Drug - Brand Name (Generic Name) PA Status Class Drug Notes droxidopa A90 - PA PA ADRENERGICS A90 disulfiram A90 ALCOHOL AND DRUG CESSATION AGENT A90 dexmedetomidine MB ALPHA-2 ADRENERGIC AGONIST MB donepezil 10 mg tablet A90 - PA 2 units/day; See Table 56; See Table 71 PA 2 units/day ALZHEIMER'S THERAPY "A90, #" "donepezil 5 mg, 23 mg tablet A90 - PA 1 unit/day; See Table 56; See Table 71" PA 1 unit/day ALZHEIMER'S THERAPY "A90, #" donepezil orally disintegrating tablet A90 - PA 1 unit/day; See Table 56; See Table 71 PA 1 unit/day ALZHEIMER'S THERAPY A90 donepezil patch - PA; See Table 56; See Table 71 PA ALZHEIMER'S THERAPY dextroamphetamine transdermal - PA; See Table 31; See Table 71 PA AMPHETAMINE PREPARATIONS Dyanavel XR (amphetamine extended-release chewable tablet) - PA; See Table 31; See Table 71 PA AMPHETAMINE PREPARATIONS D.H.E. 45 (dihydroergotamine injection) - PA PA ANALGESICS dihydroergotamine injection - PA PA ANALGESICS dihydroergotamine nasal spray A90 - PA PA ANALGESICS A90 dihydroergotamine nasal spray - PA PA ANALGESICS dimethyl sulfoxide solution ANALGESICS Duraclon # (clonidine injection) ANALGESICS # dalbavancin - PA PA ANTIBIOTICS dalfopristin / quinupristin - PA PA ANTIBIOTICS Dalvance (dalbavancin) - PA PA ANTIBIOTICS dapsone tablet A90 ANTIBIOTICS A90 daptomycin ANTIBIOTICS # delafloxacin injection - PA PA ANTIBIOTICS delafloxacin tablet - PA PA ANTIBIOTICS demeclocycline A90 ANTIBIOTICS A90 dicloxacillin A90 ANTIBIOTICS A90 Dificid (fidaxomicin) - PA PA ANTIBIOTICS "Doryx (doxycycline hyclate delayed-release 50 mg, 60 mg, 80 mg, 120 mg, 200 mg tablet) A90 - PA" PA ANTIBIOTICS A90 "double antibiotic ointment (bacitracin / polymyxin B topical ointment) *, A90" ANTIBIOTICS "*, A90" doxycycline calcium syrup ANTIBIOTICS doxycycline hyclate 100 mg capsule A90 ANTIBIOTICS "A90, #" "doxycycline hyclate 20 mg, 100 mg tablet A90" ANTIBIOTICS A90 doxycycline hyclate 50 mg capsule A90 ANTIBIOTICS A90 doxycycline hyclate 50 mg tablet A90 - PA PA ANTIBIOTICS A90 "doxycycline hyclate 75 mg, 150 mg tablet A90 - PA" PA ANTIBIOTICS A90 "doxycycline hyclate delayed-release 50 mg, 60 mg, 80 mg, 120 mg, 200 mg tablet A90 - PA" PA ANTIBIOTICS A90 "doxycycline hyclate delayed-release 75 mg, 100 mg, 150 mg tablet A90 - PA" PA ANTIBIOTICS A90 doxycycline hyclate injection ANTIBIOTICS doxycycline monohydrate 150 mg capsule A90 - PA PA ANTIBIOTICS A90 doxycycline monohydrate 150 mg tablet A90 - PA PA ANTIBIOTICS A90 doxycycline monohydrate 40 mg capsule A90 - PA PA ANTIBIOTICS A90 "doxycycline monohydrate 50 mg, 100 mg capsule A90" ANTIBIOTICS A90 "doxycycline monohydrate 50 mg, 75 mg, 100 mg tablet A90" ANTIBIOTICS A90 doxycycline monohydrate 75 mg capsule A90 - PA PA ANTIBIOTICS A90 doxycycline monohydrate suspension A90 ANTIBIOTICS "A90, #" "dabigatran capsule BP, M90" ANTICOAGULANTS "BP, M90" dabigatran oral pellet - PA PA ANTICOAGULANTS dalteparin ANTICOAGULANTS Depakene # (valproic acid) A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" "Depakote (divalproex sprinkle capsule) BP, A90 - PA < 6 years; See Table 20; See Table 71" PA ANTICONVULSANTS "BP, A90" Depakote # (divalproex immediate-release) A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" Depakote ER # (divalproex extended-release) A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" Diacomit (stiripentol) - PA PA ANTICONVULSANTS Dilantin # (phenytoin extended 30 mg and 100 mg capsule) A90 ANTICONVULSANTS "A90, #" Dilantin-125 # (phenytoin suspension) A90 ANTICONVULSANTS "A90, #" Dilantin Infatab # (phenytoin chewable tablet) A90 ANTICONVULSANTS "A90, #" divalproex extended-release A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" divalproex immediate-release A90 - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS "A90, #" "divalproex sprinkle capsule BP, A90 - PA < 6 years; See Table 20; See Table 71" PA ANTICONVULSANTS "BP, A90" desipramine A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 desvenlafaxine extended-release A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 "desvenlafaxine succinate extended-release BP, A90 - PA 1 unit/day; See Table 17; See Table 71" PA 1 unit/day ANTIDEPRESSANTS "BP, A90" dextromethorphan / bupropion - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS "doxepin capsule, oral concentrate A90 - PA < 6 years; See Table 17; See Table 71" PA ANTIDEPRESSANTS A90 "duloxetine 20 mg, 30 mg, 60 mg capsule A90 - PA < 6 years; See Table 17; See Table 71" PA ANTIDEPRESSANTS "A90, #" difenoxin / atropine - PA PA ANTIDIARRHEALS diphenoxylate / atropine ANTIDIARRHEALS # dexrazoxane ANTIDOTES dimercaprol MB ANTIDOTES MB "Diclegis (doxylamine / pyridoxine delayed-release) BP, A90 - PA" PA ANTIEMETICS "BP, A90" "doxylamine / pyridoxine delayed-release BP, A90 - PA" PA ANTIEMETICS "BP, A90" doxylamine / pyridoxine extended-release - PA PA ANTIEMETICS dronabinol capsule - PA PA ANTIEMETICS desloratadine / pseudoephedrine - PA PA ANTIHISTAMINES desloratadine orally disintegrating tablet M90 - PA PA ANTIHISTAMINES M90 desloratadine tablet M90 - PA PA ANTIHISTAMINES M90 dexchlorpheniramine solution A90 - PA PA ANTIHISTAMINES A90 dimenhydrinate injection ANTIHISTAMINES "diphenhydramine *, A90" ANTIHISTAMINES "*, A90, #" "Daraprim (pyrimethamine) BP, A90 - PA" PA ANTIMALARIALS "BP, A90" dostarlimab-gxly MB - PA PA ANTINEOPLASTICS MB diethylpropion extended-release - PA PA ANTI-OBESITY AGENTS diethylpropion - PA PA ANTI-OBESITY AGENTS Duopa (carbidopa / levodopa enteral suspension) - PA PA ANTIPARKINSON dipyridamole M90 ANTIPLATELET AGENT M90 difelikefalin MB ANTIPRURITIC MB droperidol ANTIPSYCHOTIC Dartisla ODT (glycopyrrolate orally disintegrating tablet) - PA