOLE NITRATE

1% Cream

02011948     ECOSTATIN     WSB

150MG Vaginal Suppository

02010267     ECOSTATIN     WSB

KETOCONAZOLE

2% Cream

02245662     KETODERM     TAR

00703974     NIZORAL     MCL

2% Shampoo

02182920     NIZORAL     MCL

MICONAZOLE NITRATE

2% Cream

02085852     MICATIN     MCL

02126567     MONISTAT-DERM     MCL

2% & 100MG Cream & Vaginal Suppository

02126257     MONISTAT 7 DUAL PAK     MCL

2% & 400MG Cream & Vaginal Suppository

02126249     MONISTAT 3 DUAL PAK     MCL

2% Vaginal Cream

02194368     MICONAZOLE 7     RPH

02231106     MICOZOLE     TAR

00980625     MONISTAT     MCL     *

02084309     MONISTAT 7     MCL

100MG Vaginal Suppository

02084295     MONISTAT 7     MCL

400mg Vaginal Suppository

02171775     MICONAZOLE     VTH

400MG Vaginal Suppository

02126605     MONISTAT 3     MCL

NYSTATIN

100,000IU Cream

00029092     MYCOSTATIN     BMS

02194236     RATIO-NYSTATIN     RPH

100,000IU Ointment

02194228     RATIO-NYSTATIN     RPH

Powder

00907472     NYSTATIN     WLR     *

25,000IU Vaginal Cream

00716901     NYADERM     TAR

100,000IU Vaginal Cream

02194163     RATIO-NYSTATIN     RPH

100,000IU Vaginal Tablet

02194171     RATIO-NYSTATIN     RPH

TERBINAFINE HCL

1% Cream

02031094     LAMISIL     NVR

TERCONAZOLE

0.4% Vaginal Cream

02247651     TARO-TERCONAZOLE     TAR

00894729     TERAZOL 7     JNO

0.8% Vaginal Cream

01934155     TERAZOL 3     JNO

0.8% & 80MG Vaginal Cream & Vaginal Suppository

02130874     TERAZOL 3 DUAL PAK     JNO

80MG Vaginal Suppository

00894710     TERAZOL 3     JNO

TOLNAFTATE

1% Cream

00576034     TINACTIN     SCH

00614211     TINACTIN     SCH

1% Powder

01919245     ATHLETES FOOT SPRAY     SCH

00576042     TINACTIN     SCH

02029081     ZEASORB AF     STI

1% Solution

00576026     TINACTIN     SCH

1% Spray

00576050     TINACTIN AEROSOL     SCH

84:04.12 SMMA - SCABICIDES AND PEDICULICIDES

BIOALLETHRINS, PETROLEUM, PIPERONYL BUTOXIDE

0.66% & 33.4% & 2.64% Spray

00899992     PARA     MTI

CROTAMITON

10% Cream

00623377     EURAX     NVC

ESDEPALLETHRIN, PIPERONYL BUTOXIDE

0.63% & 5.04% Aerosol

02229874     SCABENE     MTI

LINDANE

1% Lotion

00703591     PMS-LINDANE     PMS

1% Shampoo

00430617     HEXIT     ODN

00703605     PMS-LINDANE     PMS

PERMETHRIN

5% Cream

02219905     NIX DERMAL     GSK

5% Lotion

02231348     KWELLADA-P     GSK

1% Rinse

02231480     KWELLADA-P     GSK

00771368     NIX     WLA

PIPERONYL BUTOXIDE, PYRETHRINS

3% & 0.3% Shampoo

02125447     R & C     GSK

84:04.92 SMMA - MISCELLANEOUS LOCAL ANTI-INFECTIVES

BENZOYL PEROXIDE

2.5% Gel (Acetone Base)

00406813     ACETOXYL     STI

5% Gel (Acetone Base)

00406821     ACETOXYL     STI

10% Gel (Acetone Base)

00406848     ACETOXYL     VAO

5% Gel (Alcohol Base)

02162113     BENZAGEL     NVC

00263702     PANOXYL-5     STI

10% Gel (Alcohol Base)

00263699     PANOXYL-10     STI

15% Gel (Alcohol Base)

00403571     PANOXYL-15     STI

20% Gel (Alcohol Base)

00373036     PANOXYL-20     STI

2.5% Gel (Water Base)

02214830     PANOXYL AQUAGEL     STI

4% Gel (Water Base)

01975382     SOLUGEL     STI

5% Gel (Water Base)

