Drug - Brand Name (Generic Name) PA Status Class Drug Notes "tolvaptan-Samsca BP, A90 - PA" PA VASOPRESSIN ANTAGONISTS "BP, A90" tolvaptan-Jynarque - PA PA VASOPRESSIN ANTAGONISTS trospium immediate-release A90 URINARY ANTISPASMODICS A90 trospium extended-release A90 - PA PA URINARY ANTISPASMODICS A90 "Toviaz (fesoterodine) BP, A90" URINARY ANTISPASMODICS "BP, A90" tolterodine immediate-release A90 URINARY ANTISPASMODICS "A90, #" tolterodine extended-release A90 URINARY ANTISPASMODICS "A90, #" trofinetide - PA PA UNCLASSIFIED DRUG PRODUCTS Tosymra (sumatriptan 10 mg nasal spray) - PA PA TRIPTAN tafamidis - PA PA TRANSTHYRETIN STABILIZER "Tirosint (levothyroxine-Tirosint) BP, M90" THYROID PREPARATIONS "BP, M90" thyroid THYROID PREPARATIONS Thyquidity (levothyroxine-Thyquidity) THYROID PREPARATIONS Tapazole # (methimazole) M90 THYROID PREPARATIONS "M90, #" Trecator (ethionamide) TB PREPARATIONS Tascenso ODT (fingolimod orally disintegrating tablet) - PA PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR "tasimelteon BP, A90 - PA" PA "SEDATIVE, NON-BARBITURATE" "BP, A90" tesamorelin - PA PA OTHER HORMONES Tadliq (tadalafil suspension) - PA PA OTHER ANTIHYPERTENSIVES tadalafil suspension - PA PA OTHER ANTIHYPERTENSIVES tapentadol - PA PA OPIOID ANALGESICS tapentadol extended-release - PA PA OPIOID ANALGESICS Trusopt # (dorzolamide) M90 OPHTHALMIC PREPARATIONS "M90, #" tropicamide A90 OPHTHALMIC PREPARATIONS "A90, #" trimethoprim / polymyxin B ophthalmic solution A90 OPHTHALMIC PREPARATIONS "A90, #" trifluridine A90 OPHTHALMIC PREPARATIONS "A90, #" Triesence (triamcinolone ophthalmic suspension-Triesence) MB OPHTHALMIC PREPARATIONS MB triamcinolone ophthalmic suspension-Xipere MB OPHTHALMIC PREPARATIONS MB triamcinolone ophthalmic suspension-Triesence MB OPHTHALMIC PREPARATIONS MB "travoprost 0.004% eye drop BP, M90" OPHTHALMIC PREPARATIONS "BP, M90" "Travatan Z (travoprost 0.004% eye drop) BP, M90" OPHTHALMIC PREPARATIONS "BP, M90" "Tobrex # (tobramycin ophthalmic ointment, solution) A90" OPHTHALMIC PREPARATIONS "A90, #" "tobramycin ophthalmic ointment, solution A90" OPHTHALMIC PREPARATIONS "A90, #" "tobramycin 0.3% / dexamethasone 0.1%, ophthalmic ointment, suspension A90" OPHTHALMIC PREPARATIONS "A90, #" "tobramycin 0.3% / dexamethasone 0.05%, ophthalmic suspension" OPHTHALMIC PREPARATIONS tobramycin / loteprednol ophthalmic suspension OPHTHALMIC PREPARATIONS "Tobradex ST (tobramycin 0.3% / dexamethasone 0.05%, ophthalmic suspension)" OPHTHALMIC PREPARATIONS "Tobradex # (tobramycin 0.3% / dexamethasone 0.1%, ophthalmic ointment, suspension) A90" OPHTHALMIC PREPARATIONS "A90, #" Timoptic-XE (timolol ophthalmic gel forming solution) M90 - PA PA OPHTHALMIC PREPARATIONS M90 "Timoptic Ocudose (timolol ophthalmic unit dose solution) BP, M90 - PA" PA OPHTHALMIC PREPARATIONS "BP, M90" Timoptic # (timolol-Timoptic) M90 OPHTHALMIC PREPARATIONS "M90, #" timolol-Timoptic M90 OPHTHALMIC PREPARATIONS "M90, #" "timolol ophthalmic unit dose solution BP, M90 - PA" PA OPHTHALMIC