PA "ANTISPASMODICS,ANTICHOLINERGIC" dicyclomine A90 "ANTISPASMODICS,ANTICHOLINERGIC" "A90, #" darunavir / cobicistat / emtricitabine / tenofovir alafenamide PD ANTIVIRALS PD darunavir / cobicistat PD ANTIVIRALS PD "darunavir BP, A90" ANTIVIRALS "BP, A90" Delstrigo (doravirine / lamivudine / tenofovir disoproxil fumarate) PD ANTIVIRALS PD Denavir (penciclovir) A90 - PA PA ANTIVIRALS A90 Descovy (emtricitabine / tenofovir alafenamide) PD ANTIVIRALS PD didanosine A90 ANTIVIRALS A90 dolutegravir / lamivudine PD ANTIVIRALS PD dolutegravir / rilpivirine PD ANTIVIRALS PD dolutegravir tablet for oral suspension ANTIVIRALS dolutegravir tablet - PA > 1 unit/day PA > 1 unit/day ANTIVIRALS doravirine / lamivudine / tenofovir disoproxil fumarate PD ANTIVIRALS PD doravirine PD ANTIVIRALS PD Dovato (dolutegravir / lamivudine) PD ANTIVIRALS PD doxazosin extended-release BENIGN PROSTATIC HYPERPLASIA AGENTS dutasteride / tamsulosin M90 - PA PA BENIGN PROSTATIC HYPERPLASIA AGENTS M90 dutasteride M90 BENIGN PROSTATIC HYPERPLASIA AGENTS "M90, #" Diastat # (diazepam rectal gel) - PA > 5 kits (10 syringes)/30 days PA > 5 kits (10 syringes)/30 days BENZODIAZEPINES # diazepam injection BENZODIAZEPINES diazepam nasal spray - PA > 10 units/30 days PA > 10 units/30 days BENZODIAZEPINES diazepam rectal gel - PA > 5 kits (10 syringes)/30 days PA > 5 kits (10 syringes)/30 days BENZODIAZEPINES # "diazepam solution, tablet - PA < 6 years; See Table 69; See Table 71" PA BENZODIAZEPINES # Doral (quazepam) - PA; See Table 69; See Table 71 PA BENZODIAZEPINES Daptacel (diphtheria / tetanus toxoids / acellular pertussis vaccine) 1 BIOLOGICAL 1 denosumab-Prolia - PA PA BIOLOGICAL denosumab-Xgeva - PA PA BIOLOGICAL diphtheria / tetanus / acellular pertussis / poliovirus inactivated / haemophilus B conjugate / hepatitis B vaccine BIOLOGICAL diphtheria / tetanus / acellular pertussis / poliovirus inactivated / haemophilus B conjugate vaccine 1 BIOLOGICAL 1 "diphtheria / tetanus toxoids / acellular pertussis / hepatitis B, recombinant / poliovirus, inactivated vaccine 1" BIOLOGICAL 1 "diphtheria / tetanus toxoids / acellular pertussis / poliovirus, inactivated vaccine 1" BIOLOGICAL 1 diphtheria / tetanus toxoids / acellular pertussis vaccine 1 BIOLOGICAL 1 dupilumab PD - PA PA BIOLOGICAL PD Dupixent (dupilumab) PD - PA PA BIOLOGICAL PD Dysport (abobotulinumtoxinA) - PA PA BIOLOGICAL "dengue tetravalent vaccine, live" BIOLOGICALS "Dengvaxia (dengue tetravalent vaccine, live)" BIOLOGICALS diphtheria / tetanus toxoids vaccine 1 BIOLOGICALS 1 Duaklir (aclidinium / formoterol) - PA PA BRONCHODILATORS Dulera (mometasone / formoterol) BP BRONCHODILATORS BP Demser (metyrosine) BP CARDIOVASCULAR BP digoxin M90 CARDIOVASCULAR "M90, #" diltiazem-Cardizem M90 CARDIOVASCULAR "M90, #" diltiazem extended-release capsule M90 CARDIOVASCULAR "M90, #" diltiazem extended-release tablet M90 CARDIOVASCULAR "M90, #" diltiazem-Tiazac ER M90 CARDIOVASCULAR "M90, #" Diovan # (valsartan tablet) M90 CARDIOVASCULAR "M90, #" Diovan HCT # (valsartan / hydrochlorothiazide) M90 CARDIOVASCULAR "M90, #" disopyramide controlled-release CARDIOVASCULAR disopyramide immediate-release A90 CARDIOVASCULAR "A90, #" Diuril # (chlorothiazide) M90 CARDIOVASCULAR "M90, #" dofetilide M90 CARDIOVASCULAR "M90, #" doxazosin immediate-release M90; See Table 18; See Table 19 CARDIOVASCULAR "M90, #" dronedarone A90 CARDIOVASCULAR A90 Daytrana (methylphenidate transdermal) BP - PA 1 unit/day; See Table 31; See Table 71 PA 1 unit/day CEREBRAL STIMULANTS BP Desoxyn (methamphetamine) - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS "Dexedrine Spansule # (dextroamphetamine 5 mg, 10 mg, 15 mg capsule) - PA 3 units/day; See Table 31; See Table 71" PA 3 units/day CEREBRAL STIMULANTS # dexmethylphenidate extended-release BP - PA 2 units/day; See Table 31; See Table 71 PA 2 units/day CEREBRAL STIMULANTS BP dexmethylphenidate - PA 3 units/day; See Table 31; See Table 71 PA 3 units/day CEREBRAL STIMULANTS # "dextroamphetamine 2.5 mg, 7.5 mg, 15 mg, 20 mg, 30 mg tablet - PA; See Table 31; See Table 71" PA CEREBRAL STIMULANTS "dextroamphetamine 5 mg, 10 mg, 15 mg capsule - PA 3 units/day; See Table 31; See Table 71" PA 3 units/day CEREBRAL STIMULANTS # "dextroamphetamine 5 mg, 10 mg tablet - PA 3 units/day; See Table 31; See Table 71" PA 3 units/day CEREBRAL STIMULANTS dextroamphetamine solution - PA 40 mL/day; See Table 31; See Table 71 PA 40 mL/day CEREBRAL STIMULANTS Drizalma (duloxetine sprinkle capsule) - PA; See Table 17; See Table 71 PA CEREBRAL STIMULANTS duloxetine sprinkle capsule - PA; See Table 17; See Table 71 PA CEREBRAL STIMULANTS Dyanavel XR (amphetamine extended-release 2.5 mg/mL oral suspension) - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS "deferasirox 125 mg, 250 mg, 500 mg BP, A90" CHELATING AGENT "BP, A90" "deferasirox 90 mg, 180 mg, 360 mg A90" CHELATING AGENT "A90, #" deferiprone A90 - PA PA CHELATING AGENT A90 deferoxamine CHELATING AGENT # Depen # (penicillamine tablet) A90 CHELATING AGENT "A90, #" Desferal # (deferoxamine) CHELATING AGENT # dabrafenib - PA PA CHEMOTHERAPY dacarbazine MB CHEMOTHERAPY MB Dacogen (decitabine) MB CHEMOTHERAPY MB dacomitinib - PA PA CHEMOTHERAPY dactinomycin MB CHEMOTHERAPY MB Danyelza (naxitamab-gqgk) MB - PA PA CHEMOTHERAPY MB daratumumab / hyaluronidase-fihj MB - PA PA CHEMOTHERAPY MB daratumumab MB - PA PA CHEMOTHERAPY MB darolutamide - PA PA CHEMOTHERAPY Darzalex (daratumumab) MB - PA PA CHEMOTHERAPY MB Darzalex Faspro (daratumumab / hyaluronidase-fihj) MB - PA PA CHEMOTHERAPY MB dasatinib CHEMOTHERAPY daunorubicin / cytarabine MB - PA PA CHEMOTHERAPY MB daunorubicin MB CHEMOTHERAPY MB Daurismo (glasdegib) - PA