00899453     BENZAC AC     GAC

01925180     BENZAC W5     GAC     *

02214849     PANOXYL AQUAGEL     STI

8% Gel (Water Base)

02019825     SOLUGEL     STI

10% Gel (Water Base)

01912437     BENZAC AC     GAC

01925997     BENZAC W10     GAC

01908871     DESQUAM X     WSB

2.5% Lotion

02046539     OXY 5     GSK

5% Lotion

00236063     BENOXYL     STI

02166607     BENZAGEL 5     NVC

00374326     OXYDERM     VAE

10% Lotion

00370568     BENOXYL     STI

20% Lotion

00374318     OXYDERM     VAE

5% Soap

00483184     PANOXYL-5     STI

10% Soap

00527661     PANOXYL-10     STI

5% Wash

00896276     BENZAC W     GAC

02162121     BENZAGEL     NVC

01908898     DESQUAM X     WSB

02214857     PANOXYL     STI

10% Wash

01925199     BENZAC W     GAC

01908901     DESQUAM X     WSB

CHLORHEXIDINE ACETATE

0.5% Dressing

00433497     BACTIGRAS     SNE

00905097     BACTIGRAS 5X5CM     SNE     *

00960330     BACTIGRAS 5X5CM     SNE     *

CHLORHEXIDINE GLUCONATE

2% Liquid

01938991     STANHEXIDINE     SDR

4% Liquid

01938983     STANHEXIDINE     SDR

HEXACHLOROPHENE

3% Liquid

02017733     PHISOHEX     SAC

HYDROGEN PEROXIDE

3% Liquid

00167703     HYDROGEN PEROXIDE 10V     RWP

00485721     HYDROGEN PEROXIDE 10V     RPH     *

00579297     PEROXIDE D'HYDROGENE     ATL

ISOPROPYL ALCOHOL

70% Liquid

00426539     DUONALC     VAE

METRONIDAZOLE

0.75% Cream

02226839     METROCREAM     GAC

1% Cream

02156091     NORITATE     SAC

02242919     ROSASOL     STI

0.75% Gel

02092832     METROGEL     GAC

0.75% Lotion

02248206     METROLOTION     GAC

10% Vaginal Cream

01926861     FLAGYL     SAC

0.75% Vaginal Gel

02125226     NIDAGEL     MMH

METRONIDAZOLE, NYSTATIN

100MG & 20,000U/G Vaginal Cream

01926845     FLAGYSTATIN     AVT

500MG & 100,000IU Vaginal Suppository

01926829     FLAGYSTATIN     AVT

POVIDONE-IODINE

10% Dressing

00276731     BETADINE SWAB AIDS     PFR

10% Liquid

00158348     BETADINE     PFR

SELENIUM SULFIDE

2.5% Lotion

00243000     SELSUN     ABB

00594601     VERSEL     VAO

SILVER SULFADIAZINE

1% Cream

02010917     DERMAZIN     PMS

00323098     FLAMAZINE     SNE

00896861     FLAMAZINE     SNE     *

09854037     FLAMAZINE 50G     SNE     *

02170310     SSD     ABB

TRICLOSAN

0.5% Liquid

00632317     TERSASEPTIC     STI

84:06.00 SMMA - ANTI-INFLAMMATORY AGENTS

AMCINONIDE

0.1% Cream

02192284     CYCLOCORT     STI

02247098     RATIO-AMCINONIDE     RPH

02246714     TARO-AMCINONIDE     TAR

0.1% Lotion

02192276     CYCLOCORT     STI

02247097     RATIO-AMCINONIDE     RPH

0.1% Ointment

02192268     CYCLOCORT     STI

02247096     RATIO-AMCINONIDE     RPH

BECLOMETHASONE DIPROPIONATE

0.025% Cream

02089602     PROPADERM     SHI

0.025% Lotion

02089610     PROPADERM     SHI

BETAMETHASONE DIPROPIONATE

0.05% Cream

00323071     DIPROSONE     SCH

02217848     PRO-SONE     PDL

00804991     RATIO-TOPISONE     RPH

02122049     ROSONE     RIV

0.05% Lotion

00417246     DIPROSONE     SCH

02217821     PRO-SONE     PDL

00809187     RATIO-TOPISONE     RPH

02122030     ROSONE     RIV

0.05% Ointment

00344923     DIPROSONE     SCH

02217856     PRO-SONE     PDL

00805009     RATIO-TOPISONE     RPH

02122057     ROSONE     RIV