PREPARATIONS "BP, M90" timolol ophthalmic gel forming solution M90 - PA PA OPHTHALMIC PREPARATIONS M90 "timolol-Istalol BP, M90" OPHTHALMIC PREPARATIONS "BP, M90" timolol-Betimol - PA PA OPHTHALMIC PREPARATIONS tetracaine A90 OPHTHALMIC PREPARATIONS A90 "tafluprost BP, M90 - PA" PA OPHTHALMIC PREPARATIONS "BP, M90" Tegsedi (inotersen) - PA PA OLIGONUCLEOTIDE AGENTS tolmetin A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 tetrabenazine M90 - PA PA NEUROLOGIC AGENT M90 triamcinolone OTC nasal spray M90 - PA > 1 inhaler/30 days PA > 1 inhaler/30 days NASAL PREPARATIONS M90 tizanidine tablet A90 MUSCLE RELAXANT "A90, #" tizanidine capsule A90 - PA PA MUSCLE RELAXANT A90 Tysabri (natalizumab) MULTIPLE SCLEROSIS AGENTS teriflunomide A90 - PA > 1 unit/day PA > 1 unit/day MULTIPLE SCLEROSIS AGENTS "A90, #" Tecfidera # (dimethyl fumarate) A90 - PA > 2 units/day PA > 2 units/day MULTIPLE SCLEROSIS AGENTS "A90, #" Trilipix # (fenofibric acid) M90 LIPID LOWERING AGENTS "M90, #" "Tricor # (fenofibrate 48 mg, 145 mg tablet) M90" LIPID LOWERING AGENTS "M90, #" Tremfya (guselkumab) - PA PA IMMUNOMODULATOR tralokinumab-ldrm - PA PA IMMUNOMODULATOR tofacitinib - PA PA IMMUNOMODULATOR tofacitinib extended-release - PA PA IMMUNOMODULATOR tocilizumab vial MB - PA PA IMMUNOMODULATOR MB "tocilizumab auto-injection, prefilled syringe - PA" PA IMMUNOMODULATOR tildrakizumab-asmn - PA PA IMMUNOMODULATOR Thalomid (thalidomide) BP IMMUNOMODULATOR BP thalidomide BP IMMUNOMODULATOR BP Tavneos (avacopan) - PA PA IMMUNOMODULATOR Taltz (ixekizumab) PD - PA PA IMMUNOMODULATOR PD tacrolimus injection MB IMMUNOMODULATOR MB tacrolimus immediate-release capsule A90 IMMUNOMODULATOR "A90, #" tacrolimus granules - PA PA IMMUNOMODULATOR tacrolimus extended-release tablet - PA PA IMMUNOMODULATOR tacrolimus extended-release capsule IMMUNOMODULATOR Trivisc (hyaluronate-Trivisc) MB - PA PA HYALURONAN MB Triluron (hyaluronate-Triluron) MB - PA PA HYALURONAN MB Tlando (testosterone undecanoate capsule) - PA PA HORMONE REPLACEMENT THERAPY testosterone undecanoate injection MB - PA PA HORMONE REPLACEMENT THERAPY MB testosterone undecanoate capsule - PA PA HORMONE REPLACEMENT THERAPY testosterone patch - PA PA HORMONE REPLACEMENT THERAPY testosterone nasal gel - PA PA HORMONE REPLACEMENT THERAPY testosterone intramuscular pellet - PA PA HORMONE REPLACEMENT THERAPY testosterone enanthate - PA PA HORMONE REPLACEMENT THERAPY testosterone cypionate - PA PA HORMONE REPLACEMENT THERAPY testosterone 2% solution - PA PA HORMONE REPLACEMENT THERAPY testosterone 2% gel pump BP - PA PA HORMONE REPLACEMENT THERAPY BP testosterone 1% gel tube BP - PA PA HORMONE REPLACEMENT THERAPY BP "testosterone 1% gel tube, packet, pump - PA" PA HORMONE REPLACEMENT THERAPY testosterone 1% gel packet - PA PA HORMONE REPLACEMENT THERAPY testosterone 1.62% gel pump - PA PA HORMONE REPLACEMENT THERAPY testosterone 1.62% gel packet - PA PA HORMONE REPLACEMENT THERAPY Testopel (testosterone intramuscular pellet) - PA PA HORMONE REPLACEMENT