PA CHEMOTHERAPY decitabine / cedazuridine CHEMOTHERAPY decitabine MB CHEMOTHERAPY MB degarelix - PA PA CHEMOTHERAPY diclofenac 3% gel A90 CHEMOTHERAPY A90 Docefrez (docetaxel) MB CHEMOTHERAPY MB docetaxel MB CHEMOTHERAPY MB Doxil (doxorubicin liposomal injection) MB CHEMOTHERAPY MB doxorubicin liposomal injection MB CHEMOTHERAPY MB doxorubicin MB CHEMOTHERAPY MB durvalumab MB - PA PA CHEMOTHERAPY MB duvelisib - PA PA CHEMOTHERAPY docusate / benzocaine enema A90 CONSTIPATION AGENTS A90 "docusate sodium capsule, tablet *, M90" CONSTIPATION AGENTS "*, M90" docusate sodium enema A90 CONSTIPATION AGENTS A90 "docusate sodium solution, syrup *, A90" CONSTIPATION AGENTS "*, A90" Depo-Provera # (medroxyprogesterone injection) CONTRACEPTIVES # Depo-SubQ Provera 104 (medroxyprogesterone injection) CONTRACEPTIVES drospirenone CONTRACEPTIVES dapsone gel A90 - PA PA DERMATOLOGICAL A90 Dovonex # (calcipotriene cream) A90 - PA > 60 grams/month PA > 60 grams/month DERMATOLOGICAL "A90, #" doxepin cream-Prudoxin - PA PA DERMATOLOGICAL doxepin cream-Zonalon - PA PA DERMATOLOGICAL Drysol (aluminum chloride) - PA PA DERMATOLOGICAL dapagliflozin DIABETIC AGENTS dapagliflozin / metformin extended-release DIABETIC AGENTS dapagliflozin / saxagliptin - PA PA DIABETIC AGENTS dasiglucagon DIABETIC AGENTS "diazoxide BP, A90" DIABETIC AGENTS "BP, A90" "Duetact (glimepiride / pioglitazone) BP, M90 - PA" PA DIABETIC AGENTS "BP, M90" dulaglutide PD - PA > 2 mL/28 days PA > 2 mL/28 days DIABETIC AGENTS PD Dekas Bariatric (multivitamins / minerals / folic acid / coenzyme Q10-Dekas Bariatric) M90 - PA PA ELECTROLYTES AND NUTRIENTS M90 dextrose ELECTROLYTES AND NUTRIENTS Dojolvi (triheptanoin) - PA PA ELECTROLYTES AND NUTRIENTS doxercalciferol capsule M90 - PA PA ELECTROLYTES AND NUTRIENTS M90 doxercalciferol injection MB ELECTROLYTES AND NUTRIENTS MB dornase alfa ENZYMES "Duavee (estrogens, conjugated/bazedoxifene)" ESTROGENS Diflucan # (fluconazole) A90 FUNGICIDES "A90, #" "dextrin *, A90" GASTROINTESTINAL AGENT "*, A90" "Delzicol DR (mesalamine capsule) BP, A90" GI ANTI-INFLAMMATORY "BP, A90" Dipentum (olsalazine) GI ANTI-INFLAMMATORY "Decadron # (dexamethasone solution, tablet) A90" GLUCOCORTICOIDS "A90, #" deflazacort - PA PA GLUCOCORTICOIDS Depo-Medrol # (methylprednisolone acetate) GLUCOCORTICOIDS # "Derma-Smoothe-FS # (fluocinolone body oil, scalp oil) A90" GLUCOCORTICOIDS "A90, #" desonide cream A90 GLUCOCORTICOIDS A90 desonide lotion A90 - PA PA GLUCOCORTICOIDS A90 desonide ointment A90 GLUCOCORTICOIDS A90 "desoximetasone 0.05% cream, ointment A90 - PA" PA GLUCOCORTICOIDS A90 desoximetasone 0.25% cream A90 GLUCOCORTICOIDS A90 "desoximetasone 0.25% ointment, spray, 0.05% gel A90 - PA" PA GLUCOCORTICOIDS A90 dexamethasone 20 mg tablet - PA PA GLUCOCORTICOIDS dexamethasone injection GLUCOCORTICOIDS "dexamethasone