Doxycycline Hyclate TABLET 150 MG NF 3 Formulary Enhancement N/A Oral Doxycycline Hyclate TABLET 75 MG NF 3 Formulary Enhancement N/A Oral Efavirenz CAPSULE 50 MG Oral NF 3 Formulary Enhancement N/A Ethynodiol Diac-Eth Estradiol TABLET NF 2 Formulary Enhancement N/A 1-35 MG-MCG Oral Fosamprenavir Calcium TABLET 700 NF 5 Formulary Enhancement N/A MG Oral Glatiramer Acetate Solution Prefilled NF 5 + PA1 Formulary Enhancement N/A Syringe 20 MG/ML Subcutaneous Glatiramer Acetate Solution Prefilled NF 5 + PA1 Formulary Enhancement N/A Syringe 40 MG/ML Subcutaneous Gocovri CAPSULE EXTENDED NF 5 + PA1 Formulary Enhancement N/A RELEASE 24 HOUR 137 MG Oral Gocovri CAPSULE EXTENDED NF 5 + PA1 Formulary Enhancement N/A RELEASE 24 HOUR 68.5 MG Oral Haloperidol Decanoate SOLUTION 100 NF 3 Formulary Enhancement N/A MG/ML Intramuscular 1 ML Havrix SUSPENSION 1440 EL U/ML NF 4 Formulary Enhancement N/A Intramuscular (prefilled syringe) Havrix SUSPENSION 720 EL U/0.5ML NF 4 Formulary Enhancement N/A Intramuscular (prefilled syringe) Juluca TABLET 50-25 MG Oral NF 5 Formulary Enhancement N/A Kadcyla SOLUTION RECONSTITUTED 160 MG NF 5 Formulary Enhancement N/A Intravenous Klor-Con PACKET 20 MEQ Oral NF 2 Formulary Enhancement N/A
Doxycycline Hyclate TABLET 150 MG Oral NF 3 Formulary Enhancement N/A Doxycycline Hyclate TABLET 75 MG Oral NF 3 Formulary Enhancement N/A Efavirenz CAPSULE 50 MG Oral NF 3 Formulary Enhancement N/A Ethynodiol Diac-Eth Estradiol TABLET 1-35 MG-MCG Oral NF 2 Formulary Enhancement N/A Fosamprenavir Calcium TABLET 700 MG Oral NF 5 Formulary Enhancement N/A Glatiramer Acetate Solution Prefilled Syringe 20 MG/ML Subcutaneous NF 5 + PA1 Formulary Enhancement N/A Glatiramer Acetate Solution Prefilled Syringe 40 MG/ML Subcutaneous NF 5 + PA1 Formulary Enhancement N/A Gocovri CAPSULE EXTENDED RELEASE 24 HOUR 137 MG Oral NF 5 + PA1 Formulary Enhancement N/A Gocovri CAPSULE EXTENDED RELEASE 24 HOUR 68.5 MG Oral NF 5 + PA1 Formulary Enhancement N/A Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular 1 ML NF 3 Formulary Enhancement N/A Havrix SUSPENSION 1440 EL U/ML Intramuscular (prefilled syringe) NF 4 Formulary Enhancement N/A Havrix SUSPENSION 720 EL U/0.5ML Intramuscular (prefilled syringe) NF 4 Formulary Enhancement N/A Juluca TABLET 50-25 MG Oral NF 5 Formulary Enhancement N/A Kadcyla SOLUTION RECONSTITUTED 160 MG Intravenous NF 5 Formulary Enhancement N/A Klor-Con PACKET 20 MEQ Oral NF 2 Formulary Enhancement N/A