THERAPY Testim (testosterone 1% gel tube) BP - PA PA HORMONE REPLACEMENT THERAPY BP Tymlos (abaloparatide) - PA PA HORMONE AGENTS triptorelin-Triptodur - PA PA HORMONE AGENTS Triptodur (triptorelin-Triptodur) - PA PA HORMONE AGENTS teriparatide - PA PA HORMONE AGENTS teriparatide-Forteo BP - PA PA HORMONE AGENTS BP tranexamic acid tablet HEMOSTATICS # Tavalisse (fostamatinib) - PA PA HEMATOLOGIC Triferic (ferric pyrophosphate citrate) MB HEMATINIC AGENT MB TBO-filgrastim HEMATINIC AGENT Talicia (omeprazole / amoxicillin / rifabutin) - PA PA H. PYLORI AGENTS triamcinolone spray A90 - PA PA GLUCOCORTICOIDS A90 triamcinolone paste A90 GLUCOCORTICOIDS A90 triamcinolone injection GLUCOCORTICOIDS # triamcinolone extended-release injectable suspension - PA PA GLUCOCORTICOIDS triamcinolone 0.5% ointment A90 GLUCOCORTICOIDS A90 "triamcinolone 0.1% ointment, 0.5% cream A90" GLUCOCORTICOIDS A90 "triamcinolone 0.1% lotion, 0.025% ointment A90" GLUCOCORTICOIDS A90 triamcinolone 0.1% cream A90 GLUCOCORTICOIDS A90 triamcinolone 0.05% ointment A90 - PA PA GLUCOCORTICOIDS A90 "triamcinolone 0.025% cream, lotion A90" GLUCOCORTICOIDS A90 "triamcinolone, oral A90" GLUCOCORTICOIDS A90 "Topicort (desoximetasone 0.25% ointment, spray, 0.05% gel) A90 - PA" PA GLUCOCORTICOIDS A90 "Topicort (desoximetasone 0.05% cream, ointment) A90 - PA" PA GLUCOCORTICOIDS A90 "Temovate # (clobetasol propionate cream, ointment) A90" GLUCOCORTICOIDS "A90, #" Tarpeyo (budesonide 4 mg delayed-release capsule) - PA PA GLUCOCORTICOIDS "Taclonex (betamethasone / calcipotriene scalp suspension) BP, A90 - PA" PA GLUCOCORTICOIDS "BP, A90" Taclonex (betamethasone / calcipotriene ointment) A90 - PA PA GLUCOCORTICOIDS A90 teduglutide injection BP - PA PA GASTROINTESTINAL AGENT BP Tolsura (itraconazole 65 mg capsule) - PA PA FUNGICIDES "tolnaftate *, A90" FUNGICIDES "*, A90" terbinafine tablet A90 FUNGICIDES A90 tavaborole A90 - PA PA FUNGICIDES A90 taliglucerase alfa MB - PA PA ENZYMES MB triheptanoin - PA PA ELECTROLYTES AND NUTRIENTS Travasol (amino acid and electrolyte IV infusion) ELECTROLYTES AND NUTRIENTS "thiamine *, M90" ELECTROLYTES AND NUTRIENTS "*, M90" Tzield (teplizumab-mzwv) - PA PA DIABETIC THERAPY teplizumab-mzwv - PA PA DIABETIC THERAPY Trulicity (dulaglutide) PD - PA > 2 mL/28 days PA > 2 mL/28 days DIABETIC AGENTS PD Trijardy XR (empagliflozin / linagliptin / metformin extended-release) - PA PA DIABETIC AGENTS Tresiba (insulin degludec) BP DIABETIC AGENTS BP Tradjenta (linagliptin) DIABETIC AGENTS Toujeo (insulin glargine-Toujeo) DIABETIC AGENTS tirzepatide - PA PA DIABETIC AGENTS "tretinoin-Retin-A BP, A90 - PA ≥ 22 years" PA ≥ 22 years DERMATOLOGICAL "BP, A90" tretinoin microspheres A90 - PA PA DERMATOLOGICAL A90 tretinoin-Avita A90 - PA ≥ 22 years PA ≥ 22 years DERMATOLOGICAL "A90, #" tretinoin 0.05% lotion - PA ≥ 22 years PA ≥ 22 years DERMATOLOGICAL tretinoin 0.05% gel A90 - PA PA DERMATOLOGICAL A90 tazarotene lotion - PA PA DERMATOLOGICAL tazarotene foam - PA PA DERMATOLOGICAL "tazarotene 