solution, tablet A90" GLUCOCORTICOIDS "A90, #" dexamethasone tablet pack A90 - PA PA GLUCOCORTICOIDS A90 diflorasone cream / emollient A90 - PA PA GLUCOCORTICOIDS A90 diflorasone cream A90 - PA PA GLUCOCORTICOIDS A90 diflorasone ointment A90 - PA PA GLUCOCORTICOIDS A90 "Diprolene # (betamethasone dipropionate, augmented ointment) A90" GLUCOCORTICOIDS "A90, #" Duobrii (halobetasol / tazarotene lotion) - PA PA GLUCOCORTICOIDS darbepoetin alfa - PA PA HEMATINIC AGENT Dekas Essential (multivitamin-Dekas Essential) M90 - PA PA HEMATINIC AGENT M90 Dekas Plus (multivitamins / minerals / coenzyme Q10-Dekas Plus) M90 - PA PA HEMATINIC AGENT M90 Dekas Plus (multivitamins / minerals / folic acid / coenzyme Q10-Dekas Plus) M90 - PA PA HEMATINIC AGENT M90 Doptelet (avatrombopag) - PA PA HEMATOLOGIC Droxia (hydroxyurea capsule) HEMATOLOGIC danazol A90 HORMONE AGENTS A90 DDAVP # (desmopressin-DDAVP) A90 HORMONE AGENTS "A90, #" desmopressin-DDAVP A90 HORMONE AGENTS "A90, #" desmopressin-Nocdurna - PA PA HORMONE AGENTS Delestrogen # (estradiol-Delestrogen) HORMONE REPLACEMENT THERAPY # Depo-estradiol (estradiol-Depo-estradiol) HORMONE REPLACEMENT THERAPY Depo-Testosterone (testosterone cypionate) - PA PA HORMONE REPLACEMENT THERAPY "Divigel (estradiol-Divigel) BP, A90" HORMONE REPLACEMENT THERAPY "BP, A90" "Durolane (hyaluronate, stabilized) MB - PA" PA HYALURONAN MB deucravacitinib - PA PA IMMUNOMODULATOR "delandistrogene moxeparvovec-rokl CO, MB - PA" PA MISCELLANEOUS "CO, MB" dalfampridine A90 - PA > 2 units/day PA > 2 units/day MULTIPLE SCLEROSIS AGENTS "A90, #" dextromethorphan / quinidine - PA PA MULTIPLE SCLEROSIS AGENTS dimethyl fumarate A90 - PA > 2 units/day PA > 2 units/day MULTIPLE SCLEROSIS AGENTS "A90, #" diroximel fumarate - PA PA MULTIPLE SCLEROSIS AGENTS Dantrium (dantrolene injection solution) MB MUSCLE RELAXANT MB Dantrium # (dantrolene capsule) A90 MUSCLE RELAXANT "A90, #" dantrolene capsule A90 MUSCLE RELAXANT "A90, #" dantrolene injection solution MB MUSCLE RELAXANT MB dantrolene injection suspension MB MUSCLE RELAXANT MB "Dymista (azelastine / fluticasone propionate) BP, M90" NASAL PREPARATIONS "BP, M90" deutetrabenazine extended-release - PA PA NEUROLOGIC AGENT deutetrabenazine - PA PA NEUROLOGIC AGENT Daypro # (oxaprozin) A90 NONSTEROIDAL ANTI-INFLAMMATORY "A90, #" diclofenac / misoprostol A90 - PA < 60 years PA NONSTEROIDAL ANTI-INFLAMMATORY "A90, #" diclofenac 1% gel A90 NONSTEROIDAL ANTI-INFLAMMATORY A90 "diclofenac 18 mg, 35 mg capsule A90 - PA" PA NONSTEROIDAL ANTI-INFLAMMATORY A90 diclofenac 25 mg capsule A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 diclofenac extended-release A90 NONSTEROIDAL ANTI-INFLAMMATORY A90 diclofenac potassium 25 mg tablet A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 diclofenac potassium 50 mg tablet A90 NONSTEROIDAL ANTI-INFLAMMATORY