BETAMETHASONE DIPROPIONATE IN PROPYLENE GLYCOL

0.05% Cream

00688622     DIPROLENE     SCH

02217872     PRO-LENE GLYCOL     PDL

00849650     RATIO-TOPILENE GLYCOL     RPH

02122073     ROLENE     RIV

0.05% Lotion

00862975     DIPROLENE     SCH

01927914     RATIO-TOPILENE GLYCOL     RPH

02122065     ROLENE     RIV

0.05% Ointment

00629367     DIPROLENE     SCH

02217880     PRO-LENE GLYCOL     PDL

00849669     RATIO-TOPILENE GLYCOL     RPH

02122081     ROLENE     RIV

BETAMETHASONE DIPROPIONATE, CLOTRIMAZOLE

0.05% & 1% Cream

00611174     LOTRIDERM     SCH

BETAMETHASONE DIPROPIONATE, SALICYLIC ACID

0.05% & 2% Lotion

00578428     DIPROSALIC     SCH

02245688     RATIO-TOPISALIC     RPH

0.05% & 3% Ointment

00578436     DIPROSALIC     SCH

BETAMETHASONE DISODIUM PHOSPHATE

0.05MG/ML Enema

02060884     BETNESOL     SHI

BETAMETHASONE VALERATE

0.05% Cream

00535427     RATIO-ECTOSONE     RPH

0.1% Cream

00716626     BETADERM     TAR

00804541     PREVEX B     STI

00535435     RATIO-ECTOSONE     RPH

0.05% Lotion

00653209     RATIO-ECTOSONE     RPH

0.1% Lotion

00750050     RATIO-ECTOSONE     RPH

01940112     RIVASONE     RIV

0.1% Ointment

00716650     BETADERM     TAR

0.1% Scalp Lotion

00716634     BETADERM     TAR

00027944     VALISONE     SCH

BUDESONIDE

0.02MG/ML Enema

02052431     ENTOCORT     AZC

CLOBETASOL PROPIONATE

0.05% Cream

02245523     CLOBETASOL PROPIONATE     TAR

02213265     DERMOVATE     TAR

02024187     GEN-CLOBETASOL     GEN

02093162     NOVO-CLOBETASOL     NOP

02232191     PMS-CLOBETASOL     PMS

01910272     RATIO-CLOBETASOL     RPH

0.05% Ointment

02245524     CLOBETASOL PROPIONATE     TAR

02213273     DERMOVATE     TAR

02026767     GEN-CLOBETASOL     GEN

02126192     NOVO-CLOBETASOL     NOP

02232193     PMS-CLOBETASOL     PMS

01910280     RATIO-CLOBETASOL     RPH

0.05% Scalp Lotion

02213281     DERMOVATE     TAR

02216213     GEN-CLOBETASOL     GEN

02232195     PMS-CLOBETASOL     PMS

01910299     RATIO-CLOBETASOL     RPH

0.05% Solution

02245522     CLOBETASOL PROPIONATE     TAR

CLOBETASONE BUTYRATE

0.05% Cream

02214415     EUMOVATE     GSK

0.05% Ointment

02214423     EUMOVATE     GSK

DESONIDE

0.05% Cream

02048639     DESOCORT     GAC

02229315     PMS-DESONIDE     PMS

02154862     TRIDESILON     SCN

0.05% Lotion

02115514     DESOCORT     GAC

0.05% Ointment

02115522     DESOCORT     GAC

02229323     PMS-DESONIDE     PMS

02154870     TRIDESILON     SCN

DESOXIMETASONE

0.05% Cream

02221918     TOPICORT     SAC

0.25% Cream

02221896     TOPICORT     SAC

0.05% Gel

02221926     TOPICORT     SAC

0.25% Ointment

02221934     TOPICORT     SAC

DIFLUCORTOLONE VALERATE

0.1% Cream

00587826     NERISONE     STI

00587818     NERISONE OILY     STI

0.1% Ointment

00587834     NERISONE     STI

DIFLUCORTOLONE VALERATE, SALICYLIC ACID

0.1% & 3% Cream

02028719     NERISALIC OILY     STI

FLUOCINOLONE ACETONIDE

0.025% Ointment

02162512     SYNALAR     MDC

0.01% Scalp Lotion

00873292     DERMA-SMOOTHE     HIL

0.01% Shampoo

02242738     CAPEX     GAC

FLUOCINONIDE

0.05% Cream

02161923     LIDEX     MDC

00716863     LYDERM     OPT

02187655     LYDONIDE     RPH