0.1% cream, gel A90 - PA" PA DERMATOLOGICAL A90 tapinarof - PA PA DERMATOLOGICAL tacrolimus topical A90 DERMATOLOGICAL "A90, #" Trikafta (elexacaftor / tezacaftor / ivacaftor) PD - PA PA CYSTIC FIBROSIS AGENTS PD tezacaftor / ivacaftor PD - PA PA CYSTIC FIBROSIS AGENTS PD tocilizumab vial COVID MB COVID - 19 related Treatments and Vaccines MB Tyblume (levonorgestrel / ethinyl estradiol) CONTRACEPTIVES Twirla (levonorgestrel / ethinyl estradiol patch) CONTRACEPTIVES Taytulla # (ethinyl estradiol / norethindrone / ferrous fumarate) M90 CONTRACEPTIVES "M90, #" Trulance (plecanatide) - PA PA CONSTIPATION AGENTS tenapanor - PA PA CONSTIPATION AGENTS Tyrvaya (varenicline nasal spray) - PA PA CHOLINERGIC AGONIST "Tykerb (lapatinib) BP, A90" CHEMOTHERAPY "BP, A90" Turalio (pexidartinib) - PA PA CHEMOTHERAPY Tukysa (tucatinib) - PA PA CHEMOTHERAPY tucatinib - PA PA CHEMOTHERAPY Truxima (rituximab-abbs) MB - PA PA CHEMOTHERAPY MB Truseltiq (infigratinib) - PA PA CHEMOTHERAPY Trodelvy (sacituzumab govitecan-hziy) MB - PA PA CHEMOTHERAPY MB Trisenox # (arsenic trioxide) CHEMOTHERAPY # triptorelin-Trelstar MB - PA PA CHEMOTHERAPY MB trilaciclib MB - PA PA CHEMOTHERAPY MB trifluridine / tipiracil - PA PA CHEMOTHERAPY tretinoin capsule A90 CHEMOTHERAPY A90 Trelstar (triptorelin-Trelstar) MB - PA PA CHEMOTHERAPY MB Treanda (bendamustine) MB CHEMOTHERAPY MB Trazimera (trastuzumab-qyyp) MB - PA PA CHEMOTHERAPY MB trastuzumab-qyyp MB - PA PA CHEMOTHERAPY MB trastuzumab-pkrb MB - PA PA CHEMOTHERAPY MB trastuzumab MB - PA PA CHEMOTHERAPY MB trastuzumab-dttb MB - PA PA CHEMOTHERAPY MB trastuzumab-dkst MB - PA PA CHEMOTHERAPY MB trastuzumab-anns MB - PA PA CHEMOTHERAPY MB trastuzumab / hyaluronidase-oysk MB - PA PA CHEMOTHERAPY MB trametinib - PA PA CHEMOTHERAPY Torisel # (temsirolimus) CHEMOTHERAPY # toremifene A90 CHEMOTHERAPY "A90, #" topotecan injection MB CHEMOTHERAPY MB topotecan capsule CHEMOTHERAPY tivozanib - PA PA CHEMOTHERAPY Tivdak (tisotumab vedotin-tftv) MB - PA PA CHEMOTHERAPY MB tisotumab vedotin-tftv MB - PA PA CHEMOTHERAPY MB "tisagenlecleucel CO, MB - PA" PA CHEMOTHERAPY "CO, MB" Tibsovo (ivosidenib) - PA PA CHEMOTHERAPY thioguanine CHEMOTHERAPY tepotinib - PA PA CHEMOTHERAPY Tepmetko (tepotinib) - PA PA CHEMOTHERAPY teniposide CHEMOTHERAPY temsirolimus CHEMOTHERAPY # temozolomide A90 CHEMOTHERAPY "A90, #" Temodar # (temozolomide) A90 CHEMOTHERAPY "A90, #" Tecentriq (atezolizumab) MB - PA PA CHEMOTHERAPY MB "Tecartus (brexucabtagene autoleucel) CO, MB - PA" PA CHEMOTHERAPY "CO, MB" tebentafusp-tebn MB - PA PA CHEMOTHERAPY MB Tazverik (tazemetostat) - PA PA CHEMOTHERAPY tazemetostat - PA PA CHEMOTHERAPY Tasigna (nilotinib) CHEMOTHERAPY "Targretin (bexarotene) BP, A90" CHEMOTHERAPY "BP, A90" Tarceva (erlotinib) A90 - PA PA CHEMOTHERAPY A90 tamoxifen tablet M90 CHEMOTHERAPY M90 tamoxifen solution CHEMOTHERAPY Talzenna (talazoparib) - PA PA CHEMOTHERAPY talimogene laherparepvec MB - PA PA CHEMOTHERAPY MB talazoparib - PA PA CHEMOTHERAPY Tagrisso (osimertinib) - PA