A90 diclofenac powder for solution A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 diclofenac sodium tablet A90 NONSTEROIDAL ANTI-INFLAMMATORY A90 diclofenac topical patch-Flector A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 diclofenac topical patch-Licart - PA PA NONSTEROIDAL ANTI-INFLAMMATORY "diclofenac topical solution BP, A90" NONSTEROIDAL ANTI-INFLAMMATORY "BP, A90" diflunisal A90 NONSTEROIDAL ANTI-INFLAMMATORY A90 Duexis # (ibuprofen / famotidine) A90 - PA < 60 years PA NONSTEROIDAL ANTI-INFLAMMATORY "A90, #" dexamethasone intravitreal implant MB OPHTHALMIC PREPARATIONS MB dexamethasone ophthalmic insert MB OPHTHALMIC PREPARATIONS MB dexamethasone ophthalmic suspension OPHTHALMIC PREPARATIONS dexamethasone sodium phosphate ophthalmic solution A90 OPHTHALMIC PREPARATIONS A90 Dextenza (dexamethasone ophthalmic insert) MB OPHTHALMIC PREPARATIONS MB diclofenac ophthalmic solution A90 OPHTHALMIC PREPARATIONS A90 difluprednate A90 OPHTHALMIC PREPARATIONS "A90, #" "dorzolamide / timolol, preservative free BP, M90 - PA" PA OPHTHALMIC PREPARATIONS "BP, M90" dorzolamide / timolol M90 OPHTHALMIC PREPARATIONS "M90, #" dorzolamide M90 OPHTHALMIC PREPARATIONS "M90, #" Durezol # (difluprednate) A90 OPHTHALMIC PREPARATIONS "A90, #" Durysta (bimatoprost implant) MB - PA PA OPHTHALMIC PREPARATIONS MB Demerol (meperidine) - PA PA OPIOID ANALGESICS dihydrocodeine / acetaminophen / caffeine - PA PA OPIOID ANALGESICS Dilaudid # (hydromorphone) - PA > 24 mg/day PA > 24 mg/day OPIOID ANALGESICS # Dolophine (methadone oral-Dolophine) - PA PA OPIOID ANALGESICS "Duramorph (morphine, injection-Duramorph) - PA > 120 mg/day" PA > 120 mg/day OPIOID ANALGESICS "Dermotic (fluocinolone oil, otic drops) BP, A90" OTIC PREPARATIONS "BP, A90" "Dexilant (dexlansoprazole) BP, M90" PROTON PUMP INHIBITORS "BP, M90" "dexlansoprazole BP, M90" PROTON PUMP INHIBITORS "BP, M90" duloxetine 40 mg capsule A90 - PA; See Table 17; See Table 71 PA PSYCHOSTIMULANTS-ANTIDEPRESSAN A90 daridorexant - PA; See Table 15; See Table 71 PA "SEDATIVE, NON-BARBITURATE" Dayvigo (lemborexant) - PA; See Table 15; See Table 71 PA "SEDATIVE, NON-BARBITURATE" "doxylamine *, A90" "SEDATIVE, NON-BARBITURATE" "*, A90" doxepin tablet A90 - PA; See Table 15; See Table 71 PA SEDATIVES A90 doxycycline hyclate 100 mg tablet pack - PA PA TETRACYCLINES Daliresp (roflumilast tablet) M90 - PA PA UNCLASSIFIED DRUG PRODUCTS M90 Daybue (trofinetide) - PA PA UNCLASSIFIED DRUG PRODUCTS dichlorphenamide - PA PA UNCLASSIFIED DRUG PRODUCTS darifenacin A90 - PA > 1 unit/day PA > 1 unit/day URINARY ANTISPASMODICS A90 Detrol # (tolterodine immediate-release) A90 URINARY ANTISPASMODICS "A90, #" Detrol LA # (tolterodine extended-release) A90 URINARY ANTISPASMODICS "A90, #" Ditropan XL # (oxybutynin extended-release tablet) A90 URINARY ANTISPASMODICS "A90, #"