00908274     TOPACTIN     NEO     *

0.05% Emollient Cream

02163152     LIDEMOL     MDC

02187671     LYDONIDE     RPH

00598933     TIAMOL     TAR

0.05% Gel

02236997     LYDERM     OPT

02161974     TOPSYN     HLR

0.05% Ointment

02161966     LIDEX     HLR

02236996     LYDERM     OPT

02187663     LYDONIDE     RPH

FLUTICASONE PROPIONATE

0.05% Cream

02089912     CUTIVATE     GSK

HALCINONIDE

0.1% Cream

02011921     HALOG     WSB

0.1% Ointment

02010283     HALOG     WSB

0.1% Solution

02010291     HALOG     WSB

HALOBETASOL PROPIONATE

0.05% Cream

01962701     ULTRAVATE     WSB

0.05% Ointment

01962728     ULTRAVATE     WSB

HYDROCORTISONE

0.5% Cream

00513288     CORTATE     SCH

1% Cream

02086034     BARRIERE HC     SHI

00192597     EMO CORT     STI

00804533     PREVEX HC     STI

2.5% Cream

00595799     EMO CORT     STI

100MG/60ML Enema

02112736     CORTENEMA     AXC

00230316     HYCORT     VAE

0.5% Lotion

00513253     CORTATE     SCH

1% Lotion

00192600     EMO CORT     STI

00578541     SARNA HC     STI

2.5% Lotion

00595802     EMO CORT     STI

00641154     EMO CORT SCALP     STI

00856711     SARNA HC     STI

0.5% Ointment

00513261     CORTATE     SCH

1% Ointment

00716693     CORTODERM     TAR

HYDROCORTISONE ACETATE

10% Aerosol Foam

00579335     CORTIFOAM     GSK

0.5% Cream

00716820     HYDERM     TAR

1% Cream

00716839     HYDERM     TAR

2% Cream

00749834     NEO-HC     NEO

1% Lotion

00681997     DERMAFLEX HC     NEO

HYDROCORTISONE ACETATE, ZINC SULFATE

0.5% & 0.5% Ointment

02128446     ANODAN-HC     ODN

00505773     ANUSOL HC     PFI

02209764     EGOZINC-HC     PMS

00607789     RATIO-HEMCORT HC     RPH

02247691     SAB-ANUZINC HC     SDZ

10MG & 10MG Suppository

02236399     ANODAN-HC     ODN

00476285     ANUSOL HC     PFI

02210517     EGOZINC HC     PMS

00607797     RATIO-HEMCORT HC     RPH

02240112     RIVASOL-HC     RIV

02242798     SAB-ANUZINC HC     SAB

HYDROCORTISONE ACETATE, ZINC SULFATE, PRAMOXINE HCL

0.5% & 0.5% & 1% Ointment

00505781     ANUGESIC HC     PFI

02234466     PROCTODAN HC     ODN

02247692     SANDOZ-ANUZINC HC PLUS     SDZ

10MG & 10MG & 20MG Suppository

00476242     ANUGESIC HC     PFI

02240851     PROCTODAN HC     ODN

02242797     SAB-ANUZINC HC PLUS     SAB

HYDROCORTISONE VALERATE

0.2% Cream

02242984     HYDROVAL     TAR

01910124     WESTCORT     WSB

0.2% Ointment

02242985     HYDROVAL     TAR

01910132     WESTCORT     WSB

HYDROCORTISONE, DIBUCAINE HCL, ESCULIN, FRAMYCETIN SULFATE

5MG & 5MG & 10MG & 10MG Ointment

02247322     PROCTOL     ODN

02223252     PROCTOSEDYL     AXC

02226383     RATIO-PROCTOSONE     RPH

02242527     SANDOZ-PROCTOMYXIN HC     SDZ

5MG & 5MG & 10MG & 10MG Suppository

02247882     PROCTOL     ODN

02223260     PROCTOSEDYL     AXC

02226391     RATIO-PROCTOSONE     RPH

02242528     SAB-PROCTOMYXIN HC     SAB

HYDROCORTISONE, UREA

1% & 10% Cream

00503134     UREMOL HC     STI

1% & 10% Lotion

00560022     UREMOL HC     STI

MOMETASONE FUROATE

0.1% Cream

00851744     ELOCOM     SCH

0.1% Lotion

00871095     ELOCOM     SCH

0.1% Ointment

00851736     ELOCOM     SCH

02244769     PMS-MOMETASONE     PMS

02270862     PMS-MOMETASONE     PMS

02248130     RATIO-MOMETASONE     RPH

02264749     TARO-MOMETASONE     TAR

TRIAMCINOLONE ACETONIDE

0.1% Cream

02194058     ARISTOCORT R     VAO

01999818     KENALOG     WSB

0.5% Cream

02194066     ARISTOCORT C     VAO

0.1% Ointment

02194031     ARISTOCORT R     VAO

01999796     KENALOG     WSB

01999788     KENALOG ORABASE     WSB

0.1% Paste

01964054     ORACORT     TAR

84:08.00 SMMA - ANTIPRURITICS AND LOCAL ANESTHETICS

LIDOCAINE HCL

2% Liquid

01968823     LIDODAN VISCOUS     ODN

00811874     PMS-LIDOCAINE VISCOUS     PMS

00001686     XYLOCAINE VISCOUS     AZC

LIDOCAINE, PRILOCAINE

2.5% & 2.5% Cream

00886858     EMLA     AZC

2.5% & 2.5% Patch

02057794     EMLA     AZC

PHENAZOPYRIDINE HCL

100MG Tablet

00271489     PHENAZO     VAE

200MG Tablet

00454583     PHENAZO     VAE

84:16.00 SMMA - CELL STIMULANTS AND PROLIFERANTS

TRETINOIN

0.01% Cream

00897329     RETIN A     JNO

00657204     STIEVA-A     STI

01926497     VITAMIN A ACID     SAC

0.025% Cream

00897310     RETIN A     JNO

00578576     STIEVA-A     STI

01926500     VITAMIN A ACID     SAC

0.05% Cream

00443794     RETIN A     JNO

00518182     STIEVA-A     STI

01926519     VITAMIN A ACID     SAC

0.1% Cream

00870021     RETIN A     JNO

00662348     STIEVA-A FORTE     STI

01926527     VITAMIN A ACID     SAC

0.01% Gel

00587958     STIEVA-A     STI

01926462     VITAMIN A ACID     SAC

0.025% Gel

00587966     STIEVA-A     STI

01926470     VITAMIN A ACID     SAC

0.05% Gel

00641863     STIEVA-A     STI

01926489     VITAMIN A ACID     SAC

0.025% Solution

00578568     STIEVA-A     STI

84:24.12 BASIC OINTMENTS AND PROTECTANTS

DIMETHICONE

20% Cream

02060841     BARRIERE     WPC

PETROLATUM

67% Cream

00635189     PREVEX     STI

ZINC OXIDE

15% Ointment

00907480     ZINC     UNK     *

00811653     ZINCOFAX     PFI

25% Ointment

00532576     IHLES PASTE     RPH

40% Ointment

02239160     ZINCOFAX EXTRA STRENGTH     GSK

84:28.00 KERATOLYTIC AGENTS

ADAPALENE

0.1% Cream

02231592     DIFFERIN     GAC

0.1% Gel

02148749     DIFFERIN     GAC

CANTHARIDIN

0.7% Liquid

00589497     CANTHACUR     PMS

00619035     CANTHARONE     DOR

CANTHARIDIN, PODOPHYLLIN, SALICYLIC ACID

1% & 2% & 30% Liquid

00772011     CANTHARONE PLUS     DOR

1% & 5% & 30% Liquid

00589500     CANTHACUR PS     PMS

DITHRANOL

0.1% Cream

00537594     ANTHRANOL-1     MTI

0.2% Cream

00537608     ANTHRANOL-2     MTI

1% Cream

02233053     MICANOL     CDX

0.4% Lotion

00695351     ANTHRASCALP     MTI

1% Ointment

00566756     ANTHRAFORTE     MTI

2% Ointment

00566748     ANTHRAFORTE     MTI

FORMALDEHYDE, LACTIC ACID, SALICYLIC ACID

10% & 5% & 25% Ointment

00513091     DUOPLANT     STI

LACTIC ACID, SALICYLIC ACID

17% & 17% Liquid

00370576     DUOFILM     STI

PODOFILOX

0.5% Solution

01945149     CONDYLINE     CDX

PODOPHYLLIN

25% Liquid

00598208     PODOFILM     PMS

SALICYLIC ACID

27% Gel

01939645     DUOFORTE 27     STI

20% Liquid

00690333     SOLUVER     DER

26% Liquid

00754951     OCCLUSAL HP     GEN

27% Liquid

00837733     SOLUVER PLUS     DER

15% Plaster

02050285     TRANS PLANTAR     WSB

02050293     TRANS-VER-SAL     WSB

40% Plaster

01974335     CLEAR AWAY     SCH

4% Shampoo

00666106     SEBCUR     DER

SALICYLIC ACID, TRICLOSAN

2% & 0.5% Gel

00754927     PANOXYL ACNE     STI

84:32.00 KERATOPLASTIC AGENTS

COAL TAR

2% Gel

01909185     ESTAR     WSB

10% Gel

00344508     TARGEL     ODN

20% Liquid

00358495     ODANS LIQUOR CARBONIS DETERGENT     ODN

1% Shampoo

00632295     TERSA-TAR MILD     STI

3% Shampoo

00632309     TERSA-TAR     STI

4.3% Shampoo

00740314     PENTRAX     GEN

2.5% Solution

01908855     BALNETAR     WSB

COAL TAR, CHLOROXYLENOL

1% & 0.5% Shampoo

02220393     ZETAR     DER

COAL TAR, JUNIPER TAR, PINE TAR

1% Shampoo

00249866     POLYTAR     STI

COAL TAR, JUNIPER TAR, PINE TAR, ZINC PYRITHIONE

0.166% & 0.166% & 0.166% & 1% Shampoo

00628042     MULTI-TAR PLUS MILD     VAE     *

0.33% & 0.33% & 0.33% & 1% Shampoo

02240942     MULTITAR PLUS     VAE

COAL TAR, SALICYLIC ACID

8% & 2% Gel

00560448     P&S PLUS     BAK     *

10% & 3% Liquid

00510335     TARGEL SA     ODN

10% & 4% Shampoo

00666114     SEBCUR-T     DER

COAL TAR, SALICYLIC ACID, SULFUR

2% & 2% & 2% Shampoo

00444448     STEREX     IDE

84:50.06 PIGMENTING AGENTS

METHOXSALEN

10MG Capsule

00252654     OXSORALEN     VAE

01946374     OXSORALEN     VAE

00646237     ULTRA MOP     CDX

1% Lotion

01907476     OXSORALEN     VAE

00698059     ULTRA MOP     CDX

84:92.00 MISCELLANEOUS SKIN AND MUCOUS MEMBRANE AGENTS

ACITRETIN

Soriatane should be used with caution in women of childbearing potential due to its teratogenicity. Pregnancy must be excluded. Effective contraception must be used. Manufacturer's literature regarding contraindications and warnings, should be consulted prior to prescribing or dispensing this drug.

10MG Capsule

02070847     SORIATANE     HLR

25MG Capsule

02070863     SORIATANE     HLR

CALCIPOTRIOL

50MCG/G Cream

02150956     DOVONEX     LEO

50MCG/G Ointment

01976133     DOVONEX     LEO

50MCG/ML Solution

02194341     DOVONEX     LEO

CAPSAICIN

0.025% Cream

02157101     CAPSAICIN     VAO

00855766     ZODERM     PDD

00740306     ZOSTRIX     GEN

0.075% Cream

02004240     ZOSTRIX HP     GEN

0.075% Ointment

02157128     CAPSAICIN HP     VAO

COLLAGENASE

250U Ointment

02063670     SANTYL     KNO

FLUOROURACIL

5% Cream

00330582     EFUDEX     VAE

ISOTRETINOIN

Accutane should be used with caution in women of childbearing potential due to its teratogenicity. Pregnancy must be excluded. Effective contraception must be used. Manufacturer's literature regarding contraindications and warnings should be consulted prior to prescribing or dispensing this drug.

10MG Capsule

00582344     ACCUTANE     HLR

02257955     CLARUS     PRE

40MG Capsule

00582352     ACCUTANE     HLR

02257963     CLARUS     PRE

TACROLIMUS (PROTOPIC)

Limited use benefit (prior approval required).

Prescribed by a dermatologist, to be used in patients who have failed topical corticosteroid therapy or have experienced side effects from such treatment.

0.03% Ointment

02244149     PROTOPIC     AST

0.1% Ointment

02244148     PROTOPIC     AST

TAZAROTENE

0.05% Gel

02230784     TAZORAC     ALL

0.1% Gel

02230785     TAZORAC     ALL

VITAMIN E

30IU Ointment

01910787     VITAMIN E     JLF