PA CHEMOTHERAPY tagraxofusp-erzs MB - PA PA CHEMOTHERAPY MB Tafinlar (dabrafenib) - PA PA CHEMOTHERAPY tafasitamab-cxix - PA PA CHEMOTHERAPY Tabrecta (capmatinib) - PA PA CHEMOTHERAPY Tabloid (thioguanine) CHEMOTHERAPY trientine tablet - PA PA CHELATING AGENT "trientine capsule BP, A90" CHELATING AGENT "BP, A90" "tiopronin BP, A90" CHELATING AGENT "BP, A90" "Thiola (tiopronin) BP, A90" CHELATING AGENT "BP, A90" Tyvaso DPI (treprostinil inhalation powder) - PA PA CARDIOVASCULAR Tyvaso (treprostinil inhalation solution) - PA PA CARDIOVASCULAR Twynsta (amlodipine / telmisartan) M90 - PA PA CARDIOVASCULAR M90 Tribenzor (amlodipine / olmesartan / hydrochlorothiazide) M90 - PA PA CARDIOVASCULAR M90 triamterene M90 - PA PA CARDIOVASCULAR M90 treprostinil tablet - PA PA CARDIOVASCULAR treprostinil injection BP - PA PA CARDIOVASCULAR BP treprostinil inhalation solution - PA PA CARDIOVASCULAR treprostinil inhalation powder - PA PA CARDIOVASCULAR trandolapril M90 CARDIOVASCULAR M90 trandolapril / verapamil M90 - PA PA CARDIOVASCULAR M90 "Tracleer (bosentan) BP, A90 - PA" PA CARDIOVASCULAR "BP, A90" torsemide M90 CARDIOVASCULAR M90 Toprol XL # (metoprolol extended-release tablet) M90 CARDIOVASCULAR "M90, #" timolol tablet M90 CARDIOVASCULAR M90 Tikosyn # (dofetilide) M90 CARDIOVASCULAR "M90, #" Tiazac ER # (diltiazem-Tiazac ER) M90 CARDIOVASCULAR "M90, #" Thalitone (chlorthalidone) CARDIOVASCULAR tetradecyl sulfate injection MB - PA PA CARDIOVASCULAR MB terazosin M90; See Table 18; See Table 19 CARDIOVASCULAR M90 Tenormin # (atenolol) M90 CARDIOVASCULAR "M90, #" Tenoretic # (atenolol / chlorthalidone) M90 CARDIOVASCULAR "M90, #" telmisartan M90 CARDIOVASCULAR "M90, #" telmisartan / hydrochlorothiazide M90 CARDIOVASCULAR "M90, #" Tekturna HCT (aliskiren / hydrochlorothiazide) CARDIOVASCULAR "Tekturna (aliskiren) BP, M90 - PA" PA CARDIOVASCULAR "BP, M90" tadalafil tablet-Adcirca A90 - PA PA CARDIOVASCULAR A90 Tudorza (aclidinium) BRONCHODILATORS Trelegy (fluticasone furoate / umeclidinium / vilanterol) - PA PA BRONCHODILATORS tiotropium inhalation solution BRONCHODILATORS "tiotropium inhalation powder BP, A90" BRONCHODILATORS "BP, A90" tiotropium / olodaterol - PA PA BRONCHODILATORS theophylline M90 BRONCHODILATORS M90 terbutaline A90 BRONCHODILATORS A90 typhoid vaccine injection BIOLOGICAL typhoid vaccine capsule BIOLOGICAL Typhim VI (typhoid vaccine injection) BIOLOGICAL "Twinrix (hepatitis A, inactivated / hepatitis B recombinant) 1" BIOLOGICAL 1 Trumenba (meningococcal group B vaccine-Trumenba) 1 BIOLOGICAL 1 "Thymoglobulin (antithymocyte globulin, rabbit)" BIOLOGICAL Tezspire (tezepelumab-ekko) - PA PA BIOLOGICAL tezepelumab-ekko - PA PA BIOLOGICAL tetanus toxoids / diphtheria / acellular pertussis vaccine 1 BIOLOGICAL 1 tetanus toxoid / diphtheria vaccine 1 BIOLOGICAL 1 "tetanus immune globulin IM, human" BIOLOGICAL teprotumumab-trbw MB - PA PA BIOLOGICAL MB Tepezza (teprotumumab-trbw) MB - PA PA BIOLOGICAL MB Tenivac (tetanus toxoid / diphtheria vaccine) 1 BIOLOGICAL 1 Takhzyro (lanadelumab-flyo) - PA PA BIOLOGICAL Ticovac (tick-borne encephalitis vaccine) BIOLOGICALS tick-borne encephalitis vaccine BIOLOGICALS tetanus toxoids / diphtheria / acellular pertussis / inactivated poliovirus vaccine BIOLOGICALS triazolam - PA 1 unit/day; See Table 69; See Table 71 PA 1 unit/day BENZODIAZEPINES # "temazepam 7.5 mg, 15 mg, 30 mg - PA 1 unit/day; See Table 69; See Table 71" PA 1 unit/day BENZODIAZEPINES # temazepam 22.5 mg - PA; See Table 69; See Table 71 PA BENZODIAZEPINES tamsulosin M90 BENIGN PROSTATIC HYPERPLASIA AGENTS "M90, #" tadalafil tablet-Cialis - PA PA BENIGN PROSTATIC HYPERPLASIA AGENTS Tybost (cobicistat) ANTIVIRALS Truvada # (emtricitabine / tenofovir disoproxil fumarate) A90 ANTIVIRALS "A90, #" Trogarzo (ibalizumab-uiyk) - PA PA ANTIVIRALS Trizivir # (abacavir / lamivudine / zidovudine) A90 ANTIVIRALS "A90, #" Triumeq (abacavir / dolutegravir / lamivudine) PD ANTIVIRALS PD Tivicay PD (dolutegravir tablet for oral suspension) ANTIVIRALS Tivicay (dolutegravir tablet) - PA > 1 unit/day PA > 1 unit/day ANTIVIRALS tipranavir ANTIVIRALS tenofovir disoproxil fumarate tablet A90 - PA > 1 unit/day; See Table 38; See Table 44 PA > 1 unit/day ANTIVIRALS "A90, #" tenofovir disoproxil fumarate powder A90 - PA ≥ 13 years; See Table 38; See Table 44 PA ≥ 13 years ANTIVIRALS A90 tenofovir alafenamide PD ANTIVIRALS PD Temixys (lamivudine / tenofovir disoproxil fumarate) - PA PA ANTIVIRALS Tamiflu # (oseltamivir suspension) - PA > 180 mL/ claim and PA > 360 mL/ 365 days PA > 180 mL/ claim and PA > 360 mL/ 365 days ANTIVIRALS # Tamiflu # (oseltamivir 45 mg and 75 mg) - PA > 10 units/ claim and PA > 20 units/ 365 days PA > 10 units/ claim and PA > 20 units/ 365 days ANTIVIRALS # Tamiflu # (oseltamivir 30mg) - PA > 20 units/ claim and PA > 40 units/ 365 days PA > 20 units/ claim and PA > 40 units/ 365 days ANTIVIRALS # trifluoperazine A90 - PA < 6 years; See Table 24; See Table 71 PA ANTIPSYCHOTIC A90 thiothixene A90 - PA < 6 years; See Table 24; See Table 71 PA ANTIPSYCHOTIC "A90, #" thioridazine A90 - PA < 6 years; See Table 24; See Table 71 PA ANTIPSYCHOTIC A90 ticagrelor ANTIPLATELET AGENT trihexyphenidyl A90 ANTIPARKINSON A90 tolcapone A90 - PA PA ANTIPARKINSON A90 Tasmar (tolcapone) A90 - PA PA ANTIPARKINSON A90 triclabendazole - PA PA ANTIPARASITICS tinidazole A90 ANTIPARASITICS A90 tremelimumab-actl MB - PA PA ANTINEOPLASTICS MB Tecvayli (teclistamab-cqyv) MB - PA PA ANTINEOPLASTICS MB teclistamab-cqyv MB - PA PA ANTINEOPLASTICS MB tafenoquine - PA > 2 units/365 days PA > 2 units/365 days ANTIMALARIALS Tretten (factor XIII A-subunit recombinant) ANTI-HEMOPHILIA AGENTS trimethobenzamide A90 ANTIEMETICS "A90, #" "Transderm-Scop (scopolamine transdermal patch) BP, A90" ANTIEMETICS "BP, A90" Tigan # (trimethobenzamide) A90 ANTIEMETICS "A90, #" Totect (dexrazoxane) ANTIDOTES telotristat ethyl - PA PA ANTIDIARRHEALS Trintellix (vortioxetine) - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS trimipramine A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 "trazodone 50 mg, 100 mg, 150 mg A90 - PA < 6 years; See Table 17; See Table 71" PA ANTIDEPRESSANTS A90 trazodone 300 mg tablet A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 tranylcypromine A90 - PA < 6 years; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 "Trokendi XR (topiramate extended-release capsule-Trokendi XR) BP, A90 - PA; See Table 20; See Table 71" PA ANTICONVULSANTS "BP, A90" Trileptal # (oxcarbazepine tablet) A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" "Trileptal (oxcarbazepine suspension) BP, A90 - PA < 6 years; See Table 20; See Table 71" PA ANTICONVULSANTS "BP, A90" topiramate tablet A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" topiramate sprinkle capsule A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" topiramate solution - PA; See Table 20; See Table 71 PA ANTICONVULSANTS "topiramate extended-release capsule-Trokendi XR BP, A90 - PA; See Table 20; See Table 71" PA ANTICONVULSANTS "BP, A90" topiramate extended-release capsule-Qudexy XR A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" Topamax # (topiramate tablet) A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" Topamax # (topiramate sprinkle capsule) A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" tiagabine A90 - PA PA ANTICONVULSANTS A90 "Tegretol XR (carbamazepine extended-release) BP, A90 - PA < 6 years; See Table 20; See Table 71" PA ANTICONVULSANTS "BP, A90" Tegretol # (carbamazepine-Tegretol) A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" Tygacil (tigecycline) - PA PA ANTIBIOTICS "triple antibiotic ointment (neomycin / bacitracin / polymyxin B topical ointment) *, A90" ANTIBIOTICS "*, A90" trimethoprim tablet A90 ANTIBIOTICS A90 tobramycin injection ANTIBIOTICS tobramycin inhalation solution-Tobi A90 ANTIBIOTICS "A90, #" "tobramycin inhalation solution-Kitabis Pak BP, A90" ANTIBIOTICS "BP, A90" "tobramycin inhalation solution-Bethkis BP, A90 - PA" PA ANTIBIOTICS "BP, A90" tobramycin inhalation powder - PA PA ANTIBIOTICS Tobi Podhaler (tobramycin inhalation powder) - PA PA ANTIBIOTICS Tobi # (tobramycin inhalation solution-Tobi) A90 ANTIBIOTICS "A90, #" tigecycline - PA PA ANTIBIOTICS tetracycline A90 ANTIBIOTICS A90 terconazole A90 ANTIBIOTICS "A90, #" Terazol # (terconazole) A90 ANTIBIOTICS "A90, #" telavancin - PA PA ANTIBIOTICS Teflaro (ceftaroline) BP ANTIBIOTICS BP tedizolid tablet - PA PA ANTIBIOTICS tedizolid injection - PA PA ANTIBIOTICS Trudhesa (dihydroergotamine nasal spray) - PA PA ANALGESICS tramadol solution - PA PA ANALGESICS tramadol extended-release tablet - PA PA ANALGESICS tramadol extended-release capsule - PA PA ANALGESICS tramadol 50 mg - PA 400 mg/day PA 400 mg/day ANALGESICS # tramadol 100 mg - PA PA ANALGESICS tramadol / acetaminophen - PA PA ANALGESICS tofersen MB - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS MB Tiglutik (riluzole suspension) - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS timothy grass pollen allergen extract - PA